Hip Bone Research Articles

P-66 A INSTANCE OF PAPILLARY THYROID CANCER MANIFESTED WITH SCAPULAR METASTASIS

Abstract Introduction Bone metastasis of well differentiated thyroid tumors observed in 2% and 13% of the patients. Bone metastasis usually occurs mostly in spine, but also in extremities, rib cage and pelvic bones. Here we present a case differentiated thyroid cancer diagnosed with scapular bone metastasis. Clinical Case A 58-year-old male patient had pain on his left scapula that began a year ago. The intensity of the pain worsened over the months. It did not wake him up, but it worsened when he slept on his back. There was no history of trauma, shortness of breath, or pain while swallowing. Physical examination revealed soreness and abnormality at the lateral edge of the scapula. The thyroid gland was not palpable. He was diagnosed with benign prostatic hyperplasia. His family did not have a history of malignancy. He was a lifelong nonsmoker who consumed alcohol infrequently. A magnetic resonance imaging (MRI) of the left shoulder was scheduled due to a suspicious tumor seen on shoulder x-ray imaging. An MRI revealed a 44x40 millimeter mass lesion, T1A hypointense and T2A hyperintense, superimposed on the body of the scapula, causing bone structural enlargement (Figure 1). A tru-cut biopsy was performed, and the pathology results were consistent with thyroid cancer metastases. Positron emission tomography/computed tomography was planned for further metastatic investigation; no new metastases were identified. Hemoglobin: 14.3 g/dL, platelets: 192x109/L creatinine: 0.85 mg/dL calcium: 9.13 mg/dL, AST/ALT: 14/13 U/L, TSH: 1.67 mIU/L, free T4: 0.94 ng/dL. Ultrasonography showed 16x8x8 mm hypoechoic solid nodule with microcalcifications was seen in the posterior of the left lobe and 7x6 mm hypoechoic solid nodule was seen in the posterior right lobe, and reactive lymph nodes smaller than 1 cm were discovered in the bilateral cervical chain. A fine needle aspiration biopsy of a thyroid left lobe inferior nodule revealed follicular neoplasm bethesda V. Total thyroidectomy was performed. Pathology report revealed papillary carcinoma with a classic+follicular pattern, localized in the right lobe, invasion of the tumor capsule, and multifocal intrathyroidal and lymphatic invasion were present. The mitotic index was 0–1/2 mm². The patient’s cancer stage was T1bNxM1, STAGE 4B according to thyroid cancer staging calculator. Risk score was evaluated as high according to American Thyroid Association. Bone metastases received 30 GY of radiation over a 10-day period. 150 mci radioactive iodine therapy (RAI) was scheduled for two months after radiation treatment. Anti-thyroglobulin antibody 12.8 U/mL (0-115), thyroglobulin 0.0693 µg/L, TSH 0.013 mIU/L, and freeT4 1.28 ng/dL at fourth month following surgery under levothyroxin suppression medication. Conclusion Papillary thyroid cancer with bone metastasis shortens life expectancy. Total thyroidectomy, anti-resorptive bone agents, corticosteroids, RAI, metastasectomy, radiotherapy, tyrosine-kinase inhibitors are the treatment options.Figure1:44*40 milimeter mass lesion on scapula

Efficacy and safety of teriparatide in kidney transplant recipients with osteoporosis and low bone turnover: a real-world experience.

