Orthopedic Problems Research Articles

Treatment of patients with caudal regression syndrome: a systematic review of the literature

Objective. To analyze and summarize the data of modern literature on the issues of surgical treatment and natural course of the spine and spinal cord pathology in patients with various types of caudal regression syndrome (CRS).Material and Methods. A systematic review of the literature on the issue of treatment of the spine and spinal cord pathology in patients with CRS was performed. Selection criteria were: articles for the period 2002–2022, original studies of populations/patients with various forms of CRS with a description of treatment methods and long-term results of treatment or observation. A total of 28 articles on the treatment of various forms of CRS with the described results of treatment of 212 patients were analyzed: 29 patients with CRS in combination with open neural tube defects and 183 patients with closed forms of CRS. Evaluation criteria included number of patients, gender, type of spinal cord pathology, type of sacral agenesis, presence of the spine and lower extremities deformities, concomitant pathology, operations performed and their complications, and results.Results. The studied patients underwent the following surgeries on the spine and spinal cord: untethering of the spinal cord, correction and stabilization surgeries on the spine, plasty of the spinal cord herniation, plasty of the terminal meningocele, and removal of the presacarial volumetric mass. The greatest number of complications occurred after operations on the spine and sacrum. The majority of patients (67 %) with sacral agenesis by the end of the follow-up period (average 14 years) walked independently or with the help of devices, and a minority of them (33 %) could not walk. More than half of patients with CRS (67 %) had a neurogenic bladder, urinary incontinence, or suffered from a chronic urinary tract infection. Fecal incontinence and constipation were less common (46 %).Conclusions. Patients with CRS have a good potential for improvement/recovery of walking and pelvic organ dysfunction. This is extremely important to timely carry out multimodality treatment of patients with CRS who have neurosurgical, orthopedic, urogenital and colorectal problems in CRS, and to start early motor rehabilitation and physiotherapy.

Arthroscopic Deltoid Ligament Reconstruction in Rotational Ankle Instability

Chronic lateral ankle instability is a common orthopaedic problem. The continuous stress applied by the lateral instability may affect the superficial deltoid ligament. The combination of lateral ankle instability and injury to the most anterior fascicles of the deltoid ligament contributes to rotational ankle instability. The purpose of this Technical Note is to describe the details of arthroscopic deltoid ligament reconstruction in rotational ankle instability. This minimally invasive approach allows other associated lesions to be detected and managed arthroscopically.

FOXC1 Promotes Osteoblastic Differentiation of Bone Marrow Mesenchymal Stem Cells via the Dnmt3b/CXCL12 Axis.

Bone defects have remained a clinical problem in current orthopedics. Bone marrow mesenchymal stem cells (BM-MSCs) with multi-directional differentiation ability have become a research hotspot for repairing bone defects. In vitro and in vivo models were constructed, respectively. Alkaline phosphatase (ALP) staining and alizarin red staining were performed to detect osteogenic differentiation ability. Western blotting (WB) was used to detect the expression of osteogenic differentiation-related proteins. Serum inflammatory cytokine levels were detected by ELISA. Fracture recovery was evaluated by HE staining. The binding relationship between FOXC1 and Dnmt3b was verified by dual-luciferase reporter assay. The relationship between Dnmt3b and CXCL12 was explored by MSP and ChIP assays. FOXC1 overexpression promoted calcium nodule formation, upregulated osteogenic differentiation-related protein expression, promoted osteogenic differentiation, and decreased inflammatory factor levels in BM-MSCs, and promoted callus formation, upregulated osteogenic differentiation-related protein expression, and downregulated CXCL12 expression in the mouse model. Furthermore, FOXC1 targeted Dnmt3b, with Dnmt3b knockdown decreasing calcium nodule formation and downregulating osteogenic differentiation-related protein expression. Additionally, inhibiting Dnmt3b expression upregulated CXCL12 protein expression and inhibited CXCL12 methylation. Dnmt3b could be binded to CXCL12. CXCL12 overexpression attenuated the effects of FOXC1 overexpression and inhibited BM-MSCs osteogenic differentiation. This study confirmed that the FOXC1-mediated regulation of the Dnmt3b/CXCL12 axis had positive effects on the osteogenic differentiation of BM-MSCs.

