Bone Nonunion Research Articles

Triple-functional bone adhesive with enhanced internal fixation, bacteriostasis and osteoinductive properties for open fracture repair.

At present, effective fixation and anti-infection implant materials represent the mainstay for the treatment of open fractures. However, external fixation can cause nail tract infections and is ineffective for fixing small fracture fragments. Moreover, closed reduction and internal fixation during the early stage of injury can lead to potential bone infection, conducive to bone nonunion and delayed healing. Herein, we designed a bone adhesive with anti-infection, osteogenic and bone adhesion fixation properties to promote reduction and fixation of open fractures and subsequent soft tissue repair. It was prepared by the reaction of gelatin (Gel) and oxidized starch (OS) with vancomycin (VAN)-loaded mesoporous bioactive glass nanoparticles (MBGNs) covalently cross-linked with Schiff bases. Characterization and adhesion experiments were conducted to validate the successful preparation of the Gel-OS/VAN@MBGNs (GOVM-gel) adhesive. Meanwhile, in vitro cell experiments demonstrated its good antibacterial effects with the ability to stimulate bone marrow mesenchymal stem cell (BMSCs) proliferation, upregulate the expression of alkaline phosphatase (ALP) and osteogenic proteins (RunX2 and OPN) and enhance the deposition of calcium nodules. Additionally, we established a rat skull fracture model and a subcutaneous infection model. The histological analysis showed that bone adhesive enhanced osteogenesis, and in vivo experiments demonstrated that the number of inflammatory cells and bacteria was significantly reduced. Overall, the adhesive could promote early reduction of fractures and antibacterial and osteogenic effects, providing the foothold for treatment of this patient population.

Piezoelectric PDMS/AlN Film for Osteogenesis in Vitro.

Bone defect and nonunion are complex diseases which are difficult to treat due to insufficient bone regeneration. Electrical stimulation has attracted attention as a promising strategy to induce and enhance bone regeneration. Self-powered and biocompatible materials have been widely explored and used in biomedical devices, owing to their ability to produce electrical stimulation without an external power source. We aimed to prepare a piezoelectric polydimethylsiloxane (PDMS)/aluminum nitride (AlN) film with excellent biocompatibility and osteoconductive ability for the growth of murine calvarial preosteoblast MC3T3-E1 cells. By applying vibration to stimulate body movement, the PDMS/AlN film demonstrated a current density of 2-6 μA cm-2, and the generated continuous alternating current (AC) effectively promoted MC3T3-E1 cell growth, viability, and osteoblastic related gene expression (genes runt-related transcription factor 2 [RUNX2], osteocalcin [OCN], alkaline phosphatase [ALP]) and exhibited higher mineralization. Compared to blank plates and nonvibrated PDMS/AlN films, the vibrated PDMS/AlN film showed rapid and superior osteogenic differentiation. The design of the biocompatible and flexible piezoelectric PDMS/AlN film overcame the poor processability, brittleness, and instability of electrical stimulation of traditional electroactive materials, demonstrating great potential in the application of electrical stimulation for bone tissue engineering.

Limited internal fixation combined with a hinged external fixator in treatment of peri-elbow bone infection

