Treatment Of Bone Fractures Research Articles

Clinical Effectiveness of Bee Venom Acupuncture for Bone Fractures and Potential Mechanisms: A Narrative Overview

Bee venom acupuncture, a type of herbal acupuncture, combines the pharmacological actions of bioactive compounds from bee venom with the mechanical stimulation of meridian points. Bee venom acupuncture is gaining popularity, particularly in the Republic of Korea, primarily for pain relief of various conditions. This study aimed to summarize and evaluate the available evidence on the use of bee venom acupuncture for recovery after bone fractures. Electronic literature searches for experimental studies and clinical trials were conducted using the PubMed, China Academic Journals (CAJ), and OASIS databases. The search revealed 31 studies, of which six met our criteria. These studies demonstrated that bee venom acupuncture can be effective in treating bone fractures, suggesting a promising area for future research. However, evidence supporting its efficacy in this context is limited. Rigorous trials with large sample sizes and robust designs are needed to clarify the role of bee venom acupuncture for these indications. In addition, future studies should explore the optimal dosage and concentration of bee venom acupuncture.

Dynamic control of mTORC1 facilitates bone healing in mice

Bone healing requires well-orchestrated sequential actions of osteoblasts and osteoclasts. Previous studies have demonstrated that the mechanistic target of rapamycin complex 1 (mTORC1) plays a critical role in the metabolism of osteoblasts and osteoclasts. However, the role of mTORC1 in bone healing remains unclear. Here, we showed that a dynamic change in mTORC1 activity during the process was essential for proper healing and can be harnessed therapeutically for treatment of bone fractures. Low mTORC1 activity induced by osteoblastic Raptor knockout or rapamycin treatment promoted osteoblast-mediated osteogenesis, thus leading to better bone formation and shorter bone union time. Rapamycin treatment in vitro also revealed that low mTORC1 activity enhanced osteoblast differentiation and maturation. However, rapamycin treatment affected the recruitment of osteoclasts to new bone sites, thus resulting in delayed callus absorption in bone marrow cavity. Mechanistically, decreased mTORC1 activity inhibited the recruitment of osteoclast progenitor cells to healing sites through a decrease in osteoblastic expression of monocyte chemoattractant protein-1, thus inhibiting osteoclast-mediated remodeling. Therefore, normal mTORC1 activity was necessary for bone remodeling stage. Furthermore, through the use of sustained-release materials at the bone defect, we confirmed that localized application of rapamycin in early stages accelerated bone healing without affecting bone remodeling. Together, these findings revealed that the activity of mTORC1 continually changed during bone healing, and staged rapamycin treatment could be used to promote bone healing.

Effects of pulsed electromagnetic fields on bone fractures: a systematic review update.

Fractures are common bone injuries, which have a great burden on global health. Fracture healing is a long-term process that may be influenced by a number of factors. The 10-15% of all bone fractures may be complicated by an impaired healing (i.e. delayed union or non-union). The application of weak electromagnetic fields has been proposed to have different effects on bones such as enhancing proliferation - orientation - migration of osteoblast-like cells and supporting osteogenic differentiation in bone marrow-derived mesenchymal stem cells. Despite the amount of evidence on cellular and histological effects, to date the application of pulsed electromagnetic fields has not achieved univocal consensus in daily practice. The purpose of this systematic review update is to research, select, analyze and summarize the most recent scientific evidence regarding the effects of pulsed electromagnetic fields in the treatment of acute bone fractures. A systematic review using the following MeSH terms (Magnetic Field Therapy; Electromagnetic Fields; Bone and Bones; Fractures, Bone; Fractures Healing) and strings {("Magnetic Field Therapy [mh]" OR "Electromagnetic Fields [mh]) OR "magnetotherapy" OR "pulsed electromagnetic field") and ("Fractures, bone [mh]" OR "Bone and Bones [mh]") and ("Fractures Healing [mh]")} was conducted on PubMed, Cochrane Library, Epistemonikos and Scopus electronic databases. Only full articles published in English between January 2014 and December 2022 were considered. Eligibility criteria were defined according to the Population, Intervention, Comparison, Outcomes, and Study (PICOS) design framework. Case reports, case series, uncontrolled studies and expert opinions were excluded. All articles were checked for quality and risk of bias. Three randomized controlled trials were included (197 patients in total). None of the studies found significant effects of pulsed electromagnetic fields on the acute bone healing process. Contradictory results about pain relief emerged. Only one study showed a transitory positive effect of pulsed electromagnetic fields on strength and range of motion recovery in patients with acute bone fracture. This systematic review update does not support the use of pulsed electromagnetic fields for improving the bone healing process in patients with acute fractures. Controversial evidence was found about the effects of pulsed electromagnetic fields on pain and functional recovery. Considering the scant and heterogenous literature published to date, which represents a limit for our conclusion, further studies with rigorous and high-quality methodology are needed.

