Linkage of microbiota and osteoporosis:A mini literature review

The gut microbiota(GM) has become a recent topic of interest in the role of many disease states. Assessing patients with osteoporosis(OP), there is a strong correlation between gut microbe dysregulation and decreased bone density. Gut dysbiosis may lead to inflammation, dysregulation of nutrient and calcium transport across the intestine into circulation and systemic inflammation.Investigation of microbial profile relative to normal gut microbiomes, assessment of inflammatory markers such as interleukin-1(IL-1), IL-6, and tumor necrosis factor-alpha. Therapies to normalize GM in patients with OP or prevent occurrence of OP to be investigated include: High fiber prebiotic diets to promote growth of normal gut bacteria and short chain fatty acid production, Probiotics to encourage growth of normal gut microbes, and antibiotic treatment followed by fecal matter transplant.

Systematic review of dynamization vs exchange nailing for delayed/non-union femoral fractures

AIM To analyze the literature on efficacy of dynamamization vs exchange nailing in treatment of delayed and nonunion femur fractures.METHODS Ultimately, 31 peer-reviewed articles with 644 exchanged nailing patients and 131 dynamization patients were identified and analyzed. The following key words were inputted in different combinations in order to search the field of publications in its entirety: "nonunion", "delayed union", "ununited", "femur fracture", "femoral fracture", "exchange nailing", "dynaiz(s)ation", "secondary nailing", "dynamic", "static", and "nail revision". The initial search yielded over 150 results, and was refined based on the inclusion criteria: Only studies reporting on humans, non-unions and delayed unions, and the usage of exchange nailing and/or dynamization as a secondary treatment after failed IM nailing. The resulting 66 articles were obtained through online journal access. The results were filtered further based on the exclusion criteria: No articles that failed to report overall union rates, differentiate between success rates of their reported techniques, or articles that analyzed less than 5 patients. RESULTS Exchange nailing lead to fracture union in 84.785% of patients compared to the 66.412% of dynamization with statistically comparable durations until union(5.193 ± 2.310 mo and 4.769 ± 1.986 mo respectively). Dynamically locking exchange nails resulted in an average union time of 5.208 ± 2.475 mo compared to 5.149 ± 2.366 mo(P = 0.8682) in statically locked exchange nails. The overall union rate of the two procedures, statically and dynamically locked exchange nailing yielded union rates of 84.259% and 82.381% respectively. Therefore, there was no significant difference between the different locking methods of exchange nailing for union rate or time to union at a significance value of P < 0.05. The analysis showed exchange nailing to be the more successful choice in the treatment of femoral non-unions in respect to its higher success rate(491/567 EN, 24/57 dynam, P < 0.0001). However, there was no significant difference between the success rates of the two procedures for delayed union fractures(25/27 EN, 45/55 dynam, P = 0.3299). Nevertheless, dynamization was more efficient in the treatment of delayed unions(at rates comparable to exchange nailing) than in the treatment of non-unions.CONCLUSION In conclusion, after examination of factors, dynamization is recommended treatment of delayed femur fractures, while exchange nailing is the treatment of choice for non-unions.

Managements of osteoporotic vertebral compression fractures:A narrative review

Osteoporotic vertebral compression fractures(OVCFs)are the most common fragility fracture and significantly influence the quality of life in the elderly.Currently,the literature lacks a comprehensive narrative review of the management of OVCFs.The purpose of this study is to review background information,diagnosis,and surgical and non-surgical management of the OVCFs.A comprehensive search of PubMed and Google Scholar for articles in the English language between 1980 and 2021 was performed.Combinations of the following terms were used:compression fractures,vertebral compression fractures,osteoporosis,osteoporotic compression fractures,vertebroplasty,kyphoplasty,bisphosphonates,calcitonin,and osteoporosis treatments.Additional articles were also included by examining the reference list of articles found in the search.OVCFs,especially those that occur over long periods,can be asymptomatic.Symptoms of acute OVCFs include pain localized to the mid-line spine,a loss in height,and decreased mobility.The primary treatment regimens are pain control,medication management,vertebral augmentation,and anterior or posterior decompression and reconstructions.Pain control can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs for mild pain or opioids and/or calcitonin for moderate to severe pain.Bisphosphonates and denosumab are the first-line treatments for osteoporosis.Vertebroplasty and kyphoplasty are reserved for patients who have not found symptomatic relief through conservative methods and are effective in achieving pain relief.Vertebroplasty is less technical and cheaper than kyphoplasty but could have more complications.Calcium and vitamin D supplementation can have a protective and therapeutic effect.Management of OVCFs must be combined with multiple approaches.Appropriate exercises and activity modification are important in fracture prevention.Medication with different mechanisms of action is a critical long-term causal treatment strategy.The minimally invasive surgical interventions such as vertebroplasty and kyphoplasty are reserved for patients not responsive to conservative therapy and are recognized as efficient stopgap treatment methods.Posterior decompression and fixation or Anterior decompression and reconstruction may be required if neurological deficits are present.The detailed pathogenesis and related targeted treatment options still need to be developed for better clinical outcomes.