Co-occurrence of Spondyloepiphyseal Dysplasia and X-Linked Hypophosphatemia in a Three-Generation Chinese Family.

Rare genetic skeletal disorders (GSDs) remain the major problem in orthopedics and result in significant morbidity in patients, but the causes are highly diverse. Precise molecular diagnosis will benefit management and genetic counseling. This study aims to share the diagnostic experience on a three-generation Chinese family with co-occurrence of spondyloepiphyseal dysplasia (SED) and X-linked hypophosphatemia (XLH), and evaluate the therapeutic effects of two third-generation siblings. The proband, his younger brother, and mother presented with short stature, skeletal problems, and hypophosphatemia. His father, paternal grandfather, and aunt also manifested short stature and skeletal deformities. Whole exome sequencing (WES) of proband-brother-parents initially only found the proband and his younger brother had a pathogenic c.2833G>A(p.G945S) variant in the COL2A1 gene inherited from their father. Re-analysis of WES uncovered the proband and his younger brother also harbored a pathogenic ex.12 del variant in the PHEX gene transmitted from their mother. Sanger sequencing, agarose gel electrophoresis, and quantitative polymerase chain reaction proved these results. The proband and his younger brother were confirmed to have a paternally inherited SED and a maternally inherited XLH. During a 2.8-year follow-up, these two siblings remained short stature and hypophosphatemia, but their radiographic signs and serum bone alkaline phosphatase levels were improved with treatment of oral phosphate and calcitriol. Our study presents the first report of co-occurrence of SED and XLH, shows the possibility that two different rare GSDs co-exist in a single patient, and alerts clinicians and geneticists to be cautious about this condition. Our study also suggests that next-generation sequencing has limit in detecting exon-level large deletions.

MICROCIRCULATION AND BLOOD PRESSURE/HEART RATE RESPONSE DURING EXERCISE STRESS TESTING IN HYPERTENSIVE PATIENTS

Objective: A hypertensive response during exercise has been associated with adverse cardiovascular outcomes in general population and hypertensive patients. On the other hand, microcirculation is the major site of control of vascular resistance and thus has a key role in the etiopathogenesis of hypertension. The aim of our study was to investigate the presence of a possible correlation between blood pressure and heart rate response during exercise with a microcirculation index (capillary rarefaction) in a cohort of hypertensive patients. Design and method: We studied 105 untreated patients with stage I-II essential hypertension (70% men, mean age: 59.5 years, mean office blood pressure: 150/92mmHg). Patients with diabetes mellitus, secondary hypertension, atherosclerotic cardiovascular disease, heart failure, significant chronic renal or pulmonary disease and any other systemic illness or orthopedic problems that would not allow maximal effort on a treadmill were excluded. All participants underwent maximal exercise testing, using the Bruce protocol, as well as nail-fold videocapillaroscopy assessment by using VideoCap 3.0 videomicroscope. Results: A significant negative correlation between diastolic BP at minute-1 of the recovery phase and capillary density expressed in capillaries/mm was revealed (Pearson's r = -0.365, p = 0.043). A significant negative correlation was also observed between capillary density and peak heart rate (Pearson's r = -0.364, p = 0.024) as well as between heart rate increase from stage 1 to 2 and capillary density Pearson's r = -0.746, p = 0.013). Our study shows that in a small cohort of hypertensive patients, capillary rarefaction was associated with a steeper increase in heart rate during exercise, as well as with a higher peak heart rate and higher diastolic blood pressure values during the recovery phase. Conclusions: These findings suggest that new indices such as capillary rarefaction may provide insights into possible autonomic dysfunction and could also be taken into account in the assessment of hypertensive patients.

