Osteoporotic Femoral Fractures Research Articles

Corrigendum: Safety and Effectiveness of the Anchor Augmentation with Bone Cement on Osteoporotic Femoral Fracture: A Systematic Reviews

Corrigendum: Safety and Effectiveness of the Anchor Augmentation with Bone Cement on Osteoporotic Femoral Fracture: A Systematic Reviews

Metal-organic Zn-zoledronic acid and 1-hydroxyethylidene-1,1-diphosphonic acid nanostick-mediated zinc phosphate hybrid coating on biodegradable Zn for osteoporotic fracture healing implants.

Zn and its alloys are increasingly under consideration for biodegradable bone fracture fixation implants owing to their attractive biodegradability and mechanical properties. However, their clinical application is a challenge for osteoporotic bone fracture healing, due to their uneven degradation mode, burst release of zinc ions, and insufficient osteo-promotion and osteo-resorption regulating properties. In this study, a type of Zn2+ coordinated zoledronic acid (ZA) and 1-hydroxyethylidene-1,1-diphosphonic acid (HEDP) metal-organic hybrid nanostick was synthesized, which was further mixed into zinc phosphate (ZnP) solution to mediate the deposition and growth of ZnP to form a well-integrated micro-patterned metal-organic/inorganic hybrid coating on Zn. The coating protected noticeably the Zn substrate from corrosion, in particular reducing its localized occurrence as well as suppressing its Zn2+ release. Moreover, the modified Zn was osteo-compatible and osteo-promotive and, more important, performed osteogenesis in vitro and in vivo of well-balanced pro-osteoblast and anti-osteoclast responses. Such favorable functionalities are related to the nature of its bioactive components, especially the bio-functional ZA and the Zn ions it contains, as well as its unique micro- and nano-scale structure. This strategy provides not only a new avenue for surface modification of biodegradable metals but also sheds light on advanced biomaterials for osteoporotic fracture and other applications. STATEMENT OF SIGNIFICANCE: Developing appropriate biodegradable metallic materials is of clinical relevance for osteoporosis fracture healing, whereas current strategies are short of good balance between the bone formation and resorption. Here, we designed a micropatterned metal-organic nanostickmediated zinc phosphate hybrid coating modified Zn biodegradable metal to fulfill such a balanced osteogenicity. The in vitro assays verified the coated Zn demonstrated outstanding pro-osteoblasts and anti-osteoclasts properties and the coated intramedullary nail promoted fracture healing well in an osteoporotic femur fracture rat model. Our strategy may offer not only a new avenue for surface modification of biodegradable metals but also shed light on better understanding of new advanced biomaterials for orthopedic application among others.

Prophylactic Femoral Neck Fixation in an Osteoporosis Femur Model: A Novel Surgical Technique with Biomechanical Study.

Intramedullary nailing (IMN) is a popular treatment for elderly patients with femoral shaft fractures. Recently, prophylactic neck fixation has been increasingly used to prevent proximal femoral fractures during IMN. Therefore, this study aimed to investigate the biomechanical strength of prophylactic neck fixation in osteoporotic femoral fractures. An osteoporotic femur model was created to simulate the union of femoral shaft fractures with IMN. Two study groups comprising six specimens each were created for IMN with two standard proximal locking screws (SN group) and IMN with two reconstruction proximal locking screws (RN group). Axial loading was conducted to measure the stiffness, load-to-failure, and failure modes. There were no statistically significant differences in stiffness between the two groups. However, the load-to-failure in the RN group was significantly higher than that in the SN group (p < 0.05). Femoral neck fractures occurred in all specimens in the SN group. Five constructs in the RN group showed subtrochanteric fractures without femoral neck fractures. However, one construct was observed in both subtrochanteric and femoral neck fractures. Therefore, prophylactic neck fixation may be considered an alternative biomechanical solution to prevent proximal femoral fractures when performing IMN for osteoporotic femoral fractures.

