Titanium Nails Research Articles

Comparison of Titanium versus Resorbable Intramedullary Nailing in Pediatric Forearm Fractures.

Pediatric forearm fractures, particularly involving the shaft or diaphysis, are common injuries typically resulting from accidental trauma during various activities. Traditional treatment involves closed reduction and casting; however, surgical intervention may be necessary in certain cases. The gold standard surgical approach utilizes elastic stable intramedullary nailing (ESIN), but a newer technique uses bioabsorbable intramedullary nails made of poly(lactic-co-glycolic acid) (PLGA). This study aims to compare the outcomes of these two surgical methods in pediatric diaphyseal forearm fractures. We retrospectively reviewed 86 patients who underwent operative treatment due to the diaphyseal fractures of the forearm in the Surgical Division, Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary between 2018 and September 2022. The mean age was 9.48 (ranging from 4 to 17). A total of 41 patients underwent surgery with PLGA implants (RESIN technique), while 45 patients were treated with titanium elastic nails (ESIN technique). Various factors including patient demographics, injury mechanisms, fracture characteristics, and complications were assessed. Both groups showed similar gender distribution, with a majority of fractures occurring in boys (the male-female ratio was 31:10 in the PLGA group, while in the titanium elastic nailing (TEN) group, this ratio was 29:16, with no statistical difference between the groups (p > 0.005). The average age of the patients treated with PLGA implants (8.439 years) was lower compared to those treated with titanium nails (10.422 years). A statistically significant difference was found regarding the average age of the two groups (p = 0.0085). Left-sided injuries were more prevalent in both groups (59% of the cases in the PLGA group and 69% in the TEN group, with no statistically significant difference, p = 0.716), and fractures typically involved both the radius and ulna. This represents 93% of the cases in the PLGA group and 80% in the TEN group. Regarding the involvement of bones, we also did not find a statistically significant difference (p = 0.123). The mechanisms of injury predominantly involved indirect force, such as falls (30 cases in the PLGA group and 27 cases in the TEN group), and no statistically significant difference was found (p = 0.139) regarding the mechanism of the injury. Complication rates were lower in the PLGA group (7%) compared to the titanium group (20%). The treatment of pediatric diaphyseal forearm fractures using PLGA implants appears to be a viable alternative to traditional titanium implants. Advantages include no need for secondary surgery and associated cost savings and reduced complication rate and stress associated with anesthesia and surgery. Prospective randomized trials are warranted to further validate these findings and explore long-term outcomes.

Patient-Reported Outcomes After Intramedullary Nailing of Oncologic Impending or Pathologic Fractures With Carbon Fiber or Titanium Implant.

Despite the benefits of intramedullary nailing (IMN) of impending or pathologic fractures in oncologic patients, literature on patient-reported outcomes (PROs) is scarce in patients treated with carbon fiber (CF) nails. Our study compared postoperative PROs after IMN with CF or titanium implants. We conducted a retrospective propensity score-matched cohort study of patients treated at our institution with CF or titanium nails for impending or pathologic fractures from metastatic bone disease. Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Short Form (SF) Physical, Mental, and Physical Function 10a scores were collected. Pain was assessed using visual analog scale (VAS). Absolute and differential scores were compared between groups. We included 207 patients, 51 treated with CF and 156 with titanium nails. One month postoperatively, patients had a one-point decrease in the pain VAS score while PROMIS scores did not improve. At 3 months, PROMIS SF Physical and SF 10a scores improved from preoperative values. Six months postoperatively, median PROMIS SF Physical, SF Mental, and SF 10a scores were higher than preoperative scores. Absolute and differential PROMIS and pain VAS scores were similar between groups at the 6-month and 1-year marks. Patient-reported outcomes were similar after intramedullary nailing with either CF or titanium implants.

Carbon vs. Titanium Nails in the Treatment of Impending and Pathological Fractures: A Literature Review.

