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Sen RK, Tripathy SK. Stabilization of Osteoporotic Pelvis and Acetabular Fractures. Indian J Orthop 2025; 59:300-310. [PMID: 40201909 PMCID: PMC11972994 DOI: 10.1007/s43465-024-01329-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Accepted: 12/20/2024] [Indexed: 04/10/2025]
Abstract
Background The surgical management of osteoporotic pelviacetabular fractures poses distinct challenges due to poor screw purchase, severe comminution of fractures, and the inability to perform prolonged surgeries in patients with significant comorbidities. These fractures necessitate tailored modifications in surgical approaches, implant selection, and techniques based on the patient's overall health, fracture complexity, and bone quality. Methods A comprehensive literature search was conducted using PubMed and Google Scholar databases to identify relevant articles on the management of osteoporotic pelvi-acetabular fractures. Results Implant selection plays a pivotal role in addressing the fragility of osteoporotic fractures. Specialized implants, such as locking plates with multidirectional screw holes, along with augmentation using polymethylmethacrylate (PMMA) or bone substitutes, enhance screw fixation in compromised bone. Sacral fractures, which are commonly involved, are often managed with percutaneous fixation using long cancellous screws. Minimally invasive long-screw fixation techniques are particularly effective for less displaced acetabular fractures. For displaced acetabular fractures with articular impaction, fracture elevation and stabilization using bone grafts or bone graft substitutes are crucial. When feasible, less invasive surgical techniques are preferred to minimize operative trauma. In some cases, the fixation of acetabular fractures in osteoporotic bone may fail over time, necessitating conversion to total hip arthroplasty (THA). For fractures with severe comminution, primary THA combined with column reduction and fixation is frequently a safer and more effective approach. Early postoperative mobilization is critical to reduce the risk of complications such as deep vein thrombosis and pressure ulcers. Conclusion The stabilization of osteoporotic pelvic and acetabular fractures requires a multifaceted approach incorporating advanced surgical techniques, specialized implants, and augmentation methods. Early mobilization and individualized postoperative management are essential for optimizing patient outcomes and minimizing complications.
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Affiliation(s)
| | - Sujit Kumar Tripathy
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, 751019 India
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2
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Radcliffe G, Trouiller JB, Battaglia S, Larrainzar-Garijo R. Cost-effectiveness and budget impact of cement augmentation for the fixation of unstable trochanteric fractures from a European perspective: Cost-effectiveness and budget impact of cement augmentation in Europe. Injury 2024; 55:111999. [PMID: 39550804 DOI: 10.1016/j.injury.2024.111999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 10/14/2024] [Accepted: 10/26/2024] [Indexed: 11/19/2024]
Abstract
INTRODUCTION Hip fractures have a high patient burden and mortality rate, particularly following revision surgery. Cement augmentation of cephalomedullary nails has been shown to lower the risk of cut-out, aiming to reduce the need and expense of revision surgeries. The aim of this study was to assess the economic impact of cement augmentation for the fixation of trochanteric hip fractures in fragile, elderly patients, across a range of European countries (UK, Spain, Italy, Germany, and France), from both a provider (hospital) and a payer perspective. METHOD The budget impact (hospital perspective) and cost-effectiveness (payer perspective) analyses were informed by clinical outcomes from a meta-analysis published in 2021, additional published literature, registries, and clinical experts. Economic inputs included length of stay and operating time for the hospital perspective, revision surgery, outpatient, and rehabilitation days costs for the payer perspective. Outcomes included the breakeven cost below which using cement augmentation would begin to generate cost savings for the hospital, and potential cost savings for the payer with incremental costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were conducted to assess model uncertainty. RESULTS From a hospital perspective, the breakeven cost below which the hospital would start saving money using cement augmentation was £491 (UK), €1490 (Spain), €1075 (Italy), €852 (Germany), and €834 (France) per patient, driven by reduced length of hospital stay. From a payer perspective, cost savings were £1675 (UK), €2202 (Spain), €993 (Italy), €944 (Germany), and €892 (France) per patient, mainly driven by fewer revision surgeries. Payer cost savings, coupled with incremental QALY gain of 0.004 across all regions, led to cement augmentation being the dominant strategy. These budget impact and cost-effectiveness results were rigorously tested in sensitivity analyses and were found to be robust. CONCLUSION These models support the wider adoption of cement augmentation to reduce the healthcare system costs associated with length of stay and revision surgery. These results provide useful information to providers, payers, and policymakers to ultimately influence choice surrounding the 'gold-standard' treatment of an unstable trochanteric fracture following low energy trauma.