Kidney transplantation is the preferred treatment for end-stage kidney disease (ESKD), enhancing survival and quality of life. However, kidney transplant recipients (KTRs) are at high risk for bone disorders, particularly low bone turnover disease, which increases fracture risk. Teriparatide, an anabolic agent, may provide a beneficial treatment option for these patients. This single-center, retrospective observational study involved 18 KTRs with osteoporosis, low bone turnover, and a history of vertebral or non-vertebral fractures. Patients received teriparatide (20μg/day) for up to 2 years. Areal bone mineral density (aBMD) at the lumbar spine (LS), total hip (TH), femoral neck (FN), and trabecular bone score (TBS) were measured at baseline, 1 year, and 2 years. In addition, bone turnover markers (BTMs), serum calcium, phosphorus, parathyroid hormone (PTH), and kidney function were monitored. Significant increases in LS aBMD were observed after 1 year (0.941 ± 0.152 vs 1.043 ± 0.165, p = 0.04) and maintained after 2 years compared to baseline (0.941 ± 0.152 vs 1.074 ± 0.154, p = 0.03). TH aBMD significantly increased after 2 years (0.753 ± 0.145 vs 0.864 ± 0.141, p = 0.04), while FN and TBS showed non-significant improvement. Teriparatide was well-tolerated, with mild and transient hypercalcemia and hypophosphatemia. Teriparatide significantly improved BMD at the LS and TH in KTRs with osteoporosis and low bone turnover, showing a favorable safety profile.

A Case Report on Diagnosis and Management of Paget’s Disease

Background: Paget’s disease (osteitis deformans) of bone is a localized skeletal disorder characterized by either mono or polyostotic manifestations. Paget's disease might be asymptomatic as with normal biomarkers or it can be symptomatic such as bony enlargement or deformity. Case Presentation: A 47-year-old female patient was presented to our facility with an elevated alkaline phosphatase (ALP) level for 1 year. Upon reviewing the patient's test results were suggestive of increased ALP, it was determined that the elevated ALP level was likely of osseous origin. However, no bone deformities were observed in the patient. A bone scan was conducted, which indicated the presence of Paget's disease, characterized by increased blood flow, pooling and intense osteoblastic activity observed in the patient's left sided pelvic bones. The diagnosis of Paget's disease was confirmed through a technetium-99m methylene diphosphonate (Tc-99m MDP) bone scan. Inj. Zoledronic acid and oral calcium supplements were advised. Subsequently, after two months follow-up, her results showed normal alkaline phosphatase (ALP) level. Conclusion: Paget's disease, despite being classified as a skeletal disorder, may manifest without any noticeable symptoms or deformities. Its diagnosis is typically confirmed through laboratory analyses, specific findings observed in radiology or radionuclide scans and occasionally, through the confirmation of bone biopsy.

The extent of the hip bone sexual dimorphism in two Italian coeval modern skeletal samples

The rate of sexual dimorphism in the human hip bone is primarily due to the structural demands of childbirth. Genetic, environmental, and socio-cultural factors can also influence pelvic shape variations across populations. This study examines intra-population sex variation within the Italian population based on regional differences of 280 coxal bones from two documented human osteological collections (Bologna and Sassari) coming from different geographical areas, the northern continental and island regions. Nineteen metric variables were used to evaluate sexual dimorphism and population differences. Most of the variables showed sexual dimorphism, particularly the hip height and ischio-pubic measures within both populations, and accurately predicted sex for each population (Bologna: 100%; Sassari: 91.2%). Results show the Bologna sample have larger dimensions for most of the measurements than the Sassari one, especially when considering the longitudinal ones. Some female traits of the Bologna sample are larger than the correspondent ones in the Sassari males. The rate of sexual dimorphism between the populations shows significant differences, with better sex distinction for Bologna than Sassari. This study aims at interpreting these intra-population differences, considering the effect of environmental (physical and social milieu) and genetic factors, underscoring the importance of this local differences for accurate diagnostic criteria.

Global research trends in biological therapy for ankylosing spondylitis: A comprehensive visualization and bibliometric study (2004–2023)