Influence of lactational status of the surrogate mare during early pregnancy on inflammatory markers in subsequently born foals

Nutrition during pregnancy has a significant impact on the offspring and affects health, growth and metabolism in several species, including equines. Studies have associated orthopedic problems in foals, such as osteochondritis dissecans (OCD), with diet of the broodmare during pregnancy resulting in high glucose concentrations, causing suppression of the central regulation of growth hormone (GH) secretion and subsequent disruption of the GH/IGF-1 (insulin-like growth factor-1) axis. It is very common to use non-lactating mares as embryo recipients, however little is known about the effect of lactational status on pregnant mare metabolism and the effect on the resulting embryo, fetus and the offspring's metabolism and development. Our study aimed to compare inflammatory cytokines, osteocalcin and IGF-1 in foals born from lactating recipient mares (LM; n=7) and non-lactating recipient mares (NLM; n=5) from days 1-28 after birth. Twelve healthy Mangalarga Paulista mares aged 5 to 15 years of age were used. Twelve foals, eight males and four females, born by eutocia were evaluated. Recipient LMs were lactating from the day of ovulation, until a maximum of 170 days of pregnancy (124 to 170). Foal evaluations were performed at birth (D1) and at 7, 14, 21 and 28 days of age (D7, D14, D21 and D28). Leptin (ng/mL), adiponectin (µg/mL), resistin (ng/mL) analyses were performed using ELISA, and interleukin6 (IL6; pg/mL), interleukin 10 (IL10; pg/mL), tumor necrosis factor (TNFα; pg/mL), osteocalcin (ng/mL) and IGF-1 (ng/mL) were evaluated using immunoassay kits. We used a factorial arrangement between group (LM x NLM) and time (D1, D7, D14, D21 and D28). The results are the mean and standard error of the mean. There was no significant interaction in any of the variables. Concentrations of IGF-1, IL6, IL10 and TNFα were higher in the NLM group (IGF1: 29.48±3.82 vs 176.53±65.8, p=0.0002; IL6:9.89±0.74 vs 13.57±1.33, p=0.01; IL10: 75.37±3.89 vs 100.75±8.84, p=0.0006 and TNFα: 8.08±1.08 vs 12.89±1.75, p<0.001). Only in IL10 concentration, there was a difference over time (D1: 114.11±1.04; D7: 72.08±8.13; D14: 12±6.96; D21: 72.98±5.25 and D28:100.44±9.25; p<0.001). Osteocalcin correlated positively with leptin (p<0.05; r=0.27). In this study, the recipient mares’ lactational status during the first trimester of pregnancy influenced concentrations of inflammatory markers in the subsequently born foal up to 28 days of life, with higher concentrations of IGF-1, IL6, IL10 and TNFα than in foals born from non-lactating recipient mares. This raises an important discussion on the impact of lactational status of the recipient dam on the future of her offspring. Acknowledgements: FAPESP (2017/05425-0 and 2020/10260-3) and CAPES

Case Report of Delayed Treatment of Lepromatous Leprosy Masquerading as Acne Vulgaris in Post Elimination Era in Nepal

Leprosy affects multiple systems and causes morbidity. However, with attainment of global elimination, and prevalence being 0.89/10000 at national level in Nepal; it is seldom considered a diagnosis when it doesn't manifest telltale signs. Leprosy can masquerade various dermatological, orthopedic or neurological problems thus delaying the diagnosis.

Circulating miR-146b and miR-27b are efficient biomarkers for early diagnosis of Equidae osteoarthritis

One of the most orthopedic problems seen in the equine is osteoarthritis (OA). The present study tracks some biochemical, epigenetic, and transcriptomic factors along different stages of monoiodoacetate (MIA) induced OA in donkeys in serum and synovial fluid. The aim of the study was the detection of sensitive noninvasive early biomarkers. OA was induced by a single intra-articular injection of 25 mg of MIA into the left radiocarpal joint of nine donkeys. Serum and synovial samples were taken at zero-day and different intervals for assessment of total GAGs and CS levels as well as miR-146b, miR-27b, TRAF-6, and COL10A1 gene expression. The results showed that the total GAGs and CS levels increased in different stages of OA. The level of expression of both miR-146b and miR-27b were upregulated as OA progressed and then downregulated at late stages. TRAF-6 gene was upregulated at the late stage while synovial fluid COL10A1 was over-expressed at the early stage of OA and then decreased at the late stages (P < 0.05). In conclusion, both miR-146b and miR-27b together with COL10A1 could be used as promising noninvasive biomarkers for the very early diagnosis of OA.