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Affiliation(s)
| | | | | | - Ricardo Larrainzar-Garijo
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, Medical School, Universidad Complutense, Madrid, Spain.
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Dei Rossi G, Vergani LM, Buccino F. A Novel Triad of Bio-Inspired Design, Digital Fabrication, and Bio-Derived Materials for Personalised Bone Repair. MATERIALS (BASEL, SWITZERLAND) 2024; 17:5305. [PMID: 39517582 PMCID: PMC11547793 DOI: 10.3390/ma17215305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 10/22/2024] [Accepted: 10/28/2024] [Indexed: 11/16/2024]
Abstract
The emerging paradigm of personalised bone repair embodies a transformative triad comprising bio-inspired design, digital fabrication, and the exploration of innovative materials. The increasing average age of the population, alongside the rising incidence of fractures associated with age-related conditions such as osteoporosis, necessitates the development of customised, efficient, and minimally invasive treatment modalities as alternatives to conventional methods (e.g., autografts, allografts, Ilizarov distraction, and bone fixators) typically employed to promote bone regeneration. A promising innovative technique involves the use of cellularised scaffolds incorporating mesenchymal stem cells (MSCs). The selection of materials-ranging from metals and ceramics to synthetic or natural bio-derived polymers-combined with a design inspired by natural sources (including bone, corals, algae, shells, silk, and plants) facilitates the replication of geometries, architectures, porosities, biodegradation capabilities, and mechanical properties conducive to physiological bone regeneration. To mimic internal structures and geometries for construct customisation, scaffolds can be designed using Computer-aided Design (CAD) and fabricated via 3D-printing techniques. This approach not only enables precise control over external shapes and internal architectures but also accommodates the use of diverse materials that improve biological performance and provide economic advantages. Finally, advanced numerical models are employed to simulate, analyse, and optimise the complex processes involved in personalised bone regeneration, with computational predictions validated against experimental data and in vivo studies to ascertain the model's ability to predict the recovery of bone shape and function.
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Affiliation(s)
- Greta Dei Rossi
- Department of Mechanical Engineering (DMEC), Politecnico di Milano, Via La Masa 1, 20156 Milano, Italy; (G.D.R.); (F.B.)
| | - Laura Maria Vergani
- Department of Mechanical Engineering (DMEC), Politecnico di Milano, Via La Masa 1, 20156 Milano, Italy; (G.D.R.); (F.B.)
- IRCCS Orthopedic Institute Galeazzi, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Federica Buccino
- Department of Mechanical Engineering (DMEC), Politecnico di Milano, Via La Masa 1, 20156 Milano, Italy; (G.D.R.); (F.B.)