Infectious Complications after Osteosynthesis of Long Bones of the Lower Limbs: Clinical and Nosological Aspects

Summary. The number of complications in the treatment of bone fractures, including infectious ones, remains significant. Therefore, there is a need to carry out all measures aimed at improving the treatment results for this category of patients. Objective. The objective of our study was to determine the frequency and structure of infectious complications in patients after osteosynthesis of the long bones of the lower limbs depending on the location and type of osteosynthesis. Material and Methods. For our study, 140 cases of infectious complications after osteosynthesis of long bones of the lower limbs were analyzed. Results. An integral analysis of the distribution of the retrospective array of studies based on localization in the femur revealed that the infectious process is most often localized in patients with 32B hip fractures. This type of damage was observed in 29.0% of patients of the general array, where it took the first place. Infectious complications after plate osteosynthesis also prevailed, but were detected less often, in 21.2% of cases. Among the patients after blocking intramedullary osteosynthesis, 32B was detected in more than half of the cases, which is 2.5 times more often than among the patients with plate fixation. Similar results were found in patients with damage to the shin. Conclusions. The results of the analysis indicate that in cases of infectious complications after osteosynthesis of the bones of the lower extremities, damage to the diaphyseal part of the hip was detected most often. This indicates that the development of infectious complications was significantly influenced by the patient’s condition and the intervention performed.

OMIBONE: Omics-driven computer model of bone regeneration for personalized treatment

Treatment of bone fractures are standardized according to the AO classification, which mainly refers to the mechanical stabilization required in a given situation but neglect individual differences due to patient's healing potential or accompanying diseases. Specially in elderly or immune-compromised patients, the complexity of individual constrains on a biological as well as mechanical level are hard to account for. Here, we introduce a novel framework that allows to predict bone regeneration outcome using combined proteomic and mechanical analyses in a computer model. The framework uses Ingenuity Pathway Analysis (IPA) software to link protein changes to alterations in biological processes and integrates these in an Agent-Based Model (ABM) of bone regeneration. This combined framework allows to predict bone formation and the potential of an individual to heal a given fracture setting. The performance of the framework was evaluated by replicating the experimental setup of a mouse femur fracture stabilized with an intramedullary pin. The model was informed by serum derived proteomics data. The tissue formation patterns were compared against experimental data based on x-ray and histology images. The results indicate the framework potential in predicting an individual's bone formation potential and hold promise as a concept to enable personalized bone healing predictions for a chosen fracture fixation.

CORROSION BEHAVIOUR OF MAGNESIUM ALLOYS NZ30K AND NZ30K ALLOYED WITH SILVER IN THE MODEL SOLUTION OF THE OSTEOSYNTHESIS PROCESS

The corrosion behaviour of magnesium alloys NZ30K and NZ30K alloyed with 0.1 wt.% silver in Ringer's Locke solution has been studied, since their components are not toxic to the human body and do not cause clinical complications in the treatment of bone fractures, and silver has antibacterial properties inherent in antibiotics. It has been found that the Ecor potential of the silver-alloyed NZ30K sample was -1.57V during the first 100 seconds of testing, but then it intensively shifted to the positive side to -1.54V within 512 seconds at a rate of 0.051 mV/s, which decreased to 0.014 mV/s after the next 1000 seconds, and a stationary value of the potential Ecor on the sample has been recorded. The sample to uniform general corrosion has been subjected, and the improvement of its potential Ecor during its corrosion study was due to the most intense selective dissolution of magnesium, which has the most negative value of the standard potential among the alloy components, and the enrichment of its surface with Zn, Nd, Zr, Ag, which have a positive value of the standard potential. This trend contributed to a decrease in the rate of general corrosion and made it impossible to develop local corrosion. The NZ30K alloy alloyed with 0.1 wt.% silver is recommended for further potentiodynamic and volumetric corrosion studies to justify its selection as a structural material for the production of biodegradable implants in osteosynthesis.