Physical Activity Program Can Mitigate Public Health Expenses with Hospitalization for Osteoporotic Femur Fractures: An Econometric analysis of Health Gym Program - Brazil

Physical Activity Program Can Mitigate Public Health Expenses with Hospitalization for Osteoporotic Femur Fractures: An Econometric analysis of Health Gym Program - Brazil

1036 Operative Versus Non-Operative Management of Osteoporotic Femoral Fractures

Abstract Background he incidence of diaphyseal and distal osteoporotic femoral fractures (OFFs) is increasing. This cohort of patients is often frail with multiple medical co-morbidities. No published data exists neither reporting severity of pain associated with these fractures nor pain in managing their fractures. There are no comparative studies investigating outcomes between conservative (CM) and surgical management (SM). We investigated pain and outcomes between CM and SM OFFs. Method We retrospectively analysed all OFFs admitted to our unit between 2018-2019. We analysed electronic patient records including patient-reported pain scores (PRPS). PRPS were calculated for set time periods: admission; 0-24hours CM versus day 1 post-operative; day 2-3; day 4-5. Primary outcome measure was PRPS. Secondary outcome measures included use of traction; PCA use; weightbearing status; length of stay (LOS); 30 day and 1 year mortality. Data was statistically analysed using SPSS software. Results 22 patients were recruited (11CM, 11SM). There was no statistical difference between groups in terms of age; sex; cognition; Charlson Index; nor pre-morbid mobility status. There was no statistical difference for pain at admission nor PCA use. SM were less painful in the first 24-hour period postoperatively and in the first 3-day postoperative period compared to the same time period in CM. There was no difference in PRPS for the 72–120-hour period. There was no statistical difference between LOS; NWB status; 30 day nor 1 year mortality. Conclusions Operating on OFFs reduces pain in the perioperative period without increasing mortality or LOS in this frail population.

Current concepts in the management of bisphosphonate associated atypical femoral fractures.

Bisphosphonates are a class of drugs used as the mainstay of treatment for osteoporosis. Bisphosphonates function by binding to hydroxyapatite, and subsequently targeting osteoclasts by altering their ability to resorb and remodel bone. Whilst aiming to reduce the risk of fragility fractures, bisphosphonates have been associated with atypical insufficiency fractures, specifically in the femur. Atypical femoral fractures occur distal to the lesser trochanter, until the supracondylar flare. There are a number of the differing clinical and radiological features between atypical femoral fractures and osteoporotic femoral fractures, indicating that there is a distinct difference in the respective underlying pathophysiology. At the point of presentation of an atypical femoral fracture, bisphosphonate should be discontinued. This is due to the proposed inhibition of osteoclasts and apoptosis, resulting in impaired callus healing. Conservative management consists primarily of cessation of bisphosphonate therapy and partial weightbearing activity. Nutritional deficiencies should be investigated and appropriately corrected, most notably dietary calcium and vitamin D. Currently there is no established treatment guidelines for either complete or incomplete fractures. There is agreement in the literature that nonoperative management of bisphosphonate-associated femoral fractures conveys poor outcomes. Currently, the favoured methods of surgical fixation are cephalomedullary nailing and plate fixation. Newer techniques advocate the use of both modalities as it gives the plate advantage of best reducing the fracture and compressing the lateral cortex, with the support of the intramedullary nail to stabilise an atypical fracture with increased ability to load-share, and a reduced bending moment across the fracture site. The evidence suggests that cephalomedullary nailing of the fracture has lower revision rates. However, it is important to appreciate that the anatomical location and patient factors may not always allow for this. Although causation between bisphosphonates and atypical fractures is yet to be demonstrated, there is a growing evidence base to suggest a higher incidence to atypical femoral fractures in patients who take bisphosphonates. As we encounter a growing co-morbid elderly population, the prevalence of this fracture-type will likely increase. Therefore, it is imperative clinicians continue to be attentive of atypical femoral fractures and treat them effectively.

Peptide 11R‑VIVIT promotes fracture healing in osteoporotic rats.

Osteoporotic fracture healing is a complex clinical issue. The present study was conducted to investigate the repair properties of 11R-VIVIT on osteoporotic fractures and to examine the potential effects of 11R-VIVIT on osteoporotic bone marrow-derived mesenchymal stem cells (BMSCs), A rat model of osteoporotic femoral fracture was established, and the effects of the daily local injection of 11R-VIVIT or saline on fracture repairing were evaluated by micro-CT scans and H&E staining. Moreover, BMSCs from osteoporotic rats were treated with 11R-VIVIT, and the osteogenic and adipogenic differentiation of BMSCs was evaluated. The results revealed that 11R-VIVIT promoted bone formation and increased fracture healing. In addition, 11R-VIVIT promoted the differentiation of osteoporotic BMSCs into osteoblasts rather than adipocytes. Furthermore, mechanistic analysis revealed that 11R-VIVIT promoted autophagy by blocking the protein kinase B (AKT)/nuclear factor of activated T-cells (NFATc1) signaling pathway. Consistently, the activation and inhibition of autophagy using rapamycin and LY294002 confirmed the regulatory effects of 11R-VIVIT on autophagy. On the whole, the findings of the present study demonstrate that 11R-VIVIT promotes fracture healing in osteoporotic rats and enhances the osteogenic differentiation of osteoporotic BMSCs by dysregulating the AKT/NFATc1 signaling pathway.

