The Effects of Absorbable Materials in the Treatment for Non-Weight-Bearing Bone Fractures of Extremities

Objective:To study the effects of absorbable materials in non-weight-bearing bone fractures of extremities.Methods:After 66 patients with nonweight-bearing bone fractures of extremities were selected,absorbable materials were used in the observation group and metal materials were used in the control group.Results:After treatment,the bone healing in the observation group was significantly improved(P<0.05).Conclusion:the application of absorbable materials in non-weight-bearing bone fractures of extremities is effective.

Orthopedic implants and devices for bone fractures and defects:Past,present and perspective

Bone is a unique tissue that is capable of repairing itself after damage.However,there are certain instances of fractures and defects that require clinical intervention for proper alignment and healing.As with any implant,careful consideration of the material used to create the implants to treat these problems is needed.If the incorrect material is chosen,the implants themselves can lead to bone fractures or defects,or bone healing may not take place at all.All three classes of biomaterials-metals,ceramics,and polymers-have been used in the treatment of both bone fractures and bone defects,and each has its own unique benefits and limitations for its applications.Furthermore,composites of these different materials have also been created to try to take advantage of all the different benefits offered by each different material.This review highlights different materials that have been used for the development of internal fixators and bone graft substitutes to treat fracture and bone defects as well as their limitations and needed future research.

Systemic modulation of skeletal mineralization by magnesium implant promoting fracture healing: Radiological exploration enhanced with PCA-based machine learning in a rat femoral model

The clinical application of magnesium(Mg)and its alloys for bone fractures has been well supported by in vitro and in vivo trials.However,there were studies indicating negative effects of high dose Mg intake and sustained local release of Mg ions on bone metabolism or repair,which should not be ignored when developing Mg-based implants.Thus,it remains necessary to assess the biological effects of Mg implants in animal models relevant to clinical treatment modalities.The primary purpose of this study was to validate the beneficial effects of intramedullary Mg implants on the healing outcome of femoral fractures in a modified rat model.In addition,the mineralization parameters at multiple anatomical sites were evaluated,to investigate their association with healing outcome and potential clinical applications.Compared to the control group without Mg implantation,postoperative imaging at week 12 demonstrated better healing outcomes in the Mg group,with more stable unions in 3D analysis and high-mineralized bridging in 2D evaluation.The bone tissue mineral density(TMD)was higher in the Mg group at the non-operated femur and lumbar vertebra,while no differences between groups were identified regarding the bone tissue volume(TV),TMD and bone mineral content(BMC)in humerus.In the surgical femur,the Mg group presented higher TMD,but lower TV and BMC in the distal metaphyseal region,as well as reduced BMC at the osteotomy site.Principal component analysis(PCA)-based machine learning revealed that by selecting clinically relevant parameters,radiological markers could be constructed for differentiation of healing outcomes,with better performance than 2D scoring.The study provides insights and preclinical evidence for the rational investigation of bioactive materials,the identification of potential adverse effects,and the promotion of diagnostic capabilities for fracture healing.

A segmental defect adaptation of the mouse closed femur fracture model for the analysis of severely impaired bone healing

Objective: To better characterize nonunion endochondral bone healing and evaluate novel therapeutic approaches for critical size defect healing in clinically challenging bone repair, a segmental defect model of bone injury was adapted from the threepoint bending closed fracture technique in the murine femur.Methods: The mouse femur was surgically stabilized with an intramedullary threaded rod with plastic spacers and the defect adjusted to different sizes. Healing of the different defects was analyzed by radiology and histology to 8 weeks postsurgery. To determine whether this model was effective for evaluating the benefits of molecular therapy, BMP-2 was applied to the defect and healing then examined.Results: Intramedullary spacers were effective in maintaining the defect. Callus bone formation was initiated but was arrested at defect sizes of 2.5 mm and above, with no more progress in callus bone development evident to 8 weeks healing. Cartilage development in a critical size defect attenuated very early in healing without bone development, in contrast to the closed femur fracture healing, where callus cartilage was replaced by bone. BMP-2 therapy promoted osteogenesis of the resident cells of the defect, but there was no further callus development to indicate that healing to pre-surgery bone structure was successful.Conclusions: This segmental defect adaptation of the closed femur fracture model of murine bone repair severely impairs callus development and bone healing, reflecting a challenging bone injury. It is adjustable and can be compared to the closed fracture model to ascertain healing deficiencies and the efficacy of therapeutic approaches.