- IRCCS Orthopedic Institute Galeazzi, Via Cristina Belgioioso 173, 20157 Milan, Italy
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Battistini B, Greggi C, Visconti VV, Albanese M, Messina A, De Filippis P, Gasperini B, Falvino A, Piscitelli P, Palombi L, Tarantino U. Metals accumulation affects bone and muscle in osteoporotic patients: A pilot study. ENVIRONMENTAL RESEARCH 2024; 250:118514. [PMID: 38373545 DOI: 10.1016/j.envres.2024.118514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 02/21/2024]
Abstract
Osteoporosis is the most common bone disease, characterized by decreased bone mineral density (BMD) and often associated to decreased muscle mass and function. Metal exposure plays a role in the pathophysiology of osteoporosis and affects also muscle quality. The aim of this study was to assess the association between metal levels in bone and muscle samples and the degeneration of these tissues. A total of 58 subjects (30 male and 28 female) was enrolled and classified in osteoporotic (OP, n = 8), osteopenic (Ope, n = 30) and healthy (CTR, n = 20) subjects, according to BMD measures. Femoral head bone samples and vastus lateralis muscle samples were collected during hip arthroplasty surgeries. Inductively Coupled Plasma Mass Spectrometry (ICP-MS) analysis showed increased levels of Al, Cd and Pb in OP and Ope bone tissue compared to CTR subjects (p = 0.04, p = 0.005 and p = 0.01, respectively). Whereas, increased levels of Co, Cd and Pb were measured in OP and Ope muscle tissues, compared to CTRs (p < 0.001, p = 0.02 and p = 0.01, respectively). In addition, Al, Cd and Pb levels in bone and Cd and Co levels in muscle were negatively correlated with BMD. A negative association among Co, Cd, Cr and Hg levels and muscle fibers diameter was also observed in muscle tissues. This study assessed that metal exposure can affects bone and muscle tissue quality and may contribute to the onset and progression of musculoskeletal diseases such as osteoporosis. Therefore, it is important to implement metal exposure assessment and their impact on disease development, in order to manage and prevent metal accumulation effects on bone and muscle quality.
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Affiliation(s)
- Beatrice Battistini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Chiara Greggi
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
| | - Virginia Veronica Visconti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Marco Albanese
- Department of Statistics, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Alessandra Messina
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Patrizia De Filippis
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Beatrice Gasperini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Angela Falvino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Prisco Piscitelli
- Department of Experimental Medicine, University of Salento, Lecce, Italy
| | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy; University "Our Lady of Good Counsel", Tirana, Albania
| | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy; University "Our Lady of Good Counsel", Tirana, Albania; Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Viale Oxford 81, 00133, Rome, Italy
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Pankratz C, Dehner C, Gebhard F, Schuetze K. [Augmentation techniques for the treatment of osteoporosis-associated fractures of the extremities]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:253-262. [PMID: 38351179 DOI: 10.1007/s00113-024-01414-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 03/26/2024]
Abstract
The current demographic development is leading to an increasing number of cases of osteoporosis-related fractures. Affected individuals are typically part of a vulnerable, predominantly geriatric patient group with limited physical resources. Additionally, the pathophysiological characteristics of osteoporotic bones with reduced bone quality and quantity, pose a significant challenge to the osteosynthesis techniques used. Achieving rapid postoperative mobilization and stable weight-bearing osteosynthesis to prevent postoperative medical complications are the main goals of the surgical management. In recent years augmentation techniques have gained in importance in the treatment of osteoporosis-related fractures by significantly enhancing the stability of osteosyntheses and reducing mechanical complication rates. The main options available are polymethyl methacrylate (PMMA) augmentation and various bioresorbable bone substitute materials with different properties. Implant augmentations can be applied at various locations in the extremity bones and standardized procedures are now available, such as for the proximal humerus and femur. When used correctly, low complication rates and promising clinical outcomes are observed. This article aims to provide an overview of available techniques and applications based on the current literature. Guidelines and substantial scientific evidence are still limited.