Eco-friendly synthesis of reduced graphene oxide/palladium composite and its catalytic, antibacterial and antifungal activities for bone regeneration and fracture treatment

Nanocomposites based on inorganic/graphene nanoparticles have gained remarkable interest as a novel class of hybrid materials. Scientific community attention towards these substances has been increasing, because of their peculiar characteristics in combining anticipated features of building constructs for specified applications. Graphene oxide (GO) and metal nanoparticles (MNPs) are using separately in different applications due to their specific limitations. Researchers continue to explore ways to overcome these challenges and create functional nanomaterials for various fields by combining unique advantages of GO and MNPs. Here, we used a facile one-step method for the synthesis of reduced graphene oxide–palladium composite (RGO/Pd). Environmental-friendly biofabricated palladium nanoparticles adhered to Polyscias scutellaria (PS) leaf extract mediated RGO/Pd have been presented in the current investigation. The biofabricated nanohybrid (RGO/Pd) was analysed utilizing several microscopic and spectroscopic techniques. Further, we have also examined the catalytic function for the reduction of 2-nitroaniline (2-NA) in detail. Primarily, we observed that the synthesized nanocomposite can catalyse simultaneous reduction of 2-NA. Furthermore, an added advantage of the as prepared RGO/Pd nanocomposite is its antimicrobial and antifungal ability. Further, we exhibited that the mesenchymal stem cells of adult goat were viable in the presence of RGO/Pd of 0.1 mg/mL concentration and their properties of stem cells were retained. The outcomes displayed that the nanocomposites exhibited outstanding functioning in the killing of dangerous microbial and fungal pathogens. All these results strengthen the RGO/Pd composite applicability in future for potential therapy in bone tissue engineering applications.

Impact of innovations in surgical techniques and advanced imaging on postoperative recovery and reduction of complications in patients with long bone fractures: a systematic review

Long bones fracture is one of the most complicated surgeries in orthopedics and the progress in the techniques as well as technologies used has recorded a steady progression in the last few years. Minimally invasive surgery (MIS), computer-assisted surgery and improved imaging techniques can all be cited as impacting on emerging practices. Conversely, the success of such techniques and their influences on the performance results should continue to be assessed in order to adjust the treatment approaches and patients’ conditions. This paper aimed at reviewing and researching current journals and literature on the topic of managing long bone fractures with specific emphasis on the new developments in surgery, imaging, and after care. Included articles were randomized control trials, cohort studies, meta-analysis, from reputable orthopedic journals and evaluated both effectiveness, and adverse outcomes of these advancements. In light of the study, it emerges that less invasive procedures in thoracic surgery lead to fewer postoperative complications and quicker convalescence time among the patients; and magnetic resonance imaging (MRI) and intraoperative fluoroscopy improves diagnostic accuracy and also surgical localization. Computer assisted surgery and augmented reality have been recognized as useful adjuncts in both the preoperative planning and intra operative navigation through the surgical field but they are still not widely used due to the costs associated with the purchase of equipment and initial technical difficulties. In particular, the use of these technologies successfully advanced the clinical efficiency in the treatment of long bone fractures.

In silico, in vitro, and in vivo acute and sub-acute toxicity profiling of whole plant methanol extract of Equisetum diffusum D. Don from the sub-Himalayan West Bengal, India, having ethnobotanical uses