Efficacy of fascia iliaca compartment nerve block as part of multimodal analgesia after surgery for femoral bone fracture

BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture.METHODS: An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group(n=20) and a control group(n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the f irst 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale(VAS), total analgesic consumption, and the time for the f irst analgesic request.RESULTS: VAS pain scores were reduced within the f irst 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values(IQR) 0.00(0.00) vs.18.00(30.00), P=0.001; at 6 hours 0.00(0.00) vs. 34.00(20.75), P=0.000; at 24 hours 12.50(10.00) vs. 31.50(20.75), P=0.004; and at 12 hours(17.80±12.45) vs.(29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the fi rst analgesic request was signifi cantly prolonged(417.50 vs. 139.25 minutes, P=0.000).CONCLUSIONS: A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the fi rst analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.

Length unstable femoral fractures:A misnomer?

BACKGROUND Flexible intramedullary nailing(FIMN)is relatively contraindicated for pediatric length unstable femoral fractures.AIM To evaluate FIMN treatment outcomes for pediatric diaphyseal length unstable femoral fractures in patients aged 5 to 13 years.METHODS This retrospective study includes pediatric patients(age range 5-13 years)who received operative treatment for a diaphyseal femoral fracture at a single institution between 2013 and 2019.Length unstable femur fractures treated with FIMN were compared to treatment with other fixation methods[locked intramedullary nailing(IMN),submuscular plating(SMP),and external fixation]and to length stable fractures treated with FIMN.Exclusion criteria included patients who had an underlying predisposition for fractures(e.g.,pathologic fractures or osteogenesis imperfecta),polytrauma necessitating intensive care unit care and/or extensive management of other injuries,incomplete records,or no follow-up visits.Patients who had a length stable femoral fracture treated with modalities other than FIMN were excluded as well.RESULTS Ninety-five fractures from ninety-two patients were included in the study and consists of three groups.These three groups are length unstable fractures treated with FIMN(n=21),length stable fractures treated with FIMN(n=45),and length unstable fractures treated with either locked IMN,SMP,or external fixator(n=29).P values<0.05 were considered statistically significant.Patient characteristic differences that were statistically significant between the groups,length unstable with FIMN and length unstable with locked IMN,SMP,or external fixator,were average age(7.4 years vs 9.3 years,respectively),estimated blood loss(29.2 mL vs 98 mL,respectively)and body mass(27.8 kg vs 35.1 kg,respectively).All other patient characteristic differences were statistically insignificant.Regarding complications,length unstable with FIMN had 9 total complications while length unstable with locked IMN,SMP,or external fixator had 10.Grouping these complications into minor or major,length unstable with locked IMN,SMP,or external fixator had 6 major complication while length unstable with FIMN had 0 major complications.This difference in major complications was statistically significant.Lastly,when comparing patient characteristics between the groups,length unstable with FIMN and length stable with FIMN,all characteristics were statistically similar except time to weight bearing(39 d vs 29 d respectively).When analyzing complication differences between these two groups(9 total complications,0 major vs 20 total complications,4 major),the complication rates were considered statistically similar.CONCLUSION FIMN is effective for length unstable fractures,having a low rate of complications.FIMN is a suitable option for length stable and length unstable femur fractures alike.

Waders(Scolopacidae)surviving despite malaligned leg fractures in the wild:kinematics of bipedal locomotion