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Affiliation(s)
- Carlos Pankratz
- Klinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
| | - Christoph Dehner
- Klinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - Florian Gebhard
- Klinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - Konrad Schuetze
- Klinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
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Patel V, Deshpande SV, Goel S, Suneja A, Jadawala VH. Intramedullary Kirschner Wire Fixation for Metatarsal Fractures: A Comprehensive Review of Treatment Outcomes. Cureus 2024; 16:e59368. [PMID: 38817526 PMCID: PMC11137647 DOI: 10.7759/cureus.59368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Metatarsal fractures pose significant challenges in orthopedic practice, necessitating effective treatment methods to ensure optimal patient outcomes. This comprehensive review focuses on intramedullary Kirschner wire fixation as a promising intervention for metatarsal fractures. Beginning with an overview of metatarsal fractures and the imperative for effective treatments, the review delves into intramedullary fixation's definition, historical background, advantages, and disadvantages. Indications for its use in metatarsal fractures are discussed, providing a foundation for understanding its application. The surgical technique section outlines critical aspects, including patient selection criteria and preoperative planning. Before presenting a detailed step-by-step procedure for intramedullary Kirschner wire fixation, anesthesia considerations are explored. Emphasizing precision, fluoroscopic guidance, and meticulous postoperative care, this section provides insights for surgeons and healthcare practitioners. Considerations for rehabilitation follow, addressing postoperative care, expected recovery timelines, and physical therapy recommendations. Early mobilization, weight-bearing guidelines, and a structured rehabilitation program play pivotal roles in recovery. In the conclusion, key findings are summarized, highlighting the efficacy of intramedullary Kirschner wire fixation, its advantages, and recommendations for clinical practice. Additionally, areas for future research are identified, guiding further exploration and refinement of this surgical approach. This review is valuable for clinicians, researchers, and healthcare practitioners involved in metatarsal fracture management, contributing to the evolution of treatment strategies and improving patient care.
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Affiliation(s)
- Vatsal Patel
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sanjay V Deshpande
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sachin Goel
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anmol Suneja
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vivek H Jadawala
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Wilson BJ, Owston HE, Iqbal N, Giannoudis PV, McGonagle D, Pandit H, Philipose Pampadykandathil L, Jones E, Ganguly P. In Vitro Osteogenesis Study of Shell Nacre Cement with Older and Young Donor Bone Marrow Mesenchymal Stem/Stromal Cells. Bioengineering (Basel) 2024; 11:143. [PMID: 38391629 PMCID: PMC10886325 DOI: 10.3390/bioengineering11020143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
Bone void-filling cements are one of the preferred materials for managing irregular bone voids, particularly in the geriatric population who undergo many orthopedic surgeries. However, bone marrow mesenchymal stem/stromal cells (BM-MSCs) of older-age donors often exhibit reduced osteogenic capacity. Hence, it is crucial to evaluate candidate bone substitute materials with BM-MSCs from the geriatric population to determine the true osteogenic potential, thus simulating the clinical situation. With this concept, we investigated the osteogenic potential of shell nacre cement (SNC), a bone void-filling cement based on shell nacre powder and ladder-structured siloxane methacrylate, using older donor BM-MSCs (age > 55 years) and young donor BM-MSCs (age < 30 years). Direct and indirect cytotoxicity studies conducted with human BM-MSCs confirmed the non-cytotoxic nature of SNC. The standard colony-forming unit-fibroblast (CFU-F) assay and population doubling (PD) time assays revealed a significant reduction in the proliferation potential (p < 0.0001, p < 0.05) in older donor BM-MSCs compared to young donor BM-MSCs. Correspondingly, older donor BM-MSCs contained higher proportions of senescent, β-galactosidase (SA-β gal)-positive cells (nearly 2-fold, p < 0.001). In contrast, the proliferation capacity of older donor BM-MSCs, measured as the area density of CellTrackerTM green positive cells, was similar to that of young donor BM-MSCs following a 7-day culture on SNC. Furthermore, after 14 days of osteoinduction on SNC, scanning electron microscopy with energy-dispersive spectroscopy (SEM-EDS) showed that the amount of calcium and phosphorus deposited by young and older donor BM-MSCs on SNC was comparable. A similar trend was observed in the expression of the osteogenesis-related genes BMP2, RUNX2, ALP, COL1A1, OMD and SPARC. Overall, the results of this study indicated that SNC would be a promising candidate for managing bone voids in all age groups.