BackgroundEquisetum diffusum D. Don commonly known as ‘Himalayan horsetail’, has been traditionally used in the treatment of back pain, bone fracture and dislocation, and arthritis by various tribal communities of India. Our previous study confirmed the anti-inflammatory efficacy of the plant through in silico, in vitro, and in vivo model studies. Therefore, the current research is focused on safety dose evaluation for the first-time of the whole-plant methanol extract (EDME) of E. diffusum through appropriate in silico, in vitro, and in vivo approaches.MethodThe whole plant, along with its rhizomes, was collected, and the methanol extract was prepared. The in silico ADMET study was performed to predict the pharmacokinetics profile and toxicity of all the identified phyto-compounds of EDME previously screened by GC–MS study. In vitro cytotoxicity study of EDME was performed using two cell lines: kidney (HEK293) and liver (Huh7) cell lines. The in vivo toxicity study of EDME was validated by the acute toxicity (OECD 423, 2002) and sub-acute toxicity assays (OECD 407, 2008) in the Wistar Albino rat model.ResultsThe in silico ADMET study of all 47 bioactives predicted good pharmacokinetic and low toxicity profiles. In vitro cytotoxicity showed higher IC50 values of EDME viz., 672 ± 15.7 μg/mL and 1698 ± 6.54 μg/mL for both kidney (HEK293) and liver (Huh7) cell lines, respectively, which were considered as low-toxic. Based on acute oral toxicity, the LD50 value of the extract was considered “non-toxic” up to a feeding range of 2000 mg/kg of body weight. The regular consumption of the extract for an extended period (28 days) was also qualified as safe based on the body and organ weight, hematological, biochemical, and histoarchitecture results in the sub-acute toxicity assay.ConclusionThe detailed in silico, in vitro, in vivo (acute and sub-acute oral toxicity) studies gave us a new insight to the safety dose evaluation of Equisetum diffusum, which may serve as a reliable documentation for undertaking the experimental validation of the ethnobotanical uses of the plant which would help in the field of drug development for the treatment of inflammation related complications.

A novel reinforced PLA locking compression plate to eliminate stress shielding using design for additive manufacturing

Orthopaedic trauma is a predominant cause of patient mortality and prompt surgical interventions. The locking compression plate (LCP) is widely regarded as a gold standard in treating bone fractures. However, current fixation materials, such as 316 L stainless steel (316 L SS) and titanium (Ti) alloys induce stress shielding. A novel design approach is considered to design the next generation of bone plates to minimize stress shielding through design for additive manufacturing principles. Embedding of 316 L SS sheets within the bone plate structure has improved the mechanical properties by 200% compared with PLA-only plate, resulting in a flexural modulus of 9.3 GPa, which is closer to the cortical bone range of 10–25 GPa. In contrast, commercial plates measured 51 GPa for Ti and 112 GPa for 316 L SS. The novel plates showed to have a lower economic and environmental impact than commercial ones. Additively manufactured bone plates are more sustainable and cost-effective than current commercial ones.

Sheep Bone Ultrastructure Analyses Reveal Differences in Bone Maturation around Mg-Based and Ti Implants.

Magnesium alloys are some of the most convenient biodegradable materials for bone fracture treatment due to their tailorable degradation rate, biocompatibility, and mechanical properties resembling those of bone. Despite the fact that magnesium-based implants and ZX00 (Mg-0.45Zn-0.45Ca in wt.%), in particular, have been shown to have suitable degradation rates and good osseointegration, knowledge gaps remain in our understanding of the impact of their degradation properties on the bone's ultrastructure. Bone is a hierarchically structured material, where not only the microstructure but also the ultrastructure are important as properties like the local mechanical response are determined by it. This study presents the first comparative analysis of bone ultrastructure parameters with high spatial resolution around ZX00 and Ti implants after 6, 12, and 24 weeks of healing. The mineralization was investigated, revealing a significant decrease in the lattice spacing of the (002) Bragg's peak closer to the ZX00 implant in comparison to Ti, while no significant difference in the crystallite size was observed. The hydroxyapatite platelet thickness and osteon density demonstrated a decrease closer to the ZX00 implant interface. Correlative indentation and strain maps obtained by scanning X-ray diffraction measurements revealed a higher stiffness and faster mechanical adaptation of the bone surrounding Ti implants as compared to the ZX00 ones. Thus, the results suggest the incorporation of Mg2+ ions into the bone ultrastructure, as well as a lower degree of remodeling and stiffness of the bone in the presence of ZX00 implants than Ti.

Knowledge, Perception, and Awareness of the Specialty of Oral and Maxillofacial Surgery Among the Public and Medical Field in Hail, Saudi Arabia: A Cross-Sectional Study.