Peri-implant atypical femoral fracture after nail or plate osteosynthesis

BackgroundA lack of scientific information regarding the risk factors and diagnosis of peri-implant atypical femoral fracture (PI-AFF) exists. We report a case series of developed PI-AFF with a nail or plate construct wherein prior femoral fractures were already healed after osteosynthesis. This study aimed to identify the cause and risk factors of PI-AFF and to devise a preventive method based on this. MethodsWe identified 11 PI-AFFs displaying features of AFFs. All patients were ambulant females (mean age, 74.9 years). The mean T-score of the femur measured by DEXA (Dual Energy X-ray Absorptiometry) scan was 3.5. Osteosynthesis was performed with a plate and an intramedullary nail in six and five patients, respectively. Possible risk factors were investigated, including the used implant, the medication of bisphosphonate, the characteristics of previous fracture (AFF or non-AFF), and the co-existence of AFF on the contralateral side. ResultsThe PI-AFFs developed at an average of 6.6 years from the time of prior fracture. All fractures were located at the screw through the plate or nail. Regarding anatomic locations, seven and four fractures were at the subtrochanteric area and diaphysis, respectively. Diaphyseal PI-AFFs occurred in plating cases, all of which were associated with excessive femoral bowing. Subtrochanteric PI-AFFs included all five patients with nail fixation, which occurred near a proximal interlocking screw. Six of the 11 patients were on bisphosphonate treatment before or at the time of fracture. The duration of bisphosphonate treatment was 6 years on average. Concerning the previous femoral fractures, seven and four patients were AFF and non-AFF, respectively. Considering the pathology on the contralateral leg, eight had suffered diaphyseal AFF. Four patients were treated nonoperatively. Seven patients needed an operation; 6 of them healed after reconstruction nailing, and one needed hip arthroplasty because of the associated displaced femoral neck fracture. ConclusionsPI-AFFs may develop through the screw hole at the subtrochanteric or diaphyseal area due to femoral fragility and stress riser effect of the implant. An improved osteosynthesis strategy may be necessary to avoid PI-AFFs when fixing osteoporotic femoral fractures.

Boron Nano-hydroxyapatite Composite Increases the Bone Regeneration of Ovariectomized Rabbit Femurs.

Osteoporosis is a systemic metabolic disease defined by a decreased bone mineral density, microarchitectural deterioration, and an increased incidence of fragility fractures that may lead to morbidity and mortality. Boron may stimulate new bone formation and regeneration, when combined with nano-hydroxyapatite. We questioned whether injecting boron-containing nano-hydroxyapatite composites with hyaluronan increased the bone mineral density and new bone formation in osteoporotic rabbit femurs. The regenerative effects of injectable boron-containing nano-hydroxyapatite composites from 6 to 12 weeks, which may prevent osteoporotic femoral fractures, were assessed. Boron-containing (10 μg/ml) nano-hydroxyapatite composites were injected into the intramedullary femoral cavity with hyaluronan. These significantly increased the histomorphometric new bone surface to the total bone surface ratio at 6 and 9 weeks. The micro-tomographic bone volume to the total volume ratio and bone mineral density in osteoporotic rabbit femurs increased when compared to the hyaluronan (p = 0.004, p = 0.004, p = 0.004, p = 0.01, respectively) and the sham-control (p = 0.01, p = 0.004, p = 0.01, p = 0.037, respectively) groups. The boron-containing group had a higher bone mineralization and new bone formation compared to the nano-hydroxyapatite group, although the difference was not statistically significant. These findings reveal that intramedullary injection of boron-containing nano-hydroxyapatite with hyaluronan increases new bone formation and mineralization in ovariectomized rabbit femurs. Boron-containing nano-hydroxyapatite composites are promising tissue engineering biomaterials that may have regenerative potential in preventing primary and/or secondary femoral fractures in osteoporosis patients.