Study of functional outcome of dorsolumbar spine fractures treated with minimal invasive spine surgery

Spinal trauma is a common problem in modern Orthopedics. Spine surgery has recently been transformed significantly by the growth of minimally invasive surgery (MIS). Easily acceptable to patients as less invasive with smaller incisions, MIS is often perceived as superior to traditional open spine surgery. This study aims to study the functional outcome of minimally invasive surgery (MIS) in posterior thoracolumbar instrumentation in spine fractures. Present study was prospective in nature conducted among 35 patients. All patients fulfilling inclusion criteria and exclusion criteria were taken up for the study. Study was carried out over a period of 1.5 years. Majority of the patients was in the age group of 30-50 years and most of them were male. Mean VAS score &amp; ODI functional outcome scores significantly reduced after MIS. Incidence of complications after MIS was 5.71%. 86% patients had excellent to good outcome after MIS according to McNab criteria. Minimal invasive surgery is safe and effective procedure with minimal complications and good post-operative outcome.

A Novel Porous Butyryl Chitin-Animal Derived Hydroxyapatite Composite Scaffold for Cranial Bone Defect Repair.

Bone defects, a common orthopedic problem in clinical practice, are a serious threat to human health. As alternative materials to autologous bone grafts, synthetic cell-free functionalized scaffolds have been the focus of recent research in designing scaffolds for bone tissue engineering. Butyryl chitin (BC) is a derivative of chitin (CT) with improved solubility. It has good biocompatibility, but few studies have investigated its use in bone repair. In this study, BC was successfully synthesized with a degree of substitution of 2.1. BC films were prepared using the cast film method and showed strong tensile strength (47.8 ± 4.54 N) and hydrophobicity (86.4 ± 2.46°), which was favorable for mineral deposition. An in vitro cytological assay confirmed the excellent cell attachment and cytocompatibility of the BC film; meanwhile, in vivo degradation indicated the good biocompatibility of BC. Hydroxyapatite (HA), extracted from bovine cancellous bone, had good cytocompatibility and osteogenic induction activity for the mouse osteoblast cell line MC3T3-E1. With the aim of combining the advantages of BC and HA, a BC-HA composite scaffold, with a good pore structure and mechanical strength, was prepared by physical mixing. Administered into skull defects of rats, the scaffolds showed perfect bone-binding performance and effective structural support, and significantly promoted the regeneration of new bone. These results prove that the BC-HA porous scaffold is a successful bone tissue engineering scaffold and has strong potential to be further developed as a substitute for bone transplantation.

Orthobiologics: Current Status in 2023 and Future Outlook.

Orthobiologic agents, including platelet-rich plasma, connective tissue progenitor cells derived from bone marrow, adipose, and other tissues, and purified cytokines and small peptides, have tremendous potential to target deficiencies in soft-tissue healing. The principal limitation currently is the variability in the composition and biologic activity of orthobiologic formulations, making it difficult to choose the optimal treatment for a specific tissue or pathology. Current data suggest that orthobiologics are "symptom-modifying," but there is little evidence that they can lead to true tissue regeneration ("structure-modifying"). A critically important need at this time is to identify sentinel markers of potency and biologic activity for different orthobiologic formulations so that we can match the treatment to the desired biologic effect for a specific tissue or pathology. Improved understanding of the underlying cellular and molecular mechanisms of tissue degeneration and repair will allow a precision medicine approach where we can choose the optimal orthobiologic treatment of specific orthopaedic problems. It is important for the clinician to be aware of the evolving regulatory status of orthobiologic treatments. Emerging therapies such as the use of exosomes and gene therapy approaches hold great promise as improved methods to both treat symptoms and affect tissue regeneration.