Background: Bone fracture frequencies and survival rates are essential parameters in skeleton evolution, but information on the functional consequences of naturally healed fractures is scarce. No leg bone fracture healing in the wild has been reported so far from long-legged Charadriiformes(waders), which depend on bipedal locomotion for feeding.Methods: We documented a healed but malaligned tarsometatarsus fracture in a wild Willet(Tringa [Catoptrophorus]semipalmata), and a malaligned tibiotarsus fracture in a Curlew(Numenius arquata) skeleton from a museum collection. Functional consequences of the malalignments were evaluated by kinematic analyses of videos(Willet) and in silico 3D modeling(Curlew).Results: The Willet's left tarsometatarsus exhibited an angular malalignment of 70°, resulting in a limping gait that was less pronounced at high than at low walking speed. The bird seemed unable to club the toes of the left foot together, apparently a secondary effect of the deformity. The Curlew's tibiotarsus showed an angular and an axial malalignment, causing the foot to rotate outwards when the intertarsal joint was flexed. Despite the severe effects of their injuries, the birds had survived at least long enough for the fractures to heal completely.Conclusions: Somewhat unexpectedly, leg fractures are not necessarily fatal in long-legged waders, even if deformities occur in the healing process. Bipedal locomotion on vegetated grounds must have been impeded due to the bone malalignments in both analyzed cases. The birds probably alleviated the impact of their handicaps by shifting a larger proportion of their activities to vegetation-free habitats.

Usage of buttress plate internal fixation associated with autografting of fibula and iliac bone for the treatment of distal femoral C_3 type fracture

To assess the effect of using buttress plate associated with antografting of fibula and iliac bone for the treatment of distal femoral C3 type fracture.Methods Seventeen cases of distal femoral C3 type fracture using buttress plate associated with antografting of fibula and iliac bone were analyzed retrospectively.Results All cases were followed up for an average of 24 months（8～55 months）.The average time of octets bridge forming were 4 months（3～5 months） while the average time for bone union were 8 months （6～14 months）.According to Shelbourne rating system,result of all 18 cases were excellent and no malunion,infection were found.Conclusion Buttress plate associated with antografting of fibula and iliac bone is an effective alternative for the treatment of distal femoral C3 type fracture.It can provide more stable fixation to the bone and earlier functional exercises can be achieved.5 refs,3 figs,1 tab.

鼻内镜下同期行鼻骨骨折复位加鼻中隔创伤处理

鼻骨骨折是耳鼻咽喉科最为常见的外伤之一。随着鼻内镜及螺旋CT三维重建的应用,鼻骨骨折的诊断已经不局限于外鼻畸形,鼻中隔骨折、鼻中隔软骨脱位、鼻中隔血肿等原因所致的鼻中隔严重偏曲常合并存在,这就使得同期改善鼻腔的通气引流成为必须。我科于2001年7月-2010年11月，对25例鼻骨骨折同时伴有鼻中隔偏曲患者行鼻骨骨折复位并同期处理鼻中隔创伤，效果满意，报道如下。

形状记忆合金环抱器在骨折中的应用(英文)

Objective:To evaluate the effect of encircled fixer of shape memory alloy on bone fracture. Methods:A total of twenty patients with eighteen males and two females was studied. There were three patients with fractares in the upper one third of thighbone, five with fractures in the middle part of thighbone, six with humeral fractures, three with collarbone fractures,one with ulna fracture and two with thighbone fractures as complication of artificial hipbone arthroplasty. After exposure and fixation of fracture ends, prepared encircled fixer was inserted into 0～4℃ normal reline(NS) to lower its temperature, then pulled out with a clamp. Encircled fixer was put on the tersile side of the fractured bone(center pointed to fracture line), restored and stabilized after raising temperature in 40℃ NS. Results: Encircled fixers of shape memory alloy were used to treat twenty patients with bone fracture.Clinical concrescence was obtained in 1.5 to 3 months after operation,and the joint gained its normal function without complication. Conclusion:Encircled fixer of shape memory alloy has features as exerting vertical pressure continoulsy, little stress shield effect and convenient manipulation, especially adapt to stem fracture after artificial arthroplasty.

Experimental Study and Preliminary Clinical Application of Miniinvasive Percutaneous Internal Screw Fixation for Scaphoid Fracture under the Guidance of a 3D-printed Guide Plate