Evaluation and management of atypical femoral fractures: an update of current knowledge.

Atypical femoral fractures are often attributed to the use of anti-resorptive medications such as bisphosphonates (BP). Whilst they have proven effects on fragility fracture prevention, clinical and laboratory evidence is evolving linking BP-related suppression of bone remodelling to the development of atypical stress-related sub-trochanteric fractures (Shane et al. in JBMR 29:1-23, 2014; Odvina et al. in JCEM 90:1294-301, 2005; Durchschlag et al. in JBMR 21(10):1581-1590, 2006; Donnelly et al. in JBMR 27:672-678, 2012; Mashiba et al. in Bone 28(5):524-531, 2001; Dell et al. in JBMR 27(12):2544-2550, 2012; Black et al. in Lancet 348:1535-1541, 1996; Black et al. in NEJM 356:1809-1822, 2007; Black et al. in JAMA 296:2927-2938, 2006; Schwartz et al. in JBMR 25:976-82, 2010). Injuries may present asymptomatically or with prodromal thigh pain and most can be successfully managed with cephalomedullary nailing and discontinuation of BP therapy. Such injuries exhibit a prolonged time to fracture union with high rates of non-union and metal-work failure when compared to typical subtrochanteric osteoporotic femoral fractures. Despite emerging literature on AFFs, their management continues to pose a challenge to the orthopaedic and extended multi-disciplinary team. The purpose of this review includes evaluation of the current evidence supporting the management of AFFs, clinical and radiological features associated with their presentation and a review of reported surgical strategies to treat and prevent these devastating injures.

Enhanced Bone Formation in Osteoporotic Mice by a Novel Transplant Combined with Adipose-derived Stem Cells and Platelet-rich Fibrin Releasates

Osteoporotic fracture is the main complication of osteoporosis (OP) and accounts for millions of injuries annually. Local intervention by intra-marrow injection has been a good option for preventing osteoporotic bone loss when the osteoporotic femoral fracture has been treated. In this study, tail vein transplantations were examined to evaluate the cell-based therapeutic approach for treating OP with adipose-derived stem cells (ADSCs) and platelet-rich fibrin releasates (PRFr) in an ovariectomized (OVX) mice model. Thirty-six 12-wk-old female ICR mice were randomly divided into six groups: untreated control; sham-operated; OVX-control; OVX-ADSCs; OVX-PRFr; and OVX-ADSCs+PRFr. Starting 8 wk after ovariectomy, the OVX mice received tail vein injections once each week for four consecutive weeks, then were evaluated radiographically and histopathologically 8 wk after the first injection. We also assessed changes to bone trabeculae in the proximal tibial growth plate. In OVX mice treated with ADSCs or PRFr alone, or with a combination of ADSCs and PRFr, the trabecular bone mineral density (BMD), bone volume ratios (BV/TV), and numbers (Tb.N) in the proximal tibia areas were significantly higher than that in the OVX-control group. Significant differences between OVX-treated mice and OVX controls were found for trabecular separation, but not for trabecular thickness. These results indicate that ADSCs or PRFr treatment enhances bone microarchitecture in OP. The treatment of bone loss of OVX mice with ADSCs+PRFr induced greater bone consolidation with bone tissue production (P < 0.01) when compared to the others. Thus, we conclude that the transplantation of ADSCs combined with PRFr might provide an alternative strategy for the treatment of various bone disorders in OP with an unlimited source of cells and releasates.

Research progress of cannulated screw internal fixation in the treatment of femoral neck fracture