ABSTRACT Ankylosing spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine and pelvic bones. Recently, many researchers have confirmed that biological therapy is effective for AS patients, which provides a new perspective for the treatment of AS. This study aimed to evaluate the characteristics of scientific research on AS and biological therapy worldwide and investigate research hotspots and the direction of future trends. Global literature on AS and biological therapy published from 2004 to 2023 was searched in the Web of Science, Scopus, and PubMed databases. Visualization and bibliometric analysis were carried out using the VOSviewer and CiteSpace software with the retrieved data regarding countries, institutions, journals, authors, and keywords. A total of 2,243 related articles were included, showing that the number of articles in this field has increased annually. The highest number of articles were from the USA (24.39%), followed by Italy (14.36%), England (12.19%), Germany (10.66%), and Spain (7.86%). Braun J was the most prolific author, with a h-index of 16. The institution with the most articles was Charite Universitatsmedizin Berlin, and the Rheumatology journal had the highest number of publications. “janus kinase inhibitor” and “secukinumab” displayed a notable citation burst in recent years, indicating IL-17i and JAKi are research hotspots. More and more attention has been paid to the association between AS and biological therapy in the past two decades. The USA plays a leading role, and China has made remarkable progress. This study has provided a valuable reference for future research in this field.

Keratin Positive Giant Cell Rich Tumor of the Pelvic Bone with a HMGA2::NCOR2 Fusion: A Case Report.

Keratin positive giant cell rich tumor is a rare mesenchymal tumor first described in 2025. It can occur in both soft tissue and bone and predominantly affects young women. The tumor's biological behavior remains uncertain despite its low-grade classification. Characterized by keratin expression and a HMGA2::NCOR2 gene fusion, keratin positive giant cell rich tumors resemble conventional giant cell tumors but lacks H3-3A gene mutations. This article presents a 31-year-old woman with a keratin positive giant cell rich tumor in the pelvic bone, detailing her clinical presentation, diagnostic process, treatment, and postoperative recovery. Histological examination revealed numerous osteoclast-like giant cells within a mononuclear stroma, with RNA sequencing confirming the HMGA2::NCOR2 fusion. The patient's management included surgical resection, with no recurrence at six months follow-up. The discussion emphasizes the need for further research to understand keratin positive giant cell rich tumors pathogenesis and explore potential targeted therapies.

Skeletal Site-Specific Lipid Profile and Hematopoietic Progenitors of Bone Marrow Adipose Tissue in Patients Undergoing Primary Hip Arthroplasty.

Bone marrow adipose tissue (BMAT) has been described as an important biomechanic and lipotoxic factor with negative impacts on skeletal and hematopoietic system regeneration. BMAT undergoes metabolic and cellular adaptations with age and disease, being a source of potential biomarkers. However, there is no evidence on the lipid profile and cellularity at different skeletal locations in osteoarthritis patients undergoing primary hip arthroplasty. Acetabular and femoral bone marrow (BM) and gluteofemoral subcutaneous adipose tissue (gfSAT) were obtained from matched patients undergoing hip replacement surgery. BM, BMAT, and gfSAT were explored at the levels of total lipids, fatty acids, and cells by using thin-layerand gas chromatography, ex vivo cellular assays, and flow cytometry. BMAT content was significantly higher in femoral than in acetabular BM. Total lipid analyses revealed significantly lower triglyceride content in femoral than in acetabular BMAT and gfSAT. Frequencies of saturated palmitic, myristic, and stearic acids were higher in femoral than in acetabular BMAT and gfSAT. The content of CD45+CD34+ cells within femoral BMAT was higher than in acetabular BMAT or gfSAT. This was associated with a higher incidence of total clonogenic hematopoietic progenitors and late erythroid colonies CFU-E in femoral BMAT when compared to acetabular BMAT, similar to their BM counterparts. Collectively, our results indicate that the lipid profiles of hip bone and femoral BMAT impose significantly different microenvironments and distributions of cells with hematopoietic potential. These findings might bring forth new inputs for defining BMAT biology and setting novel directions in OA disease investigations.

Low-cost male urogenital simulator for penile implant surgery training:a 3D printing approach.