To evaluate the effectiveness of limited internal fixation combined with a hinged external fixator in the treatment of peri-elbow bone infection. The clinical data of 19 patients with peri-elbow bone infection treated with limited internal fixation combined with a hinged external fixator between May 2018 and May 2021 were retrospectively analyzed. There were 15 males and 4 females with an average age of 44.6 years (range, 28-61 years). There were 13 cases of distal humerus fractures and 6 cases of proximal ulna fractures. All the 19 cases were infected after internal fixation of fracture, and 2 cases were complicated with radial nerve injury. According to Cierny-Mader anatomical classification, 11 cases were type Ⅱ, 6 cases were type Ⅲ, and 2 cases were type Ⅳ. The duration of bone infection was 1-3 years. After primary debridement, the bone defect was (3.04±0.28) cm, and the antibiotic bone cement was implanted into the defect area, and the external fixator was installed; 3 cases were repaired with latissimus dorsi myocutaneous flap, and 2 cases were repaired with lateral brachial fascial flap. Bone defects repair and reconstruction were performed after 6-8 weeks of infection control. The wound healing was observed, and white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reaction protein (CRP) were reexamined regularly after operation to evaluate the infection control. X-ray films of the affected limb were taken regularly after operation to observe the bone healing in the defect area. At last follow-up, the flexion and extension range of motion and the total range of motion of the elbow joint were observed and recorded, and compared with those before operation, and the function of the elbow joint was evaluated by Mayo score. All patients were followed up 12-34 months (mean, 26.2 months). The wounds healed in 5 cases after skin flap repair. Two cases of recurrent infection were effectively controlled by debridement again and replacement of antibiotic bone cement. The infection control rate was 89.47% (17/19) in the first stage. Two patients with radial nerve injury had poor muscle strength of the affected limb, and the muscle strength of the affected limb recovered from grade Ⅲ to about grade Ⅳ after rehabilitation exercise. During the follow-up period, there was no complication such as incision ulceration, exudation, bone nonunion, infection recurrence, or infection in the bone harvesting area. Bone healing time ranged from 16 to 37 weeks, with an average of 24.2 weeks. WBC, ESR, CRP, PCT, and elbow flexion, extension, and total range of motions significantly improved at last follow-up ( P<0.05). According to Mayo elbow scoring system, the results were excellent in 14 cases, good in 3 cases, and fair in 2 cases, and the excellent and good rate was 89.47%. Limited internal fixation combined with a hinged external fixator in the treatment of the peri-elbow bone infection can effectively control infection and restore the function of the elbow joint.

Effect of body mass index on short-term effectiveness of high tibial osteotomy in treatment of varus knee arthritis

To investigate the effect of body mass index (BMI) on the short-term effectiveness of high tibial osteotomy (HTO) in the treatment of varus knee arthritis. The clinical data of 84 patients (84 knees) with varus knee arthritis treated with HTO between May 2016 and August 2020 were retrospectively analyzed. According to BMI, the patients were divided into normal group (32 patients in group A, BMI<25 kg/m 2), overweight group (27 patients in group B, BMI>30 kg/m 2), and obese group (25 patients in group C, BMI>30 kg/m 2). The BMI of groups A, B, and C were (23.35±0.89), (26.65±1.03), and (32.05±1.47) kg/m 2, respectively. There was no significant difference ( P>0.05) in gender, age, surgical side, disease duration, and preoperative Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, knee range of motion, and hip-knee-ankle angle (HKA) between groups. The operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation were recorded and compared between groups. The improvement of knee joint function and pain status were evaluated by knee joint HSS score, knee range of motion, and VAS score before and after operation, and measuring the HKA of patients on X-ray film. During the follow-up, the X-ray films of the knee joint were reexamined to observe the position of the internal fixator and the healing of osteotomy. All patients completed the operation successfully and were followed up 8-40 months (mean, 19.3 months). There was no significant difference in follow-up time, operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation between groups ( P>0.05). No operative complications such as severe vascular or nerve injury occurred. After operation, deep venous thrombosis of lower extremities occurred in 1 case in groups A and B respectively, and fat liquefaction of surgical incision occurred in 2 cases in group C. There was no significant difference in the incidence of perioperative complications between groups (3.1% vs. 3.7% vs. 8.0%) ( P=0.689). During the follow-up, there was no bone nonunion, plate fracture or loosening. At last follow-up, HSS score, VAS score, knee range of motion, and HKA significantly improved in the 3 groups when compared with those before operation ( P<0.05), but there was no significant difference in the differences of the above indexes between groups before and after operation ( P>0.05). BMI does not affect the short-term effectiveness of HTO in the treatment of varus knee arthritis. HTO can be selected for overweight and obese patients after standard medical treatment is ineffective.