Background: Long bones are commonly affected by musculoskeletal tumors, but they also represent one of the most frequent locations for metastases. The treatment is based on pain management and the prevention or stabilization of pathological fractures by intramedullary nailing. While titanium nails are probably the most used, carbon-fiber-reinforced (CFR) nails have emerged as a new option for oncological patients. The aim of this review is to compare titanium and CFR nails according to current findings. Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards were followed: a total of 1004 articles were identified and 10 were included. Results: Traditionally, titanium implants are highly valued for their optimal biomechanical properties and ease of insertion, facilitated by their radiopacity. However, the use of titanium poses challenges in radiotherapy due to interference with radiation dosage and the creation of ferromagnetic artifacts. Conversely, CFR implants have emerged as a recommended option for intramedullary fixation, due to their biomechanical and structural properties and their benefits during radiotherapy and follow-up monitoring X-ray. Conclusions: CFR nailing represents a promising advancement in the surgical management of oncological patients with long bone metastases. However, further studies are needed to increase surgeons' confidence in their use.

Displaced proximal humeral fractures in skeletally immature patients: functional outcomes of surgical treatment.

To report the functional results of our experience and to describe intraoperative findings and complications due to the techniques used in our service. From January 2018 to December 2022, 27 Pediatric patients aged from 8 to 16years underwent surgery to treat proximal humerus fractures. Their demographic characteristics were evaluated, as well as their clinical characteristics on admission, type of reduction (closed/open), presence of interposition in open reductions, type of implant, complications, and functional range of movement according to two shoulder functional scores. Mean age was 11.2years (8-15), there was a predominance of males, who accounted for 70% of the cases, and sports accidents were the cause of injury in 44% of the cases. Anatomical location was balanced between patients, including 55% of physeal fractures and 45% of metaphyseal ones. Overall, 81.5% of patients required open reduction to achieve axis correction, and that 55.5% of fractures were fixed with Kirschner wires, and 44, 4% with elastic titanium nails. Mean QuickDASH score was 0.58 (0-1.7), and Constant score was 9 (3-24). There were no major complications, but 27% of cases subjected to open reduction presented a hypertrophic scar. Surgical treatment of severely displaced proximal humerus fractures is successful, both with closed and open reduction; type of implant does not play a key role and should be selected based on the characteristics of each case. Surgical training should prevail at the time of decision-making. When these recommendations are followed, results can be excellent and sequelae are infrequent.

Minimally Invasive Treatment of Pelvic Fractures with Titanium Elastic Nailing: An Innovative Technology.

Minimally invasive treatment has become the most popular and effective treatment for pelvic fractures. This study aimed to evaluate the safety and efficacy of a new technique, titanium elastic nailing (TEN), for the minimally invasive treatment of pelvic fractures. Twenty-four patients with pelvic fractures were referred to us between January 2020 to January 2022, including sixteen males and 8 females. Pelvic fractures were temporarily fixed by pelvic fixation belt accompanied by traction from the lower limb bone. Anterior pelvic ring injuries (superior ramus of pubis) and ilium fractures were treated with closed reduction and intramedullary fixation with minimally invasive TEN. Intraoperative C-arm, including pelvic anteroposterior, pelvic outlet, inlet and ilium oblique views, and O-arm fluoroscopy (intraoperative CT) were employed to assess fractures reduction and determine the location of the elastic titanium nail within the bone channel. By adopting closed reduction and minimally invasive incision techniques, pelvic fractures could be safely fixed by placing an elastic titanium nail in the osseous medullary cavity channels of the pelvis. Postoperative investigation indicated that the wounds of all patients were healed in the first stage without any occurrence of complications, such as injuries to the nerves, blood vessels, and important tissue structures. Patients are essential quickly after the operation and could perform the functional exercise in the early stages of the recovery. TEN can be used for minimally invasive treatment of pelvic fractures. This novel technique has no obvious complications and is worthwhile in clinical practice.

Titanium Versus Carbon-Fiber Reinforced Intramedullary Nailing for Humeral Bone Tumors.