A PROSPECTIVE STUDY OF TREATMENT OF IDIOPATHIC CLUBFOOT (CTEV) USING PONSETI METHOD

Background: Congenital talipes equina varus (CTEV) or clubfoot is one of the commonest orthopedic problems seen in infants. CTEV is the term used to describe as a deformity involving in utero malalignment of the calcaneo-talar-navicular complex of the foot. The incidence is 1 in 1000 live births with male to female ratio is 3:1 and is bilateral in 50% of the infants. Idiopathic congenital talipes equinovarus (clubfoot) is a complex deformity that is difcult to correct. The deformity has four components - cavus, adductus, varus equinus and internal tibial torsion. The goal of treatment is to reduce or eliminate these deformities so that the patient has a functional pain-free foot with good mobility and does not need to wear modied shoes. Most orthopaedic surgeons agree that the initial treatment should be non-surgical and should start as soon as possible after birth. Many methods have been described, most of which involve serial manipulation and casting. If left untreated, clubfoot inevitably leads to signicant long-term disability, deformity and pain. Although various surgical techniques are used to correct clubfoot, such as soft tissue releases or bony procedures in older children, currently, conservative management is the preferred option in infants. The technique of gradual and simultaneous correction of all deformities of CTEV using manipulation and casting at weekly interval described by Dr.Ignacio V. Ponseti has gained wide acceptance throughout the world. In this study, we have attempted to analyse the functional outcome of Idiopathic clubfoot using Ponseti's technique in children. To study the outcome following the use of Ponseti technique Objectives: for idiopathic clubfoot. To evaluate the efcacy of the Ponseti method in reducing extensive corrective surgery rates for congenital idiopathic clubfoot. Children with congenital Source Of Data: idiopathic clubfoot consulted at Basaweshwar teaching and general hospital; attached to Mahadevappa Rampure Medical College, Kalaburagi. Method Of Collection Of Data: The study proposes to include patients with congenital clubfoot examined according to the protocol. Associated deformities are noted.The severity of foot deformity was assessed according to Pirani scoring system before and after treatment.Serial toe to groin castings will be applied. The number of casts required to obtain correction and the need for tenotomy was also recorded. Patients will be reviewed at weekly intervals till all deformities except equinus are corrected and once in a month following tenotomy and the use of orthotics. Results: Average number of cast applied before equinus correction in 0-6month age group was 6.3 and 7-12month age group was 6.7 average number ofnal cast used in 0-6months of age was 7.3 and in 7-12months it was 7.7 .Average number of cast increases with increase in age and Pirani severity score 98% of patient had no residual deformity at the time of follow up 2% had relapse at the time of nal follow up. There was a signicant reduction in the PSS after each cast and these difference in PSS between before equinus correction and after the last cast were signicant with the p value of &lt;0.001. Ponseti technique of treatment for Clubfoot deformity is very effective, a Interpretation / Conclusion: nd produces painless, mobile, exible, plantigrade and cosmetically acceptable foot without need of any major surgical intervention

The spectrum of imaging manifestations of Gorham–Stout disease: a novel dynamic contrast-enhanced MR lymphangiography

BackgroundTo describe the radiological features of Gorham–Stout disease (GSD) as evaluated using plain radiography and dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) imaging techniques.MethodsClinical and conventional imaging data were retrospectively reviewed for 15 patients with GSD between January 2001 and December 2020. After December 2018, DCMRL examinations were performed for lymphatic vessel evaluation in patients with GSD and reviewed in four patients.ResultsThe median age at diagnosis was 9 years (range: 2 months–53 years). The clinical manifestations were dyspnea in seven patients (46.7%), sepsis in 12 (80.0%), orthopedic problems in seven (46.7%), and bloody chylothorax in seven (46.7%). The common sites of osseous involvement were the spine (73.3%) and pelvic bone (60.0%). Among the non-osseous involvements, peri-osseous infiltrative soft-tissue abnormalities adjacent to the area of bone involvement were the most common (86.7%), followed by splenic cysts (26.7%) and interstitial thickening (26.7%). DCMRL demonstrated weak central conducting lymphatic flow in two patients with abnormal giant tortuous thoracic ducts and no flow in one patient. All patients who underwent DCMRL in this study presented with altered anatomical lymphatics and functional flow with collateralization.ConclusionDCMRL imaging and plain radiography are very useful for determining the extent of GSD. DCMRL is a novel imaging tool for the visualization of abnormal lymphatics in patients with GSD, which helps in further treatment. Therefore, in patients with GSD, it might be necessary to obtain not only plain radiographs but also MR and DCMRL images.

The effects of obesity and insulin dysregulation on mare reproduction, pregnancy, and foal health: a review.

Obesity is a growing welfare concern in modern equine populations and predisposes horses to disturbances in energy metabolism such as insulin dysregulation. However, equine metabolic syndrome has only been recognized in recent decades. Functioning energy metabolism is pivotal to normal body homeostasis and affects essentially all organ systems, including reproduction. Previous literature suggests that obesity has an effect not only on the reproductive processes in mares but also on offspring health, predisposing the offspring to later-onset orthopedic and metabolic problems. This review focuses on the effects of obesity, insulin dysregulation and hyperinsulinemia on the reproductive functions of mares and the implications on foal health before and after birth. The points of interest are the cyclicity and ovarian function, uterine environment, gestation, the postpartum period, and the newborn foal. The aim is to review the current state of knowledge, and identify outstanding questions that could stimulate future research. This topic is important not only from the equine industry and production perspective but is also relevant for the welfare of future populations and individuals.