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Affiliation(s)
- Bridget Jeyatha Wilson
- Division of Dental Products, Department of Biomaterial Science and Technology, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram 695 012, India
| | - Heather Elizabeth Owston
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK (D.M.); (H.P.)
| | - Neelam Iqbal
- School of Chemical and Process Engineering, University of Leeds, Leeds LS2 9JT, UK
| | - Peter V. Giannoudis
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK (D.M.); (H.P.)
- Leeds Orthopaedic & Trauma Sciences, Leeds General Infirmary, University of Leeds, Leeds LS2 9JT, UK
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds LS7 4SA, UK
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK (D.M.); (H.P.)
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds LS7 4SA, UK
| | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK (D.M.); (H.P.)
- Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds LS7 4SA, UK
| | - Lizymol Philipose Pampadykandathil
- Division of Dental Products, Department of Biomaterial Science and Technology, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram 695 012, India
| | - Elena Jones
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK (D.M.); (H.P.)
| | - Payal Ganguly
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK (D.M.); (H.P.)
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Xu Z, Zhang K, Cheng K, Sun G, Zhang Y, Jia J. A meta-analysis comparing the effects of cemented and uncemented prostheses on wound infection and pain in patients with femoral neck fractures. Int Wound J 2023; 20:4122-4129. [PMID: 37555547 PMCID: PMC10681411 DOI: 10.1111/iwj.14306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 08/10/2023] Open
Abstract
To providing evidence-based recommendations for surgery in patients with femoral neck fractures, a meta-analysis was conducted to comprehensively evaluate the effects of cemented and uncemented prostheses on postoperative surgical site wound infection and pain in these patients. Relevant studies on the use of cemented prostheses in femoral neck fractures were retrieved from PubMed, EMBASE, Cochrane Library, Ovid, CNKI, and Wanfang databases from the time of their establishment until March 2023. Two authors independently screened and extracted data from the included and excluded literature according to predetermined criteria. Review Manager 5.4 software was used to perform meta-analyses on the collected data. A total of 27 articles comprising 34 210 patients (24 646 cases in the cemented group and 9564 cases in the uncemented group) were included in the final analysis. The results of the meta-analysis showed that, compared with the uncemented group, cemented prostheses significantly reduced the incidence of surgical site wound infections (odds ratio [OR]: 0.75, 95% confidence interval [CI]: 0.64-0.88, p < 0.001) and relieved surgical site wound pain (standardised mean difference: -0.76, 95% CI: -1.12-0.40, p < 0.001), but did not reduce the incidence of pressure ulcers after surgery (OR: 0.50, 95% CI: 0.20-1.26, p = 0.140). Therefore, existing evidence suggests that the use of cemented prostheses in femoral neck fracture surgery can significantly reduce the incidence of surgical site wound infections and relieve surgical site wound pain, which is worthy of clinical recommendation.
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Affiliation(s)
- Ze Xu
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Ke Zhang
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Kai Cheng
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Guangwei Sun
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Yaning Zhang
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Jian Jia
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
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9
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Bonanni R, Abbondante L, Cariati I, Gasbarra E, Tarantino U. Metallosis after Hip Arthroplasty Damages Skeletal Muscle: A Case Report. Geriatrics (Basel) 2023; 8:92. [PMID: 37736892 PMCID: PMC10514854 DOI: 10.3390/geriatrics8050092] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
Good musculoskeletal quality dramatically influences the outcome of an arthroplasty operation in geriatric patients, as well as is a key element for optimal osseointegration. In this context, metallosis is a complication associated with the type of prosthesis used, as implants with a chromium-cobalt interface are known to alter the bone microarchitecture and reduce the ratio of muscle to fat, resulting in lipid accumulation. Therefore, the aim of our study was to investigate possible muscle changes by histological, morphometric, and immunohistochemical analyses in a patient undergoing hip replacement revision with elevated blood and urinary concentrations of chromium and cobalt. Interestingly, the muscle tissue showed significant structural changes and a massive infiltration of adipose tissue between muscle fibers in association with an altered expression pattern of important biomarkers of musculoskeletal health and oxidative stress, such as myostatin and NADPH Oxidase 4. Overall, our results confirm the very serious impact of metallosis on musculoskeletal health, suggesting the need for further studies to adopt a diagnostic approach to identify the cause of metallosis early and eliminate it as part of the prosthesis revision surgery.