Multiple techniques have been described to treat humeral diaphyseal bone tumors requiring curettage or excision. Recent studies have suggested that carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) intramedullary nails (IMNs) may be preferable to titanium IMNs for patients with musculoskeletal tumors due to CFR-PEEK's high tensile strength, radiolucency, a modulus of elasticity closer to native bone, and improved postoperative surveillance/radiation dosing. In this study, we describe the rate of fixation failure for both CFR-PEEK and titanium humeral IMNs when used for humeral diaphyseal bone tumors requiring curettage or excision. This was a single-institution retrospective cohort study including 81 patients (27 CFR-PEEK and 54 titanium) treated for a humeral diaphyseal bone tumor using an IMN +/- methylmethacrylate between January 2017 and December 2022. Primary outcome was revision surgery due to soft tissue complications, non-unions, structural complications such as periprosthetic fracture or IMN breakage, periprosthetic infection, tumor progression, and implant failure due to rejection or fatigue. No failures were observed in either patients treated with titanium nails or patients treated with CFR-PEEK not requiring curettage. Fixation failure due to implant failure was observed in two cases - at 214 days and 469 days after surgery - where CFR-PEEK IMN was used for stabilization after a wide segmental resection for oncologic control with a cement spacer reconstruction. In both cases, the resection was larger than 6 cm, the remaining distal humerus was less than 5 cm, and failures occurred at the interface of the residual bone and spacer. Both patients were revised using a titanium distal posterolateral humeral plate fixed with screws and cables without any subsequent complications. One additional CFR-PEEK IMN required revision surgery after 744 days due to progression of the tumor and subsequent non-union. One revision surgery was observed after 63 days for the titanium IMN due to non-union and tumor progression. Humeral diaphyseal bone tumors requiring large segmental resection with small residual bone and a large cement spacer may fail via tension due to bending forces at the distal portion. In this clinical scenario, the use of larger diameter CFR-PEEK IMNs may be indicated when these are available. In the interim, use of intercalary allografts instead of cement spacers, additional fixation with a titanium plate distally, or the use of a titanium nail when using a cement spacer may be considered.

Biomechanical Behavior of Dynamic vs. Static Distal Locking Intramedullary Nails in Subtrochanteric Femur Fractures.

Hip fractures are one of the most frequent fractures presenting to the emergency department and orthopedic trauma teams. The aim of this study was to determine the best indication and therapeutic technique for subtrochanteric fractures and unifying criteria when choosing the most suitable type of nail. To analyze the influence of the material and the type of distal locking of intramedullary nails (static or dynamic), a femur model with a fracture in the subtrochanteric region stabilized with a long Gamma intramedullary nail was applied using finite element method (FEM) simulation. The mechanical study shows that titanium nails allow for greater micromobility at the fracture site, which could act as a stimulus for the formation of callus and consolidation of the fracture. In the mechanical study, the type of distal locking mainly affects mobility at the fracture site and stress in the cortical bone around the distal screws, without in any case exceeding values that may compromise the viability of the assembly or that may result in detrimental effects (in terms of mobility at the fracture site) for the consolidation process. Subtrochanteric fractures treated with titanium nail and static distal locking is safe and does not hinder consolidation.

Mechanical behaviors of titanium, nickel–titanium, and stainless elastic intramedullary nail in fixation of tibial diaphyseal fractures

IntroductionElastic nails have been widely used in the diaphyseal fracture fixation of long bones in adolescents. However, high complication rates have been reported in cases involving weights exceeding 55 kg. The existing nails are fabricated with different metals in clinical settings; however, the effect of the materials on the mechanical responses of the fractured bone remains unclear. Hence, the present study is conducted to compare the mechanical responses of typically used metals, namely titanium, stainless, and nickel–titanium, for elastic nails in the fixation of tibial diaphyseal fractures. Material and methodsA sawbone tube is used to determine the contact force, which is developed after constraining the nail inside the narrow canal using different nail materials. Furthermore, a finite element (FE) model of the tibial diaphyseal fracture is developed to predict the fracture gap deformation based on different nail materials under axial compression and bending loads. The push-out force in the FE simulation is compared with that of a case without an end cap. ResultsIn the sawbone tube, the results indicate that the contact force developed by the titanium nail is significantly higher than those developed by stainless and nickel–titanium nails. The contact forces developed by the titanium, stainless steel, and nickel– titanium nails are 385 (SD 34), 358 (SD 49), and 258 (SD 42) N, respectively. In the FE simulation, the titanium nail yields the highest push-out force when an end cap is not used, and the push-out forces in axial compression are 201, 183, and 87 N in the titanium, stainless, and nickel–titanium nails under axial compression, respectively. By contrast, the stainless nail yields the smallest gap deformation when an end cap is used. ConclusionResults of the present study show that the end cap is an important factor affecting the mechanical responses of nails fabricated using different materials. Titanium nails are preferred when an end cap is not used, whereas stainless nails are preferred when an end cap is used.