Aim and background Oral and maxillofacial surgery is a crucial medical specialty focused on diagnosing, treating, and preventing diseases and injuries affecting the oral cavity, jaw, and face. There is a lack of awareness about this field in the specific study area of hail. This study aimed to assess the knowledge, awareness, and perception of maxillofacial surgery among healthcare professionals and the public. Methods The study included 225 participants, consisting of dental and medical professionals and the general public in Hail, Saudi Arabia. Convenience sampling was employed, and participants needed to be at least 20 years old and residents of Hail. A validated online questionnaire, translated into Arabic, was used for data collection. Results A proportion (78.2%) of dental professionals were aware of the specialty of oral and maxillofacial surgery. Among the general population and most medical professionals, the most commonly associated procedures with maxillofacial surgery were the treatment of injuries, bone fractures, and morphological changes in the mouth, jaw, and face, reported by 85.8% of the participants. Furthermore, 60.9% of the participants believed that maxillofacial surgery was the appropriate referral for cleft lip correction. Conclusion The study highlighted significant knowledge about the role of oral and maxillofacial surgeons among the target population. Out of the 225 participants, 137 participants (60.9%) chose thespecialty of maxillofacial surgery for surgical intervention to treat cleft lips. Moreover, 75.1% (n = 169) of the participants had previously heard about oral and maxillofacial surgery, while 24.9% (n = 56) had never heard of this specialty. The findings also showed that 189 participants were not aware that a maxillofacial surgeon is responsible for treating severe deformities that cannot be eliminated using orthodontics, such as growth disorders, hypoplasia and hypoplasia of the lower jaw, and asymmetry of the lower jaw (prognathism and retrognathism of the jaw). To bridge this knowledge gap, it is crucial to implement targeted educational initiatives and awareness campaigns among both the general population and healthcare professionals. By increasing awareness and understanding of the specialized role of oral and maxillofacial surgeons, patient care can be optimized, and appropriate referrals to these specialists can be ensured. Clinical significance This study shows the importance of increasing awareness of oral and maxillofacial surgery among health professionals and the general public. Improved understanding of this specialty can lead to better patient outcomes and early referrals.

Sclerostin Transduced Bone Marrow Mesenchymal Stem Cells Promote Fracture Healing in Rats Through the Wnt/β-Catenin Signal Pathway.

The prognosis of fracture is directly related to several factors. Due to the limitations of existing treatment strategies, there are still many fractures with poor healing. Bone marrow mesenchymal stem cells (BMSCs) have the potential to differentiate into osteoblasts and chondrocytes. Therefore, BMSC transplantation is promised as an effective method for treating bone fractures. We aim to explore whether silently expressing sclerostin gene (SOST) can promote bone formation through the SOST/Wnt/β-catenin signal pathway. We isolated rat BMSCs and the target gene (SOST shRNA) was transduced into them for osteogenic induction. The results showed that SOST significantly inhibited the proliferation and osteogenic differentiation of BMSCs during osteogenic induction, whereas silently expressing SOST not only increased the number of surviving BMSCs but also promoted the expression of osteogenesis-related proteins RUNX2, osteoprotegerin, Collagen I (COL-I), and bone morphogenetic protein-2 during osteogenic induction. The results of imaging examination in rats show that downregulating the expression of SOST can promote the formation of bony callus and the transformation of cartilage tissue into normal bone tissue, and then accelerate the healing of osteoporotic fracture. In addition, we also found that SOST silencing can activate the Wnt/β-catenin pathway to achieve these effects. In conclusion, SOST silencing can promote the proliferation and osteogenic differentiation of BMSCs in situ, and therefore may enhance the therapeutic efficiency of BMSC transplantation in OPF.

Emilin2 marks the target region for mesenchymal cell accumulation in bone regeneration

BackgroundRegeneration of injured tissue is dependent on stem/progenitor cells, which can undergo proliferation and maturation processes to replace the lost cells and extracellular matrix (ECM). Bone has a higher regenerative capacity than other tissues, with abundant mesenchymal progenitor cells in the bone marrow, periosteum, and surrounding muscle. However, the treatment of bone fractures is not always successful; a marked number of clinical case reports have described nonunion or delayed healing for various reasons. Supplementation of exogenous stem cells by stem cell therapy is anticipated to improve treatment outcomes; however, there are several drawbacks including the need for special devices for the expansion of stem cells outside the body, low rate of cell viability in the body after transplantation, and oncological complications. The use of endogenous stem/progenitor cells, instead of exogenous cells, would be a possible solution, but it is unclear how these cells migrate towards the injury site.MethodsThe chemoattractant capacity of the elastin microfibril interface located protein 2 (Emilin2), generated by macrophages, was identified by the migration assay and LC–MS/MS. The functions of Emilin2 in bone regeneration were further studied using Emilin2–/– mice.ResultsThe results show that in response to bone injury, there was an increase in Emilin2, an ECM protein. Produced by macrophages, Emilin2 exhibited chemoattractant properties towards mesenchymal cells. Emilin2–/– mice underwent delayed bone regeneration, with a decrease in mesenchymal cells after injury. Local administration of recombinant Emilin2 protein enhanced bone regeneration.ConclusionEmilin2 plays a crucial role in bone regeneration by increasing mesenchymal cells. Therefore, Emilin2 can be used for the treatment of bone fracture by recruiting endogenous progenitor cells.