Systematic review of periprosthetic tibia fracture after total knee arthroplasties

AIM: To investigate the known incidences, treatment options, and related outcomes of periprosthetic tibia fractures after total knee arthroplasty(TKA).METHODS: A literature search was done to identify studies that fit the inclusion criteria. The database search yielded 185 results, which were further reduced by the exclusion criteria to 13 papers, totaling 157 patients that met these criteria. Incidence rates of the different types of periprosthetic tibia fractures were determined and their treatments were subsequently analyzed based on the fracture's subclass, with patient outcomes being overall favorable.RESULTS: Of the 144 documented patients, 54(37.5%) had a subclass C fracture, which are frequently seen in revision arthroplasties or when using cement intraoperatively. The fractures of subclasses A and B occur postoperatively. There were 90 subclass A and B fractures with incidences of 18.75% and 43.75% respectively. When broken down by type, 62(55.36%) were type 1, 24(21.4%) were type 2, 24(21.4%) were type 3, and 2(1.8%) were type 4. Furthermore, from the studies that included origin of injury, the types were further classified as having non-traumatic or traumatic origins. Type 1 had 78%(40/51) non-traumatic origin and 22%(11/51) traumatic origin. Fifteen fractures were type 2, but 5 were falls and 1 through a motor vehicle accident, giving a trauma causation of 40%(6/15). Of the 24 type 3 fractures, 12 were falls and 2 vehicular accidents, leading to a trauma causation of 58%(14/24).CONCLUSION: Type 1 fractures were the most common. Subclass A was treated with locking plates, B required a revision TKA, and C was treated intraoperatively or nonoperatively.

Antibiotic bone cement's effect on infection rates in primary and revision total knee arthroplasties

AIM To compare infection rates in primary and revision total knee arthroplasty(TKA) procedures using antibiotic impregnated bone cement(AIBC) to those rates in procedures not using AIBC.METHODS A systematic review and meta-analysis was conducted in search for randomized controlled trials/studies(RCTs) pertaining to the field of antibiotic AIBC vs non-AIBC groups in both primary and revision TKA procedures. The primary literature search performed was to identify all RCTs that assessed AIBC in primary and revision TKA procedures. This search was done strictly through the Pub Med database using the article "filters" setting that identified and separated all RCTs from the overall search. The original search was "Primary/revision total knee arthroplasty using AIBC". Other key terms and phrases were included in the search as well. Eligible articles that were used in the "results" of this review met the following criteria:(1) Involved primary or revision TKA procedures(for any reason);(2) included TKA outcome infection rate information;(3) analyzed an AIBC group vs a non-AIBC control group;(4) were found through the RCT filter or hand search in Pub Med; and(5) published 1985-2017. Exclusion criteria was as follows:(1) Patients that were not undergoing primary or revision TKA procedures;(2) articles that did not separate total hip arthroplasity(THA) vs TKA results if both hip and knee revisions were evaluated;(3) papers that did not follow up on clinical outcomes of the procedure;(4) extrapolation of data was not possible given published results;(5) knee revisions not done on human patients;(6) studies that were strictly done on THAs;(7) articles that were not found through the RCT filter or through hand search in Pub Med;(8) articles that did not evaluate AIBC used in a prosthesis or a spacer during revision;(9) articles that did not compare an AIBC group vs a non-AIBC control group; and(10) articles that were published before 1985.RESULTS In total, 11 articles were deemed eligible for this analysis. Nine of the 11 studies dealt with primary TKA procedures comparing AIBC to non-AIBC treatment. The other two studies dealt with revision TKA procedures that compared such groups. From these papers, 4092 TKA procedures were found. 3903 of these were primary TKAs, while 189 were revision TKAs. Of the 3903 primary TKAs, 1979 of these used some form of AIBC while 1924 were part of a non-AIBC control group. Of the 189 revision TKAs, 96 of these used some form of AIBC while 93 were part of a non-AIBC control group. Average followup times of 47.2 mo and 62.5 mo were found in primary and revision groups respectively. A two-tailed Fisher's exact test was done to check if infection rates differed significantly between the groups. In the primary TKA group, a statistically significant difference between AIBC and non-AIBC groups was not found(AIBC infection rate = 23/1979, non-AIBC infection rate = 35/1924, P = 0.1132). In the revision TKA group, a statistically significant difference between the groups was found(AIBC infection rate = 0/96, non-AIBC infection rate = 7/93, P = 0.0062). No statistically significant differences existed in Knee Society Scores, Hospital for Special Surgery Scores, or Loosening Rates.CONCLUSION AIBC did not have a significant effect on primary TKA infection rates. AIBC did have a significant effect on revision TKA infection rates.