WITHDRAWN: Effets synergiques des concentrés plaquettaires autologues et des ondes de choc extra-corporelles dans le traitement des pseudarthroses aseptiques diaphysaires des os longs

IntroductionUnion of long bone fractures is a complicated biological mechanism affected by numerous systemic and local variables. Disruption of any of these components may result in fracture nonunion. There are various types of clinically available treatment strategies for aseptic nonunion. Both activated platelet plasma and extracorporeal shock waves play important roles in fracture healing. This study aimed to investigate the interaction of Platelet-rich plasma (PRP) and extracorporeal shock wave (ESW) in bone healing of nonunion. HypothesisPRP and ESW have synergistic effects in treating long bone nonunion. MethodsBetween January 2016 and December 2021, a total of 60 patients with established nonunion of a long bone (18 tibias, 15 femurs, 9 humerus, 6 radii, and 12 ulnae) were included in this study, comprising 31 males and 29 females, ranging from 18 to 60 years old. Patients with bone nonunion were separated into two groups: PRP alone (Monotherapy group) and those treated with PRP combined with ESW (Combined treatment group). The two groups were compared to assess the therapeutic benefits, callus development, local problems, bone healing time, and Johner Wruhs functional classification of operated limbs. ResultsFifty-five patients were followed up, 5 patients were lost to follow-up, two in the PRP group and three in the PRP+ESW group, the follow-up time varied from 6 to 18 months, with an average of 12.7±5.2months. At 8, 12, 16, 20, and 24weeks following intervention, the callus score in the monotherapy group was significantly lower than in the combined treatment group (p<0.05). Both groups had no swelling and infection in the soft tissue of the nonunion operation site. In the PRP+ESW group, the fracture union rate was 92.59 % and the healing time was 16.3±5.2 weeks. In the PRP group, the fracture union rate was 71.43 % and the healing time was 21.5±3.7 weeks. The clinical healing time of the monotherapy group was significantly longer than the combined treatment group (p<0.05). All the nonunion patients with no signs of healing were treated with revision surgery. The excellent and good rate of Johner-Wruhs functional classification of affected limbs in the monotherapy group was significantly lower than in the combined treatment group (p<0.05). ConclusionPRP combined with ESW has a certain synergistic effect in treating aseptic nonunion after fracture surgery. It can significantly improve the formation of new bone, it is a minimally invasive and effective strategy to treat aseptic nonunion in a clinical setting. Level of evidenceIII, retrospective, single-centre, case-control study.

EE22 Risk Factors and Healthcare Costs Associated with Long Bone Fracture Non-Union – A US Claims Database Analysis

Non-union is a common complication following long bone fractures, often requiring significant incremental healthcare resources. The payer cost of long bone non-union in patients with or without concurrent infection is not well documented. Our study evaluated 2-year incremental healthcare costs of non-union in patients with fractures.

Modified gradual ulnar lengthening for treatment of Masada type IIb forearm deformity in children with hereditary multiple osteochondromas.