Acetabular rim extension using a personalized titanium implant for treatment of hip dysplasia in dogs: short-term results.

Hip dysplasia (HD) is a common orthopedic problem in young dogs. To decrease the laxity of the hip joint related to HD, the surgical treatments are recommended to increase femoral head coverage. ACEtabular rim eXtension (ACE-X) using a personalized 3-dimensional printed titanium shelf implant is a new surgical treatment to increase femoral head coverage and decrease laxity of the dysplastic hip joint, however, the efficacy is less know. Client-owned dogs older than 6 months with clinical signs of coxofemoral joint subluxation and radiographic evidence of HD with no or mild osteoarthritis (OA) were included. The Norberg angle (NA), linear percentage of femoral head overlap (LFO), and percentage of femoral head coverage (PC) were investigated radiographically and with computed tomography (CT) before and after surgery. OA was graded (scores 0-3) according to the maximum osteophyte size measured on CT. In addition, joint laxity (Ortolani) test results, gait analysis, and the Helsinki chronic pain index (HCPI) questionnaire were obtained at preoperative, immediately postoperative and at 1.5- and 3-month evaluations. Acetabular rim extension was performed in 61 hips of 34 dogs; NA, LFO, and PC were significantly higher immediately postoperatively and at the 1.5- and 3-month follow-up examinations compared with preoperative values (p < 0.05). Osteophyte size gradually increased over time (p < 0.05). The OA score significantly increased between preoperatively and directly postoperatively, and between preoperatively and at 3-month follow-up (p < 0.05). The laxity test normalized in 59 out of 61 hips after surgery, and the HCPI questionnaire showed that the pain score decreased significantly at 1.5 and 3 months, postoperatively. The force plate showed no significant improvement during the 3 months follow-up. Although pain reduction by the implant was unclear in short-term results, a personalized shelf implant significantly increased femoral head coverage and eliminated subluxation of the dysplastic hip joint. Further studies are required to study the long-term efficacy of gait, chronic pain, and progression of osteoarthritis.

Temporal transcriptome highlights the involvement of cytokine/JAK/STAT3 signaling pathway in the osteoinduction of BMSCs

BackgroundMesenchymal stem cells (MSCs)-based therapy offers an effective strategy for bone regeneration to solve the clinical orthopedic problems. However, the transcriptional regulation of multiple transitional stages of continuous osteogenesis from MSCs has not been fully characterized.MethodsBone marrow mesenchymal stem cells (BMSCs) stimulated with osteogenic induction media were utilized to construct the in vitro osteogenic differentiation model. BMSCs were harvested after induction for 0, 7, 14 and 21 days, respectively, to perform the mRNA-sequencing (mRNA-Seq). The transcription factor networks and common molecules during the osteogenesis were revealed by using the temporal transcriptome. Further verification was performed by the quantitative real-time polymerase chain reaction (qRT-PCR), immunofluorescence and Western blotting.ResultsIt showed that BMSCs could differentiate into osteogenic, and crucial regulator in the MAPK signaling pathway, the PPAR signaling pathway, the Toll-like receptor signaling and the Cytokine/JAK/STAT signaling pathway. PPI protein interaction analysis also suggested that three cytokines are involved in osteogenic differentiation as core genes, including leukemia inhibitory factor (LIF), interleukin-6 (IL6) and colony-stimulating factor 3 (CSF3). The osteogenic process was negatively affected by the inhibition of JAK/STAT3 signaling pathway.ConclusionsThis work might provide new insights in the crucial features of the transcriptional regulation during the osteogenesis, as well as offer important clues about the activity and regulation of the relatively long-activated Cytokine/JAK/STAT3 signaling pathway in osteoinduction of BMSCs.