Penile implant surgery is the standard surgical treatment for end-stage erectile dysfunction. However, the growing complexity of modern high-tech penile prostheses has increased the demand for more practical training opportunities. The most advanced contemporary training methods involve simulation training using cadavers, with costs exceeding $5,000 per cadaver, inclusive of biohazard fees. This study introduces an innovative and cost-efficient male urogenital simulator designed to enhance penile implant surgery training. Utilizing image segmentation of patient pre-operative computed tomography (CT) scans, combined with three-dimensional (3D) printing and silicone molding techniques, we developed a high-fidelity simulator replicating the anatomical structures of the male urogenital system. The simulator incorporates an innovative double-layer structural design encompassing the corpus spongiosum and glans, corpora cavernosa, testes, epididymides, and pelvic bones. Additionally, it utilizes a two-stage skin manufacturing process tailored for different skin regions. The simulator was produced at a low material cost of £10, with an average production time of 3h. To evaluate its training efficacy, we conducted a penile implant surgery training session involving 15 urology trainees and surgeons ranging from specialty training levels ST3 to ST6. The session began with a demonstration of penile implant surgery and error detection. Trainees, averaging three per simulator, practiced corporotomy, dilation, measurement, penile prosthesis, and scrotal pump placement under expert guidance. Participants' feedback was collected using a Likert scale questionnaire, assessing learning, satisfaction, and anatomical accuracy. Quantitative analysis of the questionnaire responses indicated highly positive feedback from the participants. Satisfaction rates surpassed 96% in learning effectiveness, over 89% in overall satisfaction, and 86% in anatomical accuracy demonstration. The simulator was favourably reviewed by both urology trainees and experienced surgeons, highlighting its utility as a practical training tool. Its low production cost and high precision make it a viable alternative to current training models. The development of this cost-efficient, anatomically accurate urogenital simulator through advanced imaging and additive manufacturing techniques represents a significant advancement in penile implant surgical training. This state-of-the-art simulator not only provides a realistic and practical training experience but also underscores the potential for 3D printing technologies to revolutionize medical education and training.

Microcomputed tomographic analysis of the trabecular and cortical architecture of the proximal femur and hip bone of cats and small breed dogs.

This study aims to provide an initial database to gain more detailed knowledge of the trabecular and cortical bone structure of pelvic and femur bones in cats and smaller dogs. Additionally, the bony microarchitecture between cats and smaller dogs was compared to identify possible differences between those species. These findings could potentially improve the development of non-cemented total hip replacement (THR). To determine the bony microarchitecture, a total of 48 pelvises and thus 96 acetabuli and femora of smaller dogs (n=21) and cats (n=27) were analysed using microcomputed tomography. The parameters bone volume (BV/TV), bone surface (BS/BV), trabecular thickness (Tb.Th), number of trabeculae (Tb.N), trabecular spacing (Tb.Sp), degree of anisotropy (DA), connectivity density (Conn. D) and mean bone density were measured and compared between the species. In addition, the femoral angle of antetorsion was determined on both sides of the body. Overall, cats had fewer but thicker trabeculae than the small dogs in the analysed areas of the pelvis and femur. This resulted in a greater trabecular distance in cats than in small dogs. Together with a higher cortical bone density at the femoral shaft in cats, it could be determined that cats have a more stable bone architecture in the measured areas than smaller dogs. The angle of antetorsion did not differ significantly between the cats and the dogs examined.

Axial spondyloarthritis.

Axial spondyloarthritis manifests as a chronic inflammatory disease primarily affecting the sacroiliac joints and spine. Although chronic back pain and spinal stiffness are typical initial symptoms, peripheral (ie, enthesitis, arthritis, and dactylitis) and extra-musculoskeletal (ie, uveitis, inflammatory bowel disease, and psoriasis) manifestations are also common. Timely and accurate diagnosis is challenging and relies on identifying a clinical pattern with a combination of clinical, laboratory (HLA-B27 positivity), and imaging findings (eg, structural damage on pelvic radiographs and bone marrow oedema on MRI of the sacroiliac joints). The Assessment in SpondyloArthritis international Society classification criteria for axial spondyloarthritis are widely used for research and have contributed to a better understanding of the gestalt of axial spondyloarthritis. Persistent disease activity, assessed mainly by the Axial Spondyloarthritis Disease Activity Score, leads to irreversible structural damage and functional impairment. Management involves non-pharmacological (eg, education, smoking cessation, exercise, physiotherapy) and pharmacological therapy. Non-steroidal anti-inflammatory drugs remain first line pharmacotherapy, while tumour necrosis factor, IL-17, and Janus kinase inhibitors are considered second-line therapies. Future advances are expected to increase disease awareness, facilitate early and accurate diagnosis, optimise disease management, and enhance overall quality of life in patients with axial spondyloarthritis.