To investigate the effect of modified gradual ulnar lengthening in the treatment of Masada type IIb forearm deformity in children with hereditary multiple osteochondromas (HMO). From May 2015 to October 2020, 12 children with Masada type IIb forearm deformity caused by HMO underwent modified gradual ulnar lengthening in our hospital. Clinical and imaging data were retrospectively analyzed. Clinical evaluation included wrist flexion and extension, wrist ulnar and radial deviation, forearm pronation and supination, and elbow range of motion. The radiographic parameters measured included the radial articular angle, carpal slip, and relative ulnar shortening. The mean operative age of the 12 patients (9 male, 3 female) was 8.5 ± 2.7 years, the mean follow-up was 31.5 ± 5.7 months, and the mean ulnar lengthening was 43.3 ± 9.9 mm. There was no significant difference in the radial articular angle between the preoperative period and the last follow-up (from 36.5° ± 9.2° to 33.8° ± 5.1°, p > 0.05). However, significant changes were found in carpal slip (from 61.3% ± 18.8% to 33.8% ± 20.8%) and relative ulnar shortening (from 5.8 ± 3.5 mm to -0.9 ± 4.85 mm) (p < 0.05). The range of motion significantly improved after modified gradual ulnar lengthening, including wrist flexion (from 38.3° ± 6.2° to 55.8° ± 9.0°), wrist extension (from 45.0° ± 9.8° to 61.7° ± 8.1°), wrist ulnar deviation (from 41.3° ± 8.6° to 29.6° ± 7.8°), wrist radial deviation (from 18.3° ± 6.2° to 30.0° ± 5.6°), forearm pronation (from 44.6° ± 7.2° to 62.1° ± 8.6°), forearm supination (from 50.0° ± 7.1° to 52.9° ± 6.6°), and elbow range of motion (from 117.1° ± 10.1° to 127.9° ± 5.4°) (all p < 0.05). During follow-up, there was one case of needle tract infection and one case of bone nonunion. Modified gradual ulnar lengthening can effectively treat Masada type IIb forearm deformity caused by HMO and improve forearm function.

3D Printing of Porous Degradable Scaffolds with Polylactic Acid‐Loaded Bioactive Glass and Calcium Sulfate Hemihydrate for Bone Defect Repair

AbstractRepair of bone defects, especially critical‐sized bone defects, remains a major clinical problem, and bone nonunion is the biggest challenge. Herein, melt‐extrusion 3D printing is applied to prepare biodegradable composite scaffolds containing bioactive glass (BAG), calcium sulfate hemihydrate (CSH), and polylactic acid (PLA). The compressive strength of scaffolds is similar to that of human bone tissue. In vitro and in vivo experiments show that the scaffolds have good biocompatibility. The scaffold can maintain the biomechanical stability of the bone defect area during the follow‐up period of 20 weeks and has no damage to liver and kidney in animal experiments. Scaffold degradation is accompanied by trabecular bone and vessel neogenesis. While the PLA group and control group cannot carry out effective bone defect repair, the bone defect repair effect of the PLA‐CSH‐BAG group is satisfactory. In conclusion, the biodegradable porous scaffold has been proposed as a safe and effective approach for the repair of bone defects.

Molecular profiling of osteoprogenitor cells reveals FOS as a master regulator of bone non-union

Despite the advances in bone fracture treatment, a significant fraction of fracture patients will develop non-union. Most non-unions are treated with surgery since identifying the molecular causes of these defects is exceptionally challenging. In this study, compared with marrow bone, we generated a transcriptional atlas of human osteoprogenitor cells derived from healing callus and non-union fractures. Detailed comparison among the three conditions revealed a substantial similarity of callus and nonunion at the gene expression level. Nevertheless, when assayed functionally, they showed different osteogenic potential. Utilizing longitudinal transcriptional profiling of the osteoprogenitor cells, we identified FOS as a putative master regulator of non-union fractures. We validated FOS activity by profiling a validation cohort of 31 tissue samples. Our work identified new molecular targets for non-union classification and treatment while providing a valuable resource to better understand human bone healing biology.

Applications and Future Perspective of Pulsed Electromagnetic Fields in Foot and Ankle Sport-Related Injuries

Foot and ankle injuries are common in many sports. One of the main athletes issues is the time for sport resumption after trauma. Recently, extensive efforts have been made to speed up the athletes’ return-to-sport and to prevent joint degeneration. Among the conservative treatment options, biophysical stimulation with pulsed electromagnetic fields (PEMFs) is listed. This narrative review aims to outline current applications of PEMFs in main foot and ankle sport-related injuries, in particular in the treatment of bone marrow edema, osteochondral defects, fractures, and nonunions. Despite further high-quality studies on foot and ankle injuries are needed, PEMFs seem to be a valid aid to enhance the endogenous osteogenesis, to resolve the bone marrow edema, to inhibit the joint inflammation, preserving articular cartilage degeneration, and to relieve pain.