This study explored the feasibility of employing computer-aided design(CAD)and 3 dimensional(3D)-printed personalized guide plate for the mini-invasive percutaneous internal screw fixation of fractured scaphoid.The study consisted of two parts:(1)experimentation on upper limbs from corpses and(2)preliminary clinical application.Corpse experiments involved upper limbs of 6 adult corpses.The specimens of upper limbs were subjected to plain CT scan.Then the CT data were input into computer to conduct 3D reconstruction of wrist region.The direction and depth of the guide wire and screw were designed on the basis of the principle that screw should lie at the center of scaphoid and the long axis of the screw should be aligned with that of the scaphoid.The carpal bone model and the guide plate were designed and 3D-printed.By using the guide plates,the guide wire was placed and the cannulated compression screw was inserted.The wrist region was examined by X-ray and CT to observe the location of the screw in the scaphoid.The scaphoid was longitudinally excised to grossly observe the location and evaluate the result of screw insertion.For clinical application,the guide plate was employed in 4 patients with fresh scaphoid fracture using the aforementioned operative technique.Our results showed that,in the 6 corpse limbs,the guide plate well fitted the skin surface and the guide wire and screw were accurately put in place in one session.X-ray examination and gross observation confirmed that the screw was satisfactorily positioned and the result met the requirements of the preoperative design.For 4 patients,the guide wire and screw were all precisely inserted into place in one session.The operation time and X-ray exposure times were apparently reduced.The imaging examination exhibited satisfactory results and the hand functioned well.It was concluded that the operative guide plate used for the mini­invasive percutaneous internal screw fixation of fractured scaphoid not only can assist in accurate placement of screw but also shorten operation time and reduce insertion and X-ray exposure times,thereby reducing the radiation injury and damage to the substance and the blood circulation of carpal bone.Its use can also improve the learning curve of surgeons.

Surgical Management of Traumatic Facial Paralysis:A Case Review Study

Objective To evaluate efficacy of surgical treatment in traumatic facial paralysis.Methods:Thirty-three cases were reviewed,including temporal bone fracture and iatrogenic facial nerve injury.All the patients were treated with various surgical methods according to their pathogeny.Results The mean percentage facial function improvement (House-Brackmann GradeⅠ-Ⅱ) was 86% in temporal bone fracture and function was improved after proper operation to iatrogenic facial nerve injury.Conclusions Patients with traumatic facial paralysis receive proved outcomes itreaed with proper surgical methods according to their particular condition of nerve injury.

Potential bioactive coating system for high-performance absorbable magnesium bone implants

Magnesium alloys are considered the most suitable absorbable metals for bone fracture fixation implants.The main challenge in absorbable magnesium alloys is their high corrosion/degradation rate that needs to be controlled.Various coatings have been applied to magnesium alloys to slow down their corrosion rates to match their corrosion rate to the regeneration rate of the bone fracture.In this review,a bioactive coating is proposed to slow down the corrosion rate of magnesium alloys and accelerate the bone fracture healing process.The main aim of the bioactive coatings is to enhance the direct attachment of living tissues and thereby facilitate osteoconduction.Hydroxyapatite,collagen type I,recombinant human bone morphogenetic proteins 2,simvastatin,zoledronate,and strontium are six bioactive agents that show high potential for developing a bioactive coating system for high-performance absorbable magnesium bone implants.In addition to coating,the substrate itself can be made bioactive by alloying magnesium with calcium,zinc,copper,and manganese that were found to promote bone regeneration.

Bone Fracture Reduction Surgery-aimed Bone Connection Robotic Hand

Bone connection with robot is an important topic in the research of robot assisted fracture reduction surgery.With the method to achieve bone-robot connection in current robots,requirements on reliability and low trauma can not be satisfied at the same time.In this paper,the design,manufacturing,and experiments of a novel Bone Connection Robotic Hand(BCRH)with variable stiffness capability are carried out through the bionics research on human hand and the principle of particle jamming.BCRH’s variable stiffness characteristic is a special connection between“hard connection”and“soft connection”,which is different from the existing researches.It maximizes the reliability of bone-robot connection while minimizes trauma,meets the axial load requirement in clinical practice,and effectively shortens the operating time to less than 40 s(for mode 1)or 2 min(for mode 2).Meanwhile,a theoretical analysis of bone-robot connection failure based on particle jamming is carried out to provide references for the research in this paper and other related studies.