Characterization of LIPUS Parameters Suitable for Hip Bone Fracture.

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

Osteological analysis of Nyctereutes procyonoides bones excavated from the Gasan-ri archaeological site

Archaeological research has mainly focused on stone tools, pottery, and metal relics excavated from ruins. Recently, interest in natural relics such as animal bones has increased, as these relics can provide insight into the eating habits, cultural level, and perception of animals of the people at that time. This study investigated morphological structures and dimensions of Nyctereutes procyonoides bones excavated from a well at the Gasan-ri archaeological site in Jinju. These bones are presumed to be relics from the Three Kingdoms period. A total of 447 animal bones were excavated, of which 59 (13.2%) were identified as N. procyonoides bones. These identified bones weighed 47.14 g, accounting for 4.83% of the total bone weight (975.30 g). These N. procyonoides bones were found to belong to 2 individuals estimated to be 5 to 6 weeks old. These bones included 5 skull fragments, 2 mandibles, 9 vertebrae, 11 ribs, 10 forelimb bones, 3 hip bones, and 19 hindlimb bones. A fracture was observed near the bregma of one skull. The presence of a complete specimen in the well suggested that it was used in animal sacrifice rituals. This study estimated the value of animals and human dietary culture at that time by utilizing N. procyonoides bones presumed to be relics of the Three Kingdoms period.

Discordance Between Spine-Hip and Paretic-Nonparetic Hip Bone Mineral Density in Hemiplegic Stroke Patients: A Multicenter Retrospective Study

Objective: To identify the prevalence and factors associated with T-score discordance between the spine and hip, as well as between the paretic and non-paretic hips in hemiplegic stroke patients, this study investigated bone mineral density (BMD) patterns. Bone loss predominantly affects the paretic hip after a stroke, and typical clinical assessments using dual-energy X-ray absorptiometry (DXA) that scan the lumbar spine (LS) and a single hip may overlook an osteoporosis diagnosis. This oversight could potentially lead to suboptimal treatment for stroke patients.Methods: This study was a multicenter retrospective analysis of 540 patients admitted for stroke rehabilitation between October 2014 and February 2022, who underwent DXA of LS and bilateral hips.Results: The prevalence rates of concordance, low LS discordance, and low hip discordance between the LS and hips were 48.2%, 12.2%, and 39.6%, respectively. The discordance rate between bilateral hips was 17.0%. The paretic side had significantly lower total hip T-scores than the non-paretic side (p<0.001). Notably low paretic hip discordance was more prevalent during the chronic phase. DXA scans of the LS and both hips revealed a 0.7%–0.9% higher major discordance compared to LS and single hip DXA scans. The multivariate analysis revealed a significant correlation between a low paretic hip discordance and cognitive impairment (adjusted odds ratio 0.071, 95% confidence interval 0.931–1.003, p<0.05).Conclusion: Since stroke survivors are at high risk for hip fractures, comprehensive BMD assessments, which include LS and bilateral hips, should be considered for post-stroke osteoporosis care to enhance diagnostic accuracy and timely treatment.

Atypical Metastases from Prostate Cancer: Alpha-Methylacyl-Coenzyme A Racemase (AMACR) as a Potential Molecular Target in Prostate-Specific Membrane Antigen-Negative Prostate Adenocarcinoma.