Comparison of four surgical methods for pediatric forearm double diaphyseal fractures: a retrospective analysis.

One of the most frequent fractures in children is a double forearm fracture. They make up 26% of children's long bone fractures in the upper extremities and their incidence has increased in recent years. In this study, pediatric patients with double forearm fractures were treated using plate screw, intramedullary K-wire (I-KW), intramedullary titanium elastic nails (TENs), and hybrid fixation (HF) to compare the radiographic and functional results. The printed and digital medical records were retrospectively examined from our hospital's archives after receiving consent from the regional ethics committee. Legal guardians of the patients, who were under the age of 18, gave their informed consent. Based on the surgical procedure used, the patients were split into 4 groups. Double plating was the D-P group, hybrid fixation method was the HF group, intramedullary elastic titanium nail was the TEN group, and intramedullary K-wire was the I-KW group. The study comprised 78 patients in total, with 19 patients in the HF group, 21 patients in the TEN group, 20 patients in the I-KW group, and 18 patients in the D-P group. When the mean operating times of the four approaches were compared, a substantial difference was found. The D-P group's mean operating time (65.2±4.9 minutes) was noticeably longer than those of the other groups (p<0.001). The HF group's mean operating time was 55.93.4 min longer than that of the TENs and I-KW groups, which was statistically significant (p<0.001). In comparison to the other groups, the D-P group's mean intraoperative fluoroscopy time was considerably shorter (6±3 sec) (p<0.001). When compared to the D-P group, it was considerably higher in the HF group (12±2 sec) (p<0.001). In comparison to the TENs (20±4 sec) and I-KW groups (19±5 sec), it was significantly lower in the HF group (p<0.001). In comparison to the HF group, the D-P group's tourniquet use lasted much longer (p<0.001). The TENs and I-KW groups did not use a tourniquet because a mini-incision was made. The D-P group's mean blood loss (110±10 ml) was substantially larger than that of the other groups (p<0.001) in the mean blood loss data. In comparison to the TENs (40±5 ml) and I-KW (40±5 ml) groups, the mean blood loss in the HF group (90±10 ml) was considerably larger (p<0.001). All patients received an above-elbow postoperative cast. The HF group (2 weeks) and the D-P group (2 weeks) experienced significantly less postoperative immobility than the TENs and I-KW groups (4.4 weeks, p<0.001). The four fixation techniques used in the current study for juvenile diaphyseal double forearm fractures produced positive clinical and functional outcomes. The hybrid fixation technique was discovered to be comparable to the other techniques and even beneficial in some ways. So, a safe and efficient treatment option for juvenile diaphyseal double forearm fractures is hybrid fixation.

Efficacy of Single Titanium Elastic Nail in the Treatment of Child Femur Fractures.

Femoral shaft fractures in childhood constitute an important part of emergency visits to orthopedic clinics. The aim of this study was to investigate the efficacy and reliability of a method in the treatment of simple fractures in the middle of the femoral diaphysis in patients with multiple injuries or in the treatment of cases with a medullary canal that is too narrow for two nails, with a single stretch nail thicker than half the diameter of the canal. Between July 2002 and November 2006, examinations were made of 11 femoral fractures in 11 patients who were admitted to the pediatric emergency department of Tepecik Training and Research Hospital with a diagnosis of femoral fracture and who were hospitalized and treated with a single flexible intramedullary titanium nail. In the follow-up, no problem was found in terms of union and length difference in any of the cases, except for a10º varus deformity present after surgery in one case. Elastic intramedullary nailing is an effective method in the treatment of simple femoral fractures in children. A single elastic nail provides adequate stability following open reduction with minimal incision in patients whose short operating time must be kept short such as those with head trauma, thoracic trauma, or intra-abdominal pathology, or patients with a narrow medullary canal where two flexible nails cannot pass. We think that it is a feasible method because it causes minimal soft tissue damage.

CD73 inhibits titanium particle-associated aseptic loosening by alternating activation of macrophages.