Femoral neck fracture refers to the destruction of the continuity of the femoral neck bone. Due to the special anatomical structure of femoral neck, the supply of blood vessels is often destructed after the fracture, which may result in fracture nonunion, femoral head necrosis, etc. How to choose a therapeutic method which can effectively avoid these consequences has been the focus of study in the treatment of femoral neck fracture. The therapeutic methods of femoral neck fracture include conservative treatment, internal fixation surgery, artificial hip replacement, etc. With the constant updating of internal fixtures and the application of artificial hip replacement, surgical treatment of femoral neck fractures has gradually replaced conservative treatment. To repair femoral neck fractures by internal fixation and try every means to keep the femoral heads is the mainstream of current surgical treatments. Hollow compression nail fixation is currently a well-recognized method of internal fixation. In recent years, further achievement has been scored on the basis of three hollow compression nails for the treatment of femoral neck fractures. In particular, the application of cannulated screw F technology has highlighted its advantages. It is expected to be applied in the future to treat displaced and osteoporotic femoral neck fractures. This article aims to review the new applications and related advances in the treatment of femoral neck fractures with three hollow compression nails. Key words: Femoral neck fractures; Internal fixators; Bone screws; Review

A biomechanical comparison of three fixation techniques in osteoporotic reverse oblique intertrochanteric femur fracture with fragmented lateral cortex.

The treatment of the reverse oblique osteoporotic femur fractures is still problematic and can be complicated especially that are accompanied by a fragmented lateral cortex. The aim of this study was to compare three different internal fixation methods in the osteosynthesis of osteoporotic reverse oblique intertrochanteric femur fracture models with a fragmented lateral cortex. Biomechanical experiment study. A total of 24 osteoporotic femur models were obtained and divided into three groups [Group A: Proximal femoral nail(PFN), Group B: 95° angled blade plate (ABP), and Group C: proximal femoral anatomic locking plate (PFLP)] with each group which include eight bones. A standard fracture configuration was created as a reverse oblique intertrochanteric fracture and fixed with these implants. After fixation, all femur constructs were tested with an Instron 5800R tester (Instron, Canton, MA) in the biomechanics laboratory with axial loading and bending forces to assess axial and rotational stiffness and failure load. Displacement over 10mm and angulation greater than 10° in the fracture line were considered as failure. In all tests, ABP had statistically poorer results in comparison to the PFN and PFLP group. PFLP fixation had better biomechanical fixation results in comparison to the PFN group, although the results were not statistically significant. Orthopaedic surgeons should keep in mind that lateral cortex comminution brings further instability to these reverse oblique intertrochanteric osteoporotic fractures and high rates of failure may be encountered due to this instability. PFLP fixation may be an alternative fixation method biomechanically for these instable fractures.

Osteoporotic distal femur fractures in the elderly: peculiarities and treatment strategies.

Distal femur fractures account for 4-6% of osteoporosis related fractures of the femur in the elderly population. They represent a relevant cause of morbidity and mortality in the geriatric population with a reported 1-year mortality reaching 30%. Non-displaced fractures or even displaced fractures in patients with high operative risk can be treated conservatively. However, operative treatment is the most widely accepted management option for displaced fractures. The advantage resides in early mobilization and weight-bearing, reducing risks related with a prolonged immobilization when compared with conservative treatment. On the other hand, the intrinsic difficulty of fixing an osteoporotic bone is a major concern. The presence of osteosynthesis devices or prosthetic implants in the femur can make the surgical treatment more challenging, sometimes limiting therapeutic options. Aim of the present paper is to review the most recent literature about osteoporotic distal femur fractures in the elderly, including periprosthetic and other hardware related fractures, to highlight current evidence on management options and related results as a guide for the daily clinical practice. (www.actabiomedica.it)

Safety and Effectiveness of the Anchor Augmentation with Bone Cement on Osteoporotic Femoral Fracture: A Systematic Reviews

Safety and Effectiveness of the Anchor Augmentation with Bone Cement on Osteoporotic Femoral Fracture: A Systematic Reviews

In-hospital care, complications, and 4-month mortality following a hip or proximal femur fracture: the Spanish registry of osteoporotic femur fractures prospective cohort study