Prostate cancer (PCa) is a high-prevalence disease usually characterized by metastatic spread to the pelvic lymph nodes and bones and the development of visceral metastases only in the late stages of disease. Positron Emission Tomography (PET) plays a key role in the detection of PCa metastases. Several PET radiotracers are used in PCa patients according to the stage and pathological features of the disease, in particular 68Ga/18F-prostate-specific membrane antigen (PSMA) ligands. Moreover, 2-deoxy-2-[18F]fluoro-D-glucose 18F-FDG PET usually shows metastases in the late stages of disease, when dedifferentiated neoplastic clones lose PSMA expression. In some cases, PCa patients may present atypical sites of metastases, with uncommon appearance at PET imaging with different radiotracers. We present the case of a patient with biochemical recurrence of PCa (ISUP Grade Group IV; PSA 4.7 ng/mL) showing atypical sites of metastases (the testis and multiple lung nodules) with absent PSMA expression and high [18F]FDG avidity. The patient showed diffuse positivity to alpha-methylacyl-coenzyme A racemase (AMACR). Moreover, a literature review was performed by collecting cases of PCa patients with atypical metastatic spread detected via PET imaging, with the aim of highlighting the relationship between atypical sites of metastases, imaging presentation, and pathology findings.

The Relationship Between Different Body and Udder Shapes and Sizes with Milk Yield in Buffaloes

Several studies have been conducted with the objective of examining the potential relationship between different udder and body shapes and sizes and milk yield in buffaloes. In one study, it was stated that the relationship between milk yield and teat diameter was significant. In another study, conical and round teats were found to have the highest milk yield. Milk yield and udder width and lactation number were also positively correlated. It was found that there were some positive correlations between rear udder width, rear udder height, rear udder distance, udder length, front-rear teat distance; left rear teat length, left front teat length; right rear teat length and right front teat length. It was observed that body length was significantly associated with milk yield. While 1 cm increase in body length increased milk yield by 15.96 grams/day on average, each 1 cm increase in chest circumference increased milk yield by 17.96 grams/day. The highest milk yield was recorded at the height of the withers (145 cm) and at the depth of the chest (80 cm). A positive relationship was found between the distance between the hip bones and upper wedge angle and milk yield. Another study found that the thickness of the skin affects how much milk buffaloes produce. The thicker the skin in the flank and udder regions, the less milk the buffalo produces. The correlation coefficient in the flank region was -0.334 and in the udder region was -0.264.

МОРФОЛОГИЧЕСКОЕ ИССЛЕДОВАНИЕ ПОЧЕК И БЕЛКОВОГО ОТДЕЛА ЯЙЦЕВОДА У ГУСЕОБРАЗНЫХ ПТИЦ

The purpose of research is to study the features of the macro- and microscopic structure of the kidneys and the protein section in Peking duck and Italian goose. The object of the study is the carcasses of adult poultry. In the studied species of birds, the presence of paired dark brown kidneys located in the renal fossae of the pelvic bone retroperitoneally is noted. The kidneys consist of cranial, middle and caudal lobes, with microscopy of which the cortical and cerebral zones are noted. The relative weight of the kidneys to body weight is 0.36 % (Peking duck) and 0.29 % (Italian goose). In the studied species of birds, the protein section represents the longest part of the oviduct, forming 5–6 bends along its entire length, making up the cranial, middle, and caudal parts. The folds have different shapes and linear indicators. The mucous membrane of the protein section is covered with multi-row ciliated epithelium with the presence of goblet, ciliated and argyrophilic cells. A well-developed muscular coat is represented by longitudinal and circular layers of smooth muscle fibers. The serous membrane is covered on the outside with a layer of mesothelial cells that lie in loose fibrous connective tissue. In relation to the wall thickness of the protein section, the mucous membrane occupies from 65.1 to 68.1 %, the muscular one – from 21.5 to 25.3 % and the outer one – from 9.6 to 10.4 %. In the folds of the mucous membrane at the base of the lamina propria there are dense collagen and thin loose elastic fibers resembling a grid structure with the presence of epithelial and glandular cells that are part of the tubular glands.