Nonunion in Orthognathic Surgery: A Case-Series of 15 Patients

Bone nonunion is extensively studied in the orthopedic literature, but the knowledge in oral and maxillofacial surgery, specifically orthognathic surgery, is scarce. Since this complication has a significant negative impact on postoperative management of patients, more studies are needed. To report the characteristics of patients presenting with bone nonunion after orthognathic surgery. This is a retrospective case-series study on subjects who underwent orthognathic surgery between 2011 and 2021 and developed nonunion. Inclusion criteria were mobility at the site of the osteotomy and the need for a second surgical intervention. Exclusion criteria were an incomplete medical chart; the absence of nonunion upon surgical exploration, or radiological evidence of nonunion; cleft lip/palate; or syndromic patients. The outcome variable was bone healing after nonunion care. Demographics (age, sex), medical/dental comorbidities, type of surgery (type of fixation, bone grafts, Botox injection), amplitude of movements, nonunion treatment. Descriptive statistics were computed for each study variable. The sample was composed of 15 patients (11 females, mean age 40.4 years old) with nonunion (maxilla: 8 cases, mandible: 7 cases) out of 2036 patients who underwent orthognathic surgery during the period studied (incidence 0.74%). Nine (60%) were bruxers, three were smokers (20%) and one had diabetes. Mean forward movement of the maxilla was 6.55mm (4-9mm) and 7.71mm (4.8-12mm) for the mandible. All patients but one (who refused surgery) were treated by curettage of fibrous tissue and new hardware placement. In addition, 11 received a bone graft, and 4 had Botox injections. All osteotomies healed after the second surgical intervention. Curettage with or without grafting appears to be a good strategy for the cure of nonunion. Bruxism may be a risk factor (60% of patients were bruxers in this study).

A STUDY OF MANAGEMENT OF NON UNION BONES BY AUTOLOGUS BONE MARROW INJECTION.

Background : Non union is a serious complication of fracture and has multiple causes of which most common cause is lack of osteoconductive mediators, osteogenic cells and adequate vascularity. As most of the nonunion fractures are treated by open bone graft. we conducted a study on 30 patients with non union fracture treated by autologous bone marrow injection. As autologous bone marrow injections containing mesenchymal stem cells (MSC) increases the osteogenic potential of these non-union sites and can obtain healing of these non-union site. Material and Methods: A total 50 patients with non-union,33 were male and 17 were female,15 were femur nonunion,21 were tibia nonunion,6 were humerus nonunion, 5 were radius nonunion, 3 were ulna nonunion. Study conducted on these patients and were treated with autologous bone marrow injection at the fracture site under regional anaesthesia in supine position. patients were evaluated at pre operative and post operative follow up period with serial radiography at 6 weeks,12 weeks, 6 months and 9 months. average duration of treatment was 9months and outcome was evaluated with ASAMI scoring system. Union occurred in 82% patients. out of 50, 31 (64%) patients outc Results: ome was excellent, followed by 5 (10%) had good outcome, 5 (10%) had fair and 9(18%) had poor long bone and functional outcomes. Manageme Conclusion: nt of nonunion bones by autologous bone marrow injection provides an effective and reliable alternative to open bone grafting. Thus,it is observed that with an adequate amount of autologous bone marrow injection, union can be achieved in non union of bones

Outcome analysis of ilizarov and monorail fixators in the treatment of nonunion of long bones: A systematic review and proportion meta-analysis