SummaryWe have characterised 997 hip fracture patients from a representative 45 Spanish hospitals, and followed them up prospectively for up to 4 months. Despite suboptimal surgical delays (average 59.1 hours), in-hospital mortality was lower than in Northern European cohorts. The secondary fracture prevention gap is unacceptably high at 85%.PurposeTo characterise inpatient care, complications, and 4-month mortality following a hip or proximal femur fracture in Spain.MethodsDesign: prospective cohort study. Consecutive sample of patients ≥ 50 years old admitted in a representative 45 hospitals for a hip or proximal femur fragility fracture, from June 2014 to June 2016 and followed up for 4 months post-fracture. Patient characteristics, site of fracture, in-patient care (including secondary fracture prevention) and complications, and 4-month mortality are described.ResultsA total of 997 subjects (765 women) of mean (standard deviation) age 83.6 (8.4) years were included. Previous history of fracture/s (36.9%) and falls (43%) were common, and 10-year FRAX-estimated major and hip fracture risks were 15.2% (9.0%) and 8.5% (7.6%) respectively. Inter-trochanteric (44.6%) and displaced intra-capsular (28.0%) were the most common fracture sites, and fixation with short intramedullary nail (38.6%) with spinal anaesthesia (75.5%) the most common procedures. Surgery and rehabilitation were initiated within a mean 59.1 (56.7) and 61.9 (55.1) hours respectively, and average length of stay was 11.5 (9.3) days. Antithrombotic and antibiotic prophylaxis were given to 99.8% and 98.2% respectively, whilst only 12.4% received secondary fracture prevention at discharge. Common complications included delirium (36.1 %) and kidney failure (14.1%), with in-hospital and 4-month mortality of 2.1% and 11% respectively.ConclusionsDespite suboptimal surgical delay, post-hip fracture mortality is low in Spanish hospitals. The secondary fracture prevention gap is unacceptably high at > 85%, in spite of virtually universal anti-thrombotic and antibiotic prophylaxis.

Effects of hemiarthroplasty with different hip prostheses on prognosis of unstable osteoporotic intertrochanteric fractures in elderly patients

Objective To investigate the effects of hemiarthroplasty with different hip prostheses on the prognosis of unstable osteoporotic intertrochanteric fractures in elderly patients. Methods A retrospective case series study was conducted on the clinical data of 556 elderly patients with unstable osteoporotic femoral intertrochanteric fractures treated with hemiarthroplasty from January 2008 to December 2014. There were 142 males and 414 females, aged (83.1±6.9) years (range, 75-103 years). The T value of bone mineral density was -3.5--2.5 SD [(-2.8±0.2)SD]. There were 306 cases of type A2.2 and 250 cases of type A2.3 according to AO classification. There were 296 cases of cement type and 260 biological type according to prosthesis type. Operation time, blood loss, time for ambulation, Harris hip score, and incidence of perioperative major complications were used to compare the therapeutic outcomes between the two types of prostheses. Results The operation time[(75.5±9.2)minutes], blood loss [(992.9±94.2)ml], and time for ambulation[(7.1±1.8)days] in cement type group were all less than those [(86.1±9.3)minutes, (1 139.5±96.0)ml, and (8.6±2.1)days] in biological type group, but the lung infection rate (19.9%), incidence of cardio-cerebrovascular complications (15.9%) and total death rate (7.1%) in cement type group were significantly greater than the those (13.5%, 8.8% and 1.9%) in biological type group (P 0.05). Conclusions In the treatment of unstable osteoporotic intertrochanteric fractures in elderly patients by hemiarthroplasty, the use of cement type prosthesis can reduce operation time, blood loss and bed rest time, but it will lead to significant increases of cardio-cerebrovascular complication and overall mortality. The prosthesis type has no significant effect on the improvement of hip function. Key words: Arthroplasty, replacement, hip; Aged; Osteoporotic fractures; Femoral fractures

Bone cement dry prosthetic with internal fixation treat senile osteoporotic femoral fractures

Objective: To explore the treatment of senile osteoporotic femoral fractures after using internal fixation of bone cement dry prosthetic. Methods: Twelve patients aged from 74 to 94 years with mean age of (84.0±2.5) years with internal fixation of bone cement dry prosthetic surgery who were treated at Department of Orthopaedics in Nanjing Medical University Affiliated Wuxi Second Hospital between May 2013 and May 2015 were retrospectively analyzed. There were 8 male and 4 female, 10 cases of tumble and 2 cases of traffic injury. The fracture types with AO type included 1 case of A1 type, 5 cases of A2 type, 3 cases of A3 type, 1 case of B1 type, 2 cases of B2 type. The steel plate internal fixation with bone cement dry prosthetic method was chosen to treat senile severe femoral fracture. Postoperative observation of postoperative pain assessment, hip joint activity and walking ability were evaluated. Paired simple t test and Wilcoxon rank sum test were used to compare the differences of pain score and the ability to walk. Results: Twelve cases received an average of (16.0±3.6) months follow-up. The average hospitalization days are (9.0±1.4) days and average of intraoperative time was (68.0±10.6) minutes. Intraoperative blood loss compared to normal was (106.0±24.2) ml. Patients began walking load and activities in two weeks. The gait and joint activities gradually restored and there were no obvious deformity and no loose internal fixation. All of the patients didn't have fracture shift with breaking plates or screws deformation and have no bone cement reaction. The walking ability was (4.1±0.9) points, the hip joint activities were 98.5°±7.7° and pain scores were 1.22±0.58 by Holden grading standards. The differences of walking ability (Z=-3.126, P<0.05) and pain scores (t=23.047, P<0.001) between pre- and post-operative were statistically significant. One patient had contralateral hip pain, 2 patients had lateral thigh pain, 10 patients returned to preoperative level of activity. Postoperative function recovered satisfactorily, there were statistically differences. Conclusion: The treatment of severe osteoporosis fractures by internal fixation with bone cement dry prosthetic is a new and effective method, making patients less pain, improving joint function and walking ability.