Design and 3D printing of pelvis phantoms for cementoplasty.

Percutaneous image-guided cementoplasty is a medical procedure for strengthening bones structurally altered by disease, such as osteolytic metastasis. This procedure involves injecting biocompatible liquid bone cement, through one or more trocars into the damaged bone. Within a few minutes the bone cement hardens and restores the rigidity of the bony structure. The introduction of this technique in the case of large cancellous bones, such as the pelvis, raises some practical issues such as: how to manage the flow of cement with variable viscosity over time and how to inject a large amount of cement under fluoroscopy to effectively restore the patient's ability to bear weight? As a means of training for young practitioners to ensure maximal filling of a metastatic bone area, we have designed and manufactured a pelvic phantom capable of replicating cement diffusion in healthy and metastatic bone under fluoroscopic and computed tomographyguidance. The preliminary stage of the study consisted of an analysis of various lattice structures, with the objective of reproducing the haptic feedback experienced during the needle insertion and diffusion of cement within the trabecular bone. Cementoplasty tests were conducted by an experienced radiologist under fluoroscopy and CT guidance to evaluate the performance of the lattice structure. The initial analysis provided the groundwork for the design of the phantom pelvis, which was then evaluated against a patient case. The phantom was divided into two distinct components: a disposable sectionwith lattice structure, intended for the injection of cement, and a reusable part representing the pelvic bones. Two additive manufacturing methods were selected for the production of the phantom: Stereolithography (SLA) for the lattice structure and Fused Deposition Modeling (FDM) for the pelvic bones. The disposable component was composed of different lattice structures, selected to best match the anatomic conditions of both healthy and diseased areas visible on the patient images. Subsequently, the performance of the phantom was validated against patient images through a cementoplastytest. A total of 12 distinct lattice structures were subjected to three tests of cementoplasty. Stochastic lattices with 500 microns beam thickness and densities varying from 15% to 5% demonstrated the most effective replication of the needle haptic feedback, as well as the diffusion of the cement into healthy and osteolytic cancellous bone. These structures were then implanted in the phantom and validated against one patientcase. A methodology to design and manufacture a phantom dedicated to cementoplasty from patient images is proposed. Initially, a series of lattice structures, exhibiting diverse structure types, thicknesses, and densities, were evaluated to assess their capacity to accurately reproduce the haptic feedback of the needle and the diffusion of cement in the trabecular bone. Subsequent to the outcomes of these investigations, several structures were selected for the development of a phantom capable of accurately replicating a cementoplasty procedure under fluoroscopy and CT guidance. This phantom will enable the training of future practitioners on the procedure of cementoplasty in thepelvis.

Comparison of two surgical treatment strategies for fragility fractures of the pelvis based on early postoperative mobility outcomes using insole force sensors.

Increasing incidences for fragility fractures of the pelvis (FFP) have been reported and surgical treatment remains demanding. While conventional screw osteosynthesis is a common method, complications may arise due to altered bone morphology in the osteoporotic pelvic bone. The iFuse implant system is a novel implant, first introduced for treatment of degenerative sacroiliac joint dysfunction, which offers promising biomechanical characteristics with potential benefits for treatment of FFP. Yet data on the use for FFP is limited. The objective of this study is to compare early postoperative mobility of patients treated with screw osteosynthesis only versus patients treated with additional iFuse stabilization based on insole force sensor gait analysis. We hypothesized that additional iFuse implantation leads to superior postoperative mobility. In the prospective observational study, 37 orthogeriatric patients with FFP types II-IV were included. Postoperative mobility of patients treated with conventional screw osteosynthesis only (group 1) and patients with additional iFuse implantation (group 2) was compared. Mobility was examined using insole force sensors (Loadsol®, Novel GmbH). Postoperative comparison of gait analysis showed no significant difference in average (APF) and maximum peak force (MPF) between group 1 (n = 19, APF 64.9% ± 13.3, MPF 76.0% ± 14.1) and group 2 (n = 18, APF 67.6% ± 9.9, MPF 78.2% ± 10.1). Gait symmetry measured by FTI (force-time integral) ratio was significantly higher in group 2 (48.5% ± 3.3) than in group 1 (44.9% ± 5.4; p = 0.023). Median Barthel Index was higher in group 2 (55) compared to group 1 (45), yet not significantly (p = 0.058). Postoperative pain levels showed no significant differences between both groups. Comparison of early postoperative mobility showed similar mobility outcomes in both groups. Patients with additional iFuse implantation had a more balanced gait pattern, whereas no significance was found in peak force parameters. Additional iFuse implantation showed promising results regarding patient mobility, therefore our hypothesis was partly confirmed. In future long-term examinations with larger patient cohorts should be aimed for.