Aseptic inflammation is a major cause of late failure in total joint arthroplasty, and the primary factor contributing to the development and perpetuation of aseptic inflammation is classical macrophage activation (M1 phenotype polarization) induced by wear particles. CD73 (ecto-5'-nucleotidase) is an immunosuppressive factor that establishes an adenosine-induced anti-inflammatory environment. Although CD73 has been shown to suppress inflammation by promoting alternate macrophage activation (M2 phenotype polarization), its role in wear particle-induced aseptic inflammation is currently unknown. Our experiments were based on metabolomic assay results in a mouse model of aseptic loosening, and studied the function of CD73 in vivo and in vitro using a mouse aseptic loosening model and a mouse bone marrow derived macrophage (BMDM) inflammation model. Results show that aseptic loosening (AL) reduces the purine metabolic pathway and decreases the native expression of the metabolite adenosine. In vivo, CD73 expression was low in the bone tissue surrounding the titanium nail and synovial-like interface tissue, while in vitro experiments demonstrated that CD73 knockdown promoted titanium particles-induced aseptic inflammation. CD73 overexpression mitigated the titanium particle-mediated enhancement of LPS-induced M1 polarization while promoting the titanium particle-mediated attenuation of IL-4-induced M2 polarization. In BMDM exposed to titanium particles, CD73 promotes M2 polarization via the p38 pathway. Meanwhile, local injection of recombinant mouse CD73 protein slightly alleviated the progression of AL. Collectively, our data suggest that CD73 alleviates the process of AL, and this function is achieved by promoting alternate activation of macrophages.

Sodium butyrate enhances titanium nail osseointegration in ovariectomized rats by inhibiting the PKCα/NOX4/ROS/NF-κB pathways

BackgroundElevated levels of oxidative stress as a consequence of estrogen deficiency serve as a key driver of the onset of osteoporosis (OP). In addition to increasing the risk of bone fractures, OP can reduce the bone volume proximal to titanium nails implanted to treat these osteoporotic fractures, thereby contributing to titanium nail loosening. Sodium butyrate (NaB) is a short-chain fatty acid produced by members of the gut microbiota that exhibits robust antioxidant and anti-inflammatory properties.MethodsOP fracture model rats parameters including bone mineral density (BMD), new bone formation, and the number of bonelets around the implanted nail were analyzed via micro-CT scans, H&E staining, and Masson’s staining. The protective effects of NaB on such osseointegration and the underlying mechanisms were further studied in vitro using MC3T3-E1 cells treated with carbonyl cyanide m-chlorophenylhydrazone (CCCP) to induce oxidative stress. Techniques including Western immunoblotting, electron microscopy, flow cytometry, alkaline phosphatase (ALP) staining, and osteoblast mineralization assays were employed to probe behaviors such as reactive oxygen species production, mineralization activity, ALP activity, protein expression, and the ability of cells to attach to and survive on titanium plates.ResultsNaB treatment was found to enhance ALP activity, mineralization capacity, and Coll-I, BMP2, and OCN expression levels in CCCP-treated MC3T3-E1 cells, while also suppressing PKC and NF-κB expression and enhancing Nrf2 and HO-1 expression in these cells. NaB further suppressed intracellular ROS production and malondialdehyde levels within the cytosol while enhancing superoxide dismutase activity and lowering the apoptotic death rate. In line with these results, in vivo work revealed an increase in BMD in NaB-treated rats that was associated with enhanced bone formation surrounding titanium nails.ConclusionThese findings indicate that NaB may represent a valuable compound that can be postoperatively administered to aid in treating OP fractures through the enhancement of titanium nail osseointegration.