IntroductionNonunion of long bones is a major complication following fractures that requires a substantial amount of investment both monetary and time from patients and surgeons. The need to comprehensively understand the complications, outcomes and distraction capability is profound, which necessitates a review of current evidence on special fixators used for distraction. The current systematic review aims to study the available literature on distraction osteogenesis using special fixators (Ilizarov and Limb Reconstruction System) in the management of nonunion (infected and non-infected). MethodsCochrane Library, PubMed, Scopus were searched until January 2022. The review included all original studies which used Ilizarov or Monorail Fixators/LRS in the treatment of nonunion of long bones. The quality of studies was assessed using the Modified Coleman Methodology Score. ResultsA total of 35 original studies with Ilizarov (n = 29) and LRS (n = 8) were selected including two comparative studies. The pooled data meta-analysis and the subgroup analysis of these studies found both Ilizarov and LRS fixator yield similar functional outcomes for the treatment of long bones nonunion. ConclusionThe review was conducted to understand the scenario of nonunion in long bones. Pin tract infection is found to be the most common complication followed by adjacent joint stiffness and deformity. In our review we observed that both external fixator time and index were lower in LRS compared to Ilizarov group. Further RCT are required comparing Ilizarov and LRS fixators to effectively comment upon the superiority of the implants.

Incidence and Risk Factors for Extremity Osteoradionecrosis after Limb-Sparing Surgery and Adjuvant Radiotherapy

Osteoradionecrosis (ORN) is a major complication after radiotherapy. Most studies on ORN have focused on patients with mandibular lesions, with few studies including patients with extremity soft tissue sarcoma (STS). We included 198 patients with extremity STS who underwent limb-sparing surgery and adjuvant radiotherapy between 2004 and 2017. The incidence rate of extremity ORN was 3.5% (7/198), with most lesions (6/7) located in the lower extremities. The mean follow-up time was 62 months. Clinical presentations included chronic ulcers, soft tissue necrosis, sinus discharge, bone nonunion, and pathological fractures. Compared with the non-ORN group, the ORN group had a significantly higher total radiation dose (68 Gy vs. 64 Gy, p = 0.048) and greater use of intraoperative periosteal stripping (p = 0.008). Repeat surgeries and subsequent soft tissue reconstruction or limb amputation were performed as treatments. The risk and management of ORN in patients with extremity STS was ignored previously. Because the disease is complex and affects both clinicians and patients, careful surveillance should be undertaken.

Targeting RORα in macrophages to boost diabetic bone regeneration.

Diabetes mellitus (DM) has become a serious threat to human health. Bone regeneration deficiency and nonunion caused by DM is perceived as a worldwide epidemic, with a very high socioeconomic impact on public health. Here, we find that targeted activation of retinoic acid-related orphan receptor α (RORα) by SR1078 in the early stage of bone defect repair can significantly promote in situ bone regeneration of DM rats. Bone regeneration relies on the activation of macrophage RORα in the early bone repair, but RORα of DM rats fails to upregulation as hyperglycemic inflammatory microenvironment induced IGF1-AMPK signalling deficiency. Mechanistic investigations suggest that RORα is vital for macrophage-induced migration and proliferation of bone mesenchymal stem cells (BMSCs) via a CCL3/IL-6 depending manner. In summary, our study identifies RORα expressed in macrophages during the early stage of bone defect repair is crucial for in situ bone regeneration, and offers a novel strategy for bone regeneration therapy and fracture repair in DM patients.

Bone healing efficacy of Lakshagrishtiksheeradi churna over Calcium +Vit D3 in Avrana Kanda Bhagna (Closed fractures of long bones) - A Randomized controlled clinical trial

Background: Delayed bone healing or non-union of fractures owns high rate of complications, morbidity and mortality. It possesses enormous burden to both patients and healthcare system. Till now there is no proven molecule which could enhance the process of bone healing. Hence, time tested Lakshagrishtiksheeradi churna, an Ayurvedic formulation is explored for its efficacy in the management of Avrana Kanda Bhagna. Objective: To Evaluate Bone healing efficacy of Lakshagrishtiksheeradi churna in Avrana Kanda Bhagna. Methods: Total 30 patients meeting the inclusion criteria of Avrana Kanda Bhagna, with age group 14-50 years participated in the study. They were randomly divided into two groups. Group A received Lakshagrishtiksheeradi churna 6 grams and group B Tab Calcium 500 mg +VitD3 respectively twice a day for 30days. Assessments were done through various variables like Pain, Tenderness, Swelling and Bone callus index. Follow up visit was on 30th day and 45th day. Results: Study showed that both Lakshagrishtiksheeradi churna and Calcium + Vit D3 produced improvement in most of the variables and were comparable. However, marked improvements were seen in various variables like Pain, Tenderness, Swelling and Bone callus Index. Conclusion: Clinical efficacy showed that Lakshagrishtiksheeradi churna is safe, effective oral medication in the management of Avrana Kanda Bhagna (Closed Fractures of long bones).