Study of Titanium Elastic Nailing in Forearm Fractures in Elderly Patients

Background: As operative techniques and the quality of implants are improving, surgical management of diaphyseal fractures of forearm bones in elderly patients is gaining widespread acceptance. Titanium elastic nailing system (TENS) provides flexural, axial, translational, and adequate rotational stability. This study aims to analyze the outcomes of the treatment of diaphyseal forearm bone fracture with TENS nail. Methods: Elderly patients with both-bone forearm (BBFA) fractures in diaphysis were evaluated clinically and radiologically and followed for an average of six months. The outcome was assessed using the Grace-Eversmann scoring system. We followed up with all 25 patients and evaluated them every two weeks until the fracture united. Results: After approval of the ethics committee, twenty-five elderly patients with AO type 22A3 and 22B3 fractures of the forearm bone who fulfilled the inclusion and exclusion criteria were taken for the study. The mean age of the participants was 65 years. The average time to bone union was 12 weeks, and the average surgery time was 35 minutes. There was a superficial infection in one case. Most patients had a full range of elbow and wrist movements after the union. Conclusion: The TENS is an acceptable and good tachnique for displaced BBFA diaphyseal fractures in elderly patients. It is easy, cheap, and convenient and gives elastic mobility, promoting a rapid union of fractures and stability, which is ideal for early mobilization. It provides a lower complication rate, shorter surgery time, good cosmetic outcome, and easy implant removal.

Surgical methods of treatment for tibial diaphyseal fractures

Background. Bone fractures are a public health concern. In recent years, there has been an upward trend in body weight of people of all age groups. Obesity has long been thought to help protect against fractures, but recent studies have shown that for every 5 cm increase in waist circumference, the risk of any fracture is 3 % higher. The purpose: according to the meta-analysis of modern medical literature, to determine the main directions of surgical treatment for long bone fractures, their advantages, and disadvantages, including in overweight patients, the features of diaphyseal fracture fixation in overweight patients. Materials and methods. A meta-analysis of special literature from scientific databases was conducted: Cochrane Library, Scopus, National Library of Medicine — National Institutes of Health, ReLAB-HS Rehabilitation Resources Repository. One hundred and thirty articles were analyzed, from them 31 were selected, which, in our opinion, reflect the purpose of the study. Results. All methods of surgical fixation of fractures have their advantages and disadvantages. The frequency of nonunions caused by intramedullary fixation of the femoral shaft can reach 10 %, and varus/valgus and rotational deformities and shortening can also be observed. But the use of locking screws prevents the occurrence of most complications. When fixing the fractures with plates, the main complications are related to superficial and deep infections, which were more often observed in overweight patients. The analysis demonstrated that in overweight and obese patients, the main complicating factor is not the method for fixing the fracture zone, but factors related to the health of the patient himself. So, despite the fact that the results of treatment of fractures in patients with normal weight and obesity did not have a statistically significant difference, an increase in cardiovascular complications, exacerbation of chronic respiratory diseases was observed. Moreover, it is the presence of concomitant diseases that often makes surgical intervention impossible. Conclusions. There is a large amount of research on surgical methods of fixing tibial diaphyseal fractures, but data on the choice of fixation method in overweight and obese patients as a separate approach were not found. There are data on complicating factors of excess weight in the treatment of fractures and surgical interventions. Systematic studies related specifically to the algorithm for choosing the method of fracture fixation and complications have also not been found.

Implants removal in children: results of a survey among Italian orthopaedic surgeons.