Impact of telescopic intramedullary rodding on the growth of tibia: Comparative experimental study in dogs

IntroductionThe most commonly accepted method of long bone deformity correction in children with osteogenesis imperfecta is surgical realignment with transphyseal telescopic intramedullary rodding. This approach ensures reinforcement of the bone throughout the growth period. Although longitudinal growth does occur with these implants there has been very little work carried out to calculate the effect of such factors as rod position or implant material on growth. We carried out a prospective comparative study on 12 puppies using titanium alloy telescopic tibial rods with and without hydroxyl-apatite coating. The aim of this non-randomized controlled experimental study was to assess the impact of telescopic intramedullary rodding on spontaneous growth of the tibia. Material and methodsTwelve mongrel puppies aged of 5 months underwent intramedullary transphyseal rodding of the right tibia. In group I (6 dogs) a titanium telescopic rod was used, in group II (6 dogs) a titanium rod with hydroxyapatite (HA)-coated threaded end was used. The following radiological criteria were assessed before surgery and every month until age of 12 months (natural fusion of physes in dogs): length of tibia, amount of superposition of inner (male) rod into external (female) rod; alteration of anatomy in terms of joint angles (mMPTA, mLDTA, mPPTA, mADTA); positioning of threaded ends in proximal and distal epiphyses and evidence of premature growth arrest. Parameters were compared with left tibia serving as control segment. The null hypothesis was that neither rod position nor implant material altered growth. ResultsThe transphyseal rods did not lead to irreversible epiphysiodesis in either group. In group II (HA-coated) some loss of residual length was found in all six dogs, over 7mm (5.9%) in comparison to left intact tibia. In contrast to that, in group I (titanium nail) only one animal (16.7%) demonstrated a tibia length discrepancy of 8mm (4.8%). Eccentric ( posterior) positioning of the rod in the distal epiphysis resulted in a procurvatum deformity (increased anterior distal tibial angle) in both groups. We found no failure of telescoping and no loss of fixation of threaded parts in either epiphyses. DiscussionThe presence of telescopic rods with HA-coated threads parts clearly contributes to inhibition of spontaneous longitudinal growth. We hypothesize that HA stimulates maturation of chondrocytes of growth plate. Our findings regarding the potential adverse effect of thread position in the distal physis demonstrate the importance of attempting to place the rod as central as possible. ConclusionTitanium alloy telescopic rods did not reveal significant effect on physeal growth in puppies in comparison to HA-coated implants. Transphyseal HA-coated implants did however inhibit growth plate function with mean loss of length of 5.2% compared to the other side. Eccentric positioning of rods relative to center of physis resulted in angular deformity due to irregular growth. There were no cases of mechanical failure or loss of telescopic function with either group of titanium implant. Level of evidenceII; prospective comparative experimental study.

Technical aspects that may affect the outcomes of pediatric patients with both-bone forearm diaphyseal fractures treated using elastic stable intramedullary nails.

We assessed the radiological and functional results of pediatric both-bone forearm diaphyseal fractures treated using elastic stable intramedullary nails (ESINs), as well as factors affecting the results. In total, 36 patients (33 males and three females; mean age, 11.6 years) were included. The mean follow-up time was 41.5 (18-96) months. Patient demographic characteristics and the details of the surgical techniques were analyzed retrospectively. In addition to standard radiographic evaluations, the ratio between the nail diameter and medullary canal diameter (ND/MCD) was measured, as well as the maximal radial bowing. According to the criteria of Price and Flynn, 28 (77.8%) and eight (22.2%) patients had excellent and good results, respectively. There were no cases of nonunion or delayed union. There was no significant difference in functional or radiological results according to whether titanium nails (24 patients) or stainless steel nails (12 patients) were used (all P > 0.05). Nail prebending (performed in 19 patients) did not affect the functional or radiological results ( P > 0.05). Loss of reduction was observed in four patients with an ND/MCD ratio <40%. The maximal radial bowing improved in all patients. The mean change was significantly greater in patients with diastases and 22D/4.1 fractures. Regardless of nail type or prebending status, surgery using ESIN placement effectively treats both-bone forearm diaphyseal fractures; radial bow remodeling outcomes are excellent. We recommend that the ND/MCD ratio should be 40-70%.

Customized bioceramic scaffolds and metal meshes for challenging large-size mandibular bone defect regeneration and repair.