Intra-bone marrow injection of trace elements co-doped calcium phosphate microparticles for the treatment of osteoporotic rat.

Osteoporotic femur fractures are the most common fragility fracture and account for approximately one million injuries per year. Local intervention by intra-marrow injection is potentially a good choice for preventing osteoporotic bone loss when the osteoporotic femoral fracture was treated. Previously, it was shown that trace element co-doped calcium phosphate (teCaP) implants could stimulate osteoporotic bone marrow mesenchymal stem cell activity in vitro and bone regeneration in femoral bone defects in osteoporotic animal models. They hypothesized that local intra-marrow injection of teCaP particles could improve bone function because the teCaP can sustain release of biologically essential inorganic minerals and improve bone remodeling in osteoporosis. The teCaP and CaP particles were synthesized in simulated body fluid with and without adding silicon, zinc and strontium ions. Female rats (8 months) were ovariectomized (OVX) or sham-operated, and then intervened in the femoral marrow space at 12 months old. Groups include: (1) saline water; (2) CaP particles; and (3) teCaP particles. After 2-3 months of intervention, the sham groups showed higher bone mineral density (MBD) in the femur, and teCaP group increased the BMD in the OVX groups. The compressive strength of the OVX-teCaP group was significantly higher than that in the OVX-CaP group. Significant differences between OVX-teCaP and OVX-CaP groups were found for bone mineral microarchitecture, bone mineral density, and trace mineral content, but not for feces composition. These results confirm the teCaP particles could suppress osteoporotic bone loss by local intramarrow injection. Therefore, this biomaterial could be used as a next-generation combination treatment for osteoporotic trauma and osteoporosis itself. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 1422-1432, 2017.

Clinical observation of improved proximal femoral locking plate in treating osteoporotic intertrochanteric fractures

To investigate the effects of proximal femoral locking plate (PFP) in treating osteoporotic intertrochanteric fractures and to analyze the failure cases. Totally 32 patients with osteoporotic intertrochanteric fractures of Evans I and II were treated with improved locking PFP, including 17 males and 15 females with an average age of 77.3 years old ranging from 70 to 86 years old. After operation, according to Harris hip scores, the hip function and therapeutic effects were evaluated. The observed 32 patients' operative time was (60.5±15.7) min, intraoperative blood loss was (128.8±73.6) ml;perioperative blood transfusion was (224.0±72.7) ml. Hospitalization time was from 14 to 20 d with an average of 17.2 d. All patients were followed up from 6 to 18 months with an average of 14.1 months. The fracture healing time was from 3 to 6 months with an average of 3.1 months. One patient occurred internal fixation loosening and screw backward, 4 cases occurred urinary tract infection, 1 patient died of cardiovascular disease for 6 months postoperative, 2 patients died of a stroke for 1 year postoperative. No incision deep infection, peri internal fixation fractures, lower extremity deep venous thrombosis, internal fixation breakage, nonunion, severe coax vara and coax valgus occurred. The final Harris score was 89.74±6.84, the result was excellent in 10 cases, good in 16 cases, fair in 4 cases, and poor in 2 cases. Locking PFP can provide relative stable fixation to proximal end of osteoporotic femoral fractures, which is a good choice for the treatment of intertrochanteric fractures. It could provide stableness of fractures and bone union, even avoid screws loose or slide out.