Wnt-associated adult stem cell marker Lgr6 is required for osteogenesis and fracture healing.

Despite the remarkable regenerative capacity of skeletal tissues, nonunion of bone and failure of fractures to heal properly presents a significant clinical concern. Stem and progenitor cells are present in bone and become activated following injury; thus, elucidating mechanisms that promote adult stem cell-mediated healing is important. Wnt-associated adult stem marker Lgr6 is implicated in the regeneration of tissues with well-defined stem cell niches in stem cell-reliant organs. Here, we demonstrate that Lgr6 is dynamically expressed in osteoprogenitors in response to fracture injury. We used an Lgr6-null mouse model and found that Lgr6 expression is necessary for maintaining bone volume and efficient postnatal bone regeneration in adult mice. Skeletal progenitors isolated from Lgr6-null mice have reduced colony-forming potential and reduced osteogenic differentiation capacity due to attenuated cWnt signaling. Lgr6-null mice consist of a lower proportion of self-renewing stem cells. In response to fracture injury, Lgr6-null mice have a deficiency in the proliferation of periosteal progenitors and reduced ALP activity. Further, analysis of the bone regeneration phase and remodeling phase of fracture healing in Lgr6-null mice showed impaired endochondral ossification and decreased mineralization. We propose that in contrast to not being required for successful skeletal development, Lgr6-positive cells have a direct role in endochondral bone repair.

Scaphoid Bone Nonunions: Clinical and Functional Outcomes of Collagen/PGA Scaffolds and Cell-Based Therapy.

In this study, the procedure for treating the nonunion complication of scaphoid fractures using collagen/poly glycolic acid (CPGA) scaffolds with bone marrow mesenchymal stem cell (BM-MSC) therapy was adopted and compared with the commonly employed autologous bone tissue graft. With conducting a two-armed clinical trial, 10 patients with scaphoid nonunions were enrolled in this investigation. Patients were randomly assigned to two groups treated with (1) CPGA + cell therapy and (2) autologous iliac crest bone graft standard therapy. Treatment outcomes were evaluated three months after surgery, measuring the grip and pinch strengths and wrist range of motion, with two questionnaires: Patient-Rated Wrist Evaluation (PRWE) and Quick form of Disabilities of the Arm, Shoulder, and Hand (QDASH). We have also assessed the union rate using clinical and radiologic healing criteria one and three months post-operatively. Restorative effects of CPGA + cell therapy were similar to those of the autologous bone graft standard therapy, except for the grip strength (P = 0.048) and QDASH score (P = 0.044) changes, which were higher in the CPGA + cell therapy group. Three months following the surgery, radiographic images and computed tomography (CT) scans also demonstrated that the scaphoid union rate in the test group was comparable to that of scaphoids treated with the standard autograft method. Our findings demonstrate that the CPGA + cell therapy is a potential alternative for bone grafting in the treatment of bone nonunions.