Large-size mandible graft has huge needs in clinic caused by infection, tumor, congenital deformity, bone trauma and so on. However, the reconstruction of large-size mandible defect is challenged due to its complex anatomical structure and large-range bone injury. The design and fabrication of porous implants with large segments and specific shapes matching the native mandible remain a considerable challenge. Herein, the 6% Mg-doped calcium silicate (CSi-Mg6) and β- and α-tricalcium phosphate (β-TCP, α-TCP) bioceramics were fabricated by digital light processing as the porous scaffolds of over 50% in porosity, while the titanium mesh was fabricated by selective laser melting. The mechanical tests showed that the initial flexible/compressive resistance of CSi-Mg6 scaffolds was markedly higher than that of β-TCP and α-TCP scaffolds. Cell experiments showed that these materials all had good biocompatibility, while CSi-Mg6 significantly promoted cell proliferation. In the rabbit critically sized mandible bone defects (∼13 mm in length) filled with porous bioceramic scaffolds, the titanium meshes and titanium nails were acted as fixation and load bearing. The results showed that the defects were kept during the observation period in the blank (control) group; in contrast, the osteogenic capability was significantly enhanced in the CSi-Mg6 and α-TCP groups in comparison with the β-TCP group, and these two groups not only had significantly increased new bone formation but also had thicker trabecular and smaller trabecular spacing. Besides, the CSi-Mg6 and α-TCP groups showed appreciable material biodegradation in the later stage (from 8 to 12 weeks) in comparison with the β-TCP scaffolds while the CSi-Mg6 group showed much outstanding mechanical capacity in vivo in the early stage compared to the β-TCP and α-TCP groups. Totally, these findings suggest that the combination of customized strength-strong bioactive CSi-Mg6 scaffolds together with titanium meshes is a promising way for repairing the large-size load-bearing mandible defects.

SURGICAL OUTCOME OF PAEDIATRICS LONG BONE SHAFT FRACTURES TREATED WITH PERCUTANEOUS TITANIUM ELASTIC NAIL SYSTEM: A PROSPECTIVE STUDY ON SCHOOL-AGED CHILDREN &amp; ADOLESCENT IN A TERTIARY HEALTH CARE

Background: The incidence of paediatric long bone shaft fractures have been increased drastically owing to increase in no. of Road Trafc Accidents. Flexible Titanium nails are simple, effective, minimal invasive method of xation, Early ambulation, preservation of fracture hematoma &amp; having a physis sparing entry with cosmetic benet. A Prospecti Materials &amp; Methods: ve Interventional Study was conducted with 124 paediatric patients with various long bone fractures who got admitted from Trauma Care Unit of Government Medical College &amp; General Hospital, Srikakulam, from July 2020 to November 2022. Out of 124 patients, 75 both bone fracture Results: forearm,19 cases were femur fractures, 17 cases were tibia fractures and 13 cases were humerus fractures. In our surgery, we took Flynn criteria [2] found 88%(109) patient had excellent to good, 12.0(15)% had fair. Titanium elastic nailing (TENS) is an ef Conclusion: fective &amp; ideal method of treatment in unstable paediatric long bone diaphyseal fractures

A novel device with pedicular anchorage provides better biomechanical properties than balloon kyphoplasty for the treatment of vertebral compression fractures

PurposeTo compare the biomechanical behavior of vertebrae with vertebral compression fractures (VCF) treated by a novel system with pedicular anchorage (dowelplasty) versus balloon kyphoplasty.MethodsFour cadaveric spines (T12-L5) were harvested, cleaned from soft tissues, and separated into vertebrae. Axial compressive loads were applied to each vertebra until a VCF was generated. Half of the vertebrae (n = 11) were instrumented using the “dowelplasty” system, consisting of a hollow titanium dowel anchored into the pedicle, through which a cannulated titanium nail is inserted and locked and through which cement is injected. The other half (n = 11) were instrumented using balloon kyphoplasty. Axial compressive loads were re-applied to each vertebra until fracture. Fracture load and fracture energy were calculated from load–displacement data for the pre- and post-treatment states.ResultsCompared to balloon kyphoplasty, dowelplasty granted greater net change in fracture load (373N; 95%CI,-331–1076N) and fracture energy (755Nmm; 95%CI,-563–2072Nmm). A sensitivity analysis was performed without L4 and L5 vertebrae from the dowelplasty group, since the length of the cannulated nails was too short for these vertebrae: compared to balloon kyphoplasty, dowelplasty granted an even greater net change in fracture load (680N; 95%CI,-96–1457N) and fracture energy (1274Nmm; 95%CI,-233–2781Nmm).ConclusionTreating VCFs with dowelplasty grants increased fracture load and fracture energy compared to the pre-treatment state. Furthermore, dowelplasty grants greater improvement in fracture load and fracture energy compared to balloon kyphoplasty, which suggests that dowelplasty may be a good alternative for the treatment of VCF.Level of evidencelevel IV.