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Affiliation(s)
- Roberto Bonanni
- Department of Biomedicine and Prevention, “Tor Vergata” University of Rome, Via Montpellier 1, 00133 Rome, Italy;
| | - Lorenzo Abbondante
- Department of Orthopaedics and Traumatology, “Policlinico Tor Vergata” Foundation, Viale Oxford 81, 00133 Rome, Italy; (L.A.); (E.G.); (U.T.)
| | - Ida Cariati
- Department of Systems Medicine, “Tor Vergata” University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Elena Gasbarra
- Department of Orthopaedics and Traumatology, “Policlinico Tor Vergata” Foundation, Viale Oxford 81, 00133 Rome, Italy; (L.A.); (E.G.); (U.T.)
| | - Umberto Tarantino
- Department of Orthopaedics and Traumatology, “Policlinico Tor Vergata” Foundation, Viale Oxford 81, 00133 Rome, Italy; (L.A.); (E.G.); (U.T.)
- Department of Clinical Sciences and Translational Medicine, “Tor Vergata” University of Rome, Via Montpellier 1, 00133 Rome, Italy
- Centre of Space Bio-Medicine, “Tor Vergata” University of Rome, Via Montpellier 1, 00133 Rome, Italy
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Wilson BJ, Philipose Pampadykandathil L. Novel Bone Void Filling Cement Compositions Based on Shell Nacre and Siloxane Methacrylate Resin: Development and Characterization. Bioengineering (Basel) 2023; 10:752. [PMID: 37508779 PMCID: PMC10376770 DOI: 10.3390/bioengineering10070752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/09/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
Shell nacre from Pinctada species has been extensively researched for managing bone defects. However, there is a gap in the research regarding using shell nacre powder as a cement with improved biological and physicochemical properties. To address this, bone void filling cement was formulated by incorporating shell nacre powder and an organically modified ceramic resin (ormocer). The shell nacre powder was specifically processed from the shells of Pinctada fucata and analysed using thermogravimetric analysis (TGA), X-ray diffraction spectroscopy, Fourier transform infrared (FTIR), and Raman spectroscopy, confirming the presence of organic constituents and inorganic aragonite. Trace element analysis confirmed the eligibility of shell nacre powder for biomedical applications. Next, the ormocer SNLSM2 was synthesized through a modified sol-gel method. FTIR, Raman, TGA, and transmission electron microscopy studies revealed the presence of a ladder-structured siloxane backbone and methacrylate side chain. To develop chemical curable composite shell nacre cement (SNC), different amounts of shell nacre (24%, 48%, and 72%) were added to the SNLSM2 resin, and the impact on the physicochemical properties of the cement was studied. Among the compositions, SNC 72 exhibited significantly lower linear polymerization shrinkage (0.4%) and higher compressive (>100 MPa) and flexural strength (>35 MPa). SNC 72 was radiopaque, and the exotherm generated during the cement curing was minimal. Cytotoxicity studies with L929 cells revealed the non-cytotoxic nature of the cement. Overall, the findings of this study prove that the shell nacre cement is a promising candidate for managing bone voids.
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Affiliation(s)
- Bridget Jeyatha Wilson
- Division of Dental Products, Department of Biomaterial Science and Technology, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram 695 012, India
| | - Lizymol Philipose Pampadykandathil
- Division of Dental Products, Department of Biomaterial Science and Technology, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram 695 012, India
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