The relationship between baseline BMD and fracture incidence in the placebo groups of RCTs using individual patient data from the FNIH-ASBMR-SABRE Project.

We have proposed to the Food and Drug Administration (FDA) that treatment-related increases in total hip bone mineral density (TH BMD) at two years could be a surrogate endpoint for fracture risk reduction in clinical trials. The qualification of a surrogate includes a strong association of the surrogate with the clinical outcome. We compiled a large database of individual patient data (IPD) through the FNIH-ASBMR-SABRE project, and this analysis aimed to assess the relationship between baseline BMD and fracture risk in the placebo groups. We estimated the association of baseline TH, femoral neck (FN) and lumbar spine (LS) BMD with fracture risk using IPD from the combined placebo groups which included data from 46 666 placebo participants in 25 randomised controlled trials (RCTs). We estimated the relative risk (RR) of fracture per standard deviation (SD) decrease in baseline BMD using logistic regression models for radiographic vertebral fractures and proportional hazards models for hip, non-vertebral, "all" and "all clinical" fractures. Total person-years in the combined placebo groups was 250 662 (mean baseline age 70.2 ± 7.2years, mean TH BMD T-score -1.97 ± 0.90). We observed significant relationships between baseline TH BMD and vertebral (RR = 1.55/SD), hip (RR = 2.27), non-vertebral (RR = 1.31), all (RR = 1.43) and all clinical (RR = 1.35) fracture risk. Fracture risk estimates were similar for FN BMD and after adjustment for age, race and study. Fracture incidence increased with decreasing TH BMD quintile, confirming the strong graded association between TH BMD and fracture risk. There was a strong relationship between LS BMD and vertebral fracture risk (RR = 1.56/SD), but only a weak association with non-vertebral (RR = 1.07) and no association with hip (RR = 1.01) fracture risk. These data support the very strong relationship between hip BMD and fracture risk and provide supporting rationale for change in TH BMD as a surrogate for fracture risk reduction in future RCTs.

FEA-based Virtual Operation and Stress Distribution Analysis of DHS Screws in Proximal Femoral Bone Fractures: A Strategic Guide for Orthopedic Surgeons in Operational Planning

Background Accidents are the major reasons causing hip bone fractures. These are due to reduced bone density due to aging effect which may cause fractures typically in proximal part of the femur bone. Purpose The purpose of this work is to concentrate on preoperative planning by using a 3D model developed with a virtual operation using a dynamic hip screw (DHS). Methods DHS is generally preferred for the stabilization of stable fractures. The virtual operation was performed on the proximal femoral fracture site, typically for stable fractures. Finite element analysis (FEA) of operated bone was performed to estimate Von Misses stress distribution on the implant post-operatively, resulting in less stress on the fracture site. Results FEA indicates a transfer of stress of the fracture site (35–62%) on the implant, resulting in the operation’s success. Such work will assist orthopedic surgeons in determining load-bearing capacities after the mobilization of the patient. Conclusion Virtual surgery helps the surgeon to identify fracture geometry, the success of the operation, and proper fixation of the implant to avoid post-surgery complications. This aids in the quick recovery of patients, resulting in early rehabilitation.