Use of a Novel Anti-Infective Noble Metal Alloy-Coated Titanium Orthopedic Nail in Patients with Open Fractures: A Case Series from Malaysia.

Fracture-related infection is a serious complication in orthopedic surgery with severe consequences for the patient. We evaluated whether a novel noble metal nail-coating technology can prevent bacterial adhesion and biofilm formation without interfering with bony union. In this retrospective, single-center case series, we described the incidence of fracture-related infections and bony union achievement in patients who had Gustilo type IIIa or IIIb femoral or tibial fractures treated with noble metal alloy-coated titanium nails. Patients were treated between January 2017 and January 2019 at the Sultanah Aminah Hospital, Johor Bahru, Malaysia. Information on fracture-related infections and bone healing assessments was collected from patient records. Additionally, three independent experts retrospectively reviewed patient X-ray images from follow-up visits to further evaluate bony union achievement. Thirty-five patients were included. Infection developed in 3/35 (8.6%) patients; all cases were resolved by antibiotic therapy. Radiographs were available for 32 patients; these confirmed the presence of bone healing in 30/32 (93.8%) patients. However, according to patient records, bony union was achieved in all patients. No safety issues were recorded. This case series suggests that a noble metal alloy-coated titanium nail can prevent infection and facilitate bony union achievement in patients undergoing surgery for severe open fractures.

Wettability and biological responses of titanium surface's biomimetic hexagonal microstructure.

In this research, an experiment was conducted on how the surface wettability and biocompatibility of staplers' titanium nails impact the healing of gastrointestinal tissue. Firstly, the bionic hexagonal structure was prepared on the surface of Ti metal by laser processing technology, and the laser textured titanium samples were observed by scanning electron microscope. Then, the liquid-solid contact angle-measuring instrument was used to characterize the wettability of titanium samples. Finally, cells were cultured on the surface of different titanium samples, CCK8 assay and qRT-PCR were carried out to investigate cell adhesion and collagen secretion on the surface of different samples. The results showed that the bionic hexagonal surface increased the surface roughness, reduced the liquid-solid contact angle, and promoted the adhesion and collagen secretion of fibroblasts. The increased wettability provided a better growth environment for cell growth. Microtexture is an important factor affecting the behavior of cells and its size parameters regulate cell gene expression, which is worthy of further study.

Intramedullary nailing for impending or pathologic fracture of the long bone: titanium vs carbon fiber peek nailing

Purpose The aim of this study is to compare titanium vs carbon fiber intramedullary (IM) nailing in terms of response to radiotherapy, local control of the disease, time of surgery, fluoroscopy exposure, and complications.Methods From 2015 to 2021, 52 impending or pathologic fractures were treated with IM nailing in 47 patients: 18 males and 29 females with a mean age of 73. Titanium nails were used in 27 cases: femur (17 cases), humerus (8 cases), and tibia (2 cases). Carbon fiber nails were used in 25 cases: femur (17 cases), humerus (7 cases), and tibia (1 case).Results At a mean follow-up of 8.4 months, most patients died from the disease (63.4%). Fracture healing without osteolysis progression was present in 52% of titanium nailing at a mean time of 6 months and in 53% of carbon fiber nails at a mean time of 4.6 months. No statistically significant difference has been shown in terms of healing (P = 0.5), intraoperative fluoroscopy (P = 0.7), and time of surgery in femoral nailing (P = 0.6), while a significantly lower surgical time for carbon fiber humeral nailing (P = 0.01) was found. Two breakages of carbon fiber femoral nails were observed, and both were treated with revision with modular tumor megaprosthesis.Conclusions Our results suggest that surgical time and fluoroscopy exposure are not longer for carbon fiber nails compared to titanium ones. Healing seems to be faster in carbon fiber nails. Further clinical studies are needed to clarify the long-term outcomes of these implants.