Bone fractures in children and adolescents: a frequent problem with a diverse aetiology

Bone fractures in children and adolescents are primarily an orthopaedic problem; however, frequent fractures or multiple fractures at a time require a more extensive diagnostic investigation performed by a paediatrician, endocrinologist and even a geneticist. It is estimated that one in three children aged up to 17 years will experience a bone fracture. The frequency of fractures rises with age, peaking at 11–14 years. The majority of fractures happen as a result of trauma; however, some of them are a sign of genetic diseases (osteogenesis imperfecta, osteopetrosis) or mineral imbalance (metabolic bone disease of prematurity, rickets, osteoporosis). Bone fractures in small children require particular attention, since they may be a sign of not only systemic disorders, but also of battered child syndrome. Not only fractures of long bones, but also fractures of the vertebrae are an underappreciated problem in young patients. They may be spontaneous or associated with inflammatory, autoimmune or neoplastic diseases. Glucocorticoids that are used to treat these diseases are considered to be the main risk factor for the development of steroid-related osteoporosis, regardless of the patient’s age. Due to the diverse aetiology of bone fractures in children and adolescents, the cooperation of multiple specialists in the diagnostic investigation of calcium and phosphate imbalance and disorders of bone mineralisation is important.

Comparison of body mass index level by triage level in the emergency department

INTRODUCTION: Obesity is a high cause of death in both non-communicable and communicable diseases such as COVID-19. The aim of this study is to increase the awareness of emergency department (ED) managers and employees about this problem by showing obesity rates according to triage level in patients admitted to the ED. MATERIAL AND METHODS: BMI levels and complaints of 1246 patients admitted to the ED according to the 3-level triage were re-evaluated with the 5-level ESI (Emergency Severity Index) triage for this study. RESULTS: The mean BMI of 1246 patients was found to be 27.25 ± 5.88 (overweight). 26% of the ED patients were found to be obese and 37.7% of them were overweight. While the mean BMI score of the 6–11 age group was found to be class 1 obesity, the other pediatric and adult age groups were found to be overweight. The highest mean BMI according to both the 3-stage triage system and the 5-stage ESI triage system was found in triage 1 patients (28.8011 ± 7.98; 28.18 ± 6.78, respectively). Obese patients mostly applied to the ED with orthopedic problems and trauma (26.5%). Also, of the patients with class 3 severe obesity, 50% presented with trauma. CONCLUSIONS: The higher the BMI, the higher the triage severity level. BMI levels should be evaluated in the field of triage together with vital signs, especially in trauma patients, and obesity should be considered in ED and hospital management.

Combined application of pulsed low-frequency electrostatic field and robotic mechanotherapy for damage to capsular ligamentous apparatus of the knee joint in children (Methodological recommendations, SAHI MSPC MRRSM MHD. 2022. - 19 p.).

Pathology of the knee joint in children is an urgent problem in pediatric traumatology, orthopedics and pediatrics. Features of the anatomical structure of the knee joint, its functioning, high static and dynamic loads determine the frequency of injuries of this localization (up to 25% among all injuries of the musculoskeletal system).

Multilayer functional bionic fabricated polycaprolactone based fibrous membranes for osteochondral integrated repair

Osteochondral defect repair is one of the challenging problems in orthopedics. In this study, a multilayer polycaprolactone (PCL) based fibrous membrane for osteochondral defect repair was biomimetically fabricated by combining self-induced crystallization, biomimetic mineralization and layer-by-layer electrospinning techniques. The multilayer functional bionic fibrous membrane consisted of cartilage repair layer, intermediate transition repair layer and subchondral bone repair layer. Glucosamine hydrochloride (GAH) encapsulated in core-shell structured PCL fibrous membrane (MGPCL) was suitable for cartilage repair. Shish-kebab (SK) structured PCL fibrous membrane with calcium phosphate coating (MSKPCL) was designed for subchondral bone repair. SK structured MGPCL fibrous membrane (SKMGPCL) was used as intermediate transition repair. The tensile modulus of MG/SKMG/MSKPCL fibrous membrane was 34.24 ± 2.39 MPa which met the requirements of cartilage and subchondral bone repair scaffolds, and in vitro culture results showed that MG/SKMG/MSKPCL fibrous membrane had good biological activity and osteogenic ability. These results showed that MG/SKMG/MSKPCL fibrous membrane provides a promising material basis for osteochondral integrated repair scaffold.