In the treatment of paediatric limb disorders, the use of metal implants has been increasing over the last decades. Recent studies have addressed the decision of orthopaedic surgeons regarding the removal of implants after the treatment of fracture, and there is a growing consensus within the scientific community supporting the choice of not removing implants in children. This survey aimed to investigate the rationale behind the Italian orthopaedic community's decision regarding metal implant removal in paediatric patients. An electronic questionnaire was sent to all members of the Italian Paediatric Orthopaedic and Traumatology Society, Italian Orthopaedic and Traumatology Society, Italian Club of Osteosynthesis, and South Italy Society of Orthopaedic and Traumatology. The survey comprised 34 questions about hardware removal after the treatment of long bone fractures, epiphyseal growth plate injuries, slipped capital femoral epiphysis (SCFE), and flat foot. Of the 3500 orthopaedic surgeons who received the questionnaire, 5.5% responded. The leading indications for implant removal were the patient's intolerance, pain, ROM limitations, and hardware breakage. Removal of elastic nails for long bone fractures, cannulated screws for growth plate injuries, and SCFE and screws for arthroereisis for flat foot correction were analysed in detail. The consensus among Italian Orthopaedic Surgeons is to remove elastic nails and cannulated screws in cases of pain, intolerance, or breakage and to reduce further risks during patient growth. An increasing number of physicians, however, are endorsing and advocating the growing trend in the literature of not routinely removing the hardware.

Oral Administration of Plant formulations to Treat Bone Fractures in Domestic and Pet Animals in Nallamalla Forest Region of Eastern Ghats of India, Andhra Pradesh

Bone fractures in domestic and pet animals were treated with oral administration of Plant formulations in the villages of Nallamalla Forest regions of Eastern Ghats of India, Andhra Pradesh. A total of 37 plant species with therapeutical importance were identified and these species were belonging to 34 genera and 27 families. plant formulations were prepared from these plant species for treating bone fractures. Bone fractures are caused due to accidents and are accompanied by severe pain, swelling and injuries also. In this modern era more than 80% population still depends traditional medicine (Anonymous, 2002). Ethno medicinal / ethano veterinary use of plants is successful criteria in the pharmaceutical industry for searching new therapeutic agents (Cox and Balick, 1994). Various authors studied the ethno veterinary practices in different parts of Andhra Pradesh (Murty and Narasimha Rao, 2012; Lakshminarayana and Narasimha Rao, 2013 a; 2013b; 2013c; 2015a and 2015b). In continuation with our earlier work on external application of medicated poultice for treating bone fractures (Jayanth Babu et al., 2024), we are presenting the oral administration of plant formulations prepared from medicated herbs for treating the bone fractures in domestic animals of the villages in Nallamalla forest region of Andhra Pradesh.

Research on general treatment principles and methods of bone fracture in Mongolian medicine

The Mongolian nomadic nation has created bone healing, or fracture healing, which is suitable for the extreme weather and territory, unique living conditions, and physical characteristics while struggling to fight diseases during a long historical period. Gradually, this treatment method has gradually developed into a more comprehensive theoretical system throughout history and has unique names due to the thinking scope of the Mongols, their cognition development, and thus their use of it in their everyday lives and continuing to enrich their knowledge. Mongols have rich experience healing bone fractures and injuries from ancient times. They are usually used to perform bone setting and massage therapy. On the other hand, they have experience using herbal and mineral medicines to heal bone fractures and injuries. During their practice, the knowledge of herbal and mineral medicines used for bone fractures and injuries became expansive. After Buddhism reemerged in the 16th century, Mongolian doctors and knowledgeable people wrote many medical books in Tibetan. One of the major representatives was Jambaldorj, who wrote Mongolian materia medica, called “The beautiful wondrous eye ornament,” based on “Four medical tantras.” In treating bone fracture and injury in traditional medicine, firstly, the four treatment methods mentioned in “Four medical tantras” are the main principles and methods, which are wind, bile and phlegm theory, dietary recommendations, advice on behavior, prescribing medicine, and accessory therapy. We concluded that the names of herbal and mineral medicines used to practice bone setting are the same, even though they are mentioned in various sources.

External Application of Ethno-Veterinary Plants to Treat Bone Fractures in Domestic and Pet Animals of the Villages in Nallamalla Forest Region of Eastern Ghats of AP, India

Bone fractures are resulted due to accidents or violent acts caused by others either willfully or negligently. In some cases, it may be due to falling or due to pathological reasons. The present survey provides information on external application of Ethno veterinary plant medicine for treating bone fractures of domestic animals by the natives of AP region in Nallamalas of Eastern Ghats of India. The therapeutical properties of 65 plant species belonging to 59 genera and 42 families are being used for treating bone fractures. Information on botanical name, vernacular name, family, plant parts used, mode of drug preparation, administration and mode of preparation of poultice are provided. The Information gathered in this study would act as vital data for scientific community.