Effectiveness analysis of resection and reconstruction of primary bone tumor in pelvic zone Ⅱ

To investigate the effectiveness of complete resection of bone tumor in pelvic zone Ⅱ and reconstruction with allogeneic pelvis, modular prosthesis, and three-dimensional (3D) printing prosthesis. The clinical data of 13 patients with primary bone tumor in pelvic zone Ⅱ who underwent tumor resection and acetabular reconstruction between March 2011 and March 2022 were retrospectively analyzed. There were 4 males and 9 females with an average age of 39.0 years ranging from 16 to 59 years. There were 4 cases of giant cell tumor, 5 cases of chondrosarcoma, 2 cases of osteosarcoma, and 2 cases of Ewing sarcoma. The Enneking classification of pelvic tumors showed that 4 cases involved zone Ⅱ, 4 cases involved zone Ⅰ and zone Ⅱ, and 5 cases involved zone Ⅱ and zone Ⅲ. The disease duration ranged from 1 to 24 months, with an average of 9.5 months. The patients were followed up to observe the recurrence and metastasis of the tumor, and the imaging examination was performed to observe the status of implant in place, fracture, bone resorption, bone nonunion, and so on. The improvement of hip pain was evaluated by visual analogue scale (VAS) score before operation and at 1 week after operation, and the recovery of hip function was evaluated according to the Musculoskeletal Tumor Society (MSTS) scoring system after operation. The operation time was 4-7 hours, with an average of 4.6 hours; the intraoperative blood loss ranged from 800 to 1 600 mL, with an average of 1 200.0 mL. There was no reoperation or death after operation. All patients were followed up 9-60 months (mean, 33.5 months). No tumor metastasis was found in 4 patients receiving chemotherapy during follow-up. Postoperative wound infection occurred in 1 case, and prosthesis dislocation occurred in 1 case at 1 month after prosthesis replacement. One case of giant cell tumor recurred at 12 months after operation, and the puncture biopsy showed malignant transformation of giant cell tumor, and hemipelvic amputation was performed. The postoperative hip pain significantly relieved, and the VAS score was 6.1±0.9 at 1 week after operation, which was significantly different from the preoperative score (8.2±1.3) ( t=9.699, P<0.001). At 12 months after operation, the MSTS score was 23.0±2.1, including 22.8±2.1 for patients with allogenic pelvis reconstruction and 23.3±2.3 for patients with prosthsis reconstruction. There was no significant difference in the MSTS score between the two reconstruction methods ( t=0.450, P=0.516). At last follow-up, 5 patients could walk with cane assistance and 7 patients could walk without cane assistance. The resection and reconstruction of primary bone tumor in pelvic zone Ⅱ can obtain satisfactory hip function, and the interface of allogeneic pelvis and 3D printing prosthesis have better bone ingrowth, which is more in line with the requirements of biomechanics and biological reconstruction. However, pelvis reconstruction is difficult, the patient's condition should be evaluated comprehensively before operation, and the long-term effectiveness needs further follow-up.

“DOUBLE TENSION BAND OSTEOSYNTHESIS IN DISTAL HUMERUS FRACTURE IN OSTEOPOROTIC ADULTS AND INFECTED NONUNIONS”

Background: It is a challenge for orthopedic surgeon to x osteoporotic distal humerus fracture rigidly for early mobilization because holding power of plate and screws is low in osteoporotic bone fracture and have higher failure rate. Second challenge is to x an infected nonunion of distal humerus fracture because of restriction to use plate and screw. To achieve a stable , pain free and mobile joint require appropriate planning , systematic approach and anatomical reduction. To evaluate effectiveness of double tension band osteosynthesis in distal hume Aim: rus fracture of osteoporotic adult bone and infected nonunions. Ten patients presenting six fractures and three Method: nonunion of the distal humeral ,treated with double tension band wiring between 2018 and 2023 were retrospectively evaluated , two fracture were type A2 , two were type C1, remaining two were type C2 and rest are previously operated infected nonunions. Patients age averaged about 55 years. There are 5 males and 5 females. Out of 10 cases treated with t Results: his method, rigid xation and union was achieved in all of them. Radiological union was achieved at an average of 10.8 weeks (8-14weeks). Average range of motion was 104.5 degrees with maximum range of motion 120 degrees (10-130) and minimum of 70 degrees (30-100). Excellent or good results were obtained in 80% of the patients in our study. Double tension b Conclusion: and is a reliable, less demanding and cost effective method of xation of distal fractures of humerus in osteoporitic adults and infected nonunions.