Biodegradable metals for bone fracture repair in animal models: a systematic review

Biodegradable metals hold promises for bone fracture repair.Their clinical translation requires pre-clinical evaluations including animal studies,which demonstrate the safety and performance of such materials prior to clinical trials.This evidence-based study investigates and analyzes the performance of bone fractures repair as well as degr adation properties of biodegradable metals in animal models.Data were carefully collected after identification of population,interventions,com-parisons,outcomes and study design,as well as inclusion criteria combining biodegradable metals and animal study.Twelve publications on pure Mg,Mg alloys and Zn alloys were finally included and reviewed after extraction from a collected database of 2122 publications.Compared to controls of traditional non-degradable metals or resorbable polymers,biodegradable metals showed mixed or contradictory outcomes of fracture repair and degradation in animal models.Although quantita-tive meta-analysis cannot be conducted because of the data heterogeneity,this systematic review revealed that the quality of evidence for biodegradable metals to repair bone fractures in animal models is'very low'.Recommendations to standardize the animal studies of biodegradable metals were proposed.Evidence based biomaterials research could help to both identify reliable scientific evidence and ensure future clinical translation of biodegradable metals for bone fracture repair.

Virtual preoperative planning and 3D printing are valuable for the management of complex orthopaedic trauma

Purpose:The technology of 3D printing(3DP)exists for quite some time,but it is still not utilized to its full potential in the field of orthopaedics and traumatology,such as underestimating its worth in virtual preoperative planning(VPP)and designing various models,templates,and jigs.It can be a significant tool in the reduction of surgical morbidity and better surgical outcome avoiding various associated complications.Methods:An observational study was done including 91 cases of complex trauma presented in our institution requiring operative fixation.Virtual preoperative planning and 3DP were used in the management of these fractures.Surgeons managing these cases were given a set of questionnaire and responses were recorded and assessed as a quantitative data.Results:In all the 91 cases,where VPP and 3DP were used,the surgeons were satisfied with the outcome which they got intraoperatively and postoperatively.Surgical time was reduced,with a better outcome.Three dimensional models of complex fracture were helpful in understanding the anatomy and sketching out the plans for optimum reduction and fixation.The average score of the questionnaire was 4.5,out of a maximum of 6,suggesting a positive role of 3DP in orthopaedics.Conclusion:3DP is useful in complex trauma management by accurate reduction and placement of implants,reduction of surgical time and with a better outcome.Although there is an initial learning curve to understand and execute the VPP and 3DP,these become easier with practice and experience.

Transient cortical blindness in fat embolism syndrome—a diagnostic enigma

Fat embolism syndrome(FES)is a serious life-threatening manifestation of the fat embolism phenomenon characterized by Bergman’s triad of dyspnea,petechiae and mental confusion.While fat embolization into systemic circulation is common,FES occurs in a meagre 0.05%e3%of patients having isolated long bone fractures.Though visual symptoms are commonly attributed to fat embolism retinopathy and is a later occurrence,it may not always be the case.Cortical blindness has been seldom reported in association with FES,and less so as a presenting complaint.Furthermore,no previous literature has described the same in context of an isolated tibia fracture.We report a 20-year-old gentleman with an isolated right tibia shaft fracture who developed sudden onset diminution of vision in both eyes less than 24 h following trauma with no other complaints.Lack of any remarkable ophthalmoscopic findings or other symptoms left us with a diagnostic conundrum.He later went on to develop altered mentation,hypoxia and generalized tonic-clonic seizures with subsequent MRI revealing multiple cerebral fat emboli also involving both occipital lobes.Supportive measures were instituted and his general condition as well as vision gradually improved following which he underwent plate fixation of the fracture under spinal anaesthesia.The perioperative period was uneventful and he was discharged following staple removal.At one month of follow-up,the patient had no residual visual field defects or neurological deficits.Though FES is rare among isolated tibia fractures,this clinical catastrophe may strike in any unsuspected setting thereby warranting a high index of suspicion to ensure early diagnosis and improved patient outcomes.

Research status of biodegradable metals designed for oral and maxillofacial applications:A review

The oral and maxillofacial regions have complex anatomical structures and different tissue types,which have vital health and aesthetic functions.Biodegradable metals(BMs)is a promising bioactive materials to treat oral and maxillofacial diseases.This review summarizes the research status and future research directions of BMs for oral and maxillofacial applications.Mg-based BMs and Zn-based BMs for bone fracture fixation systems,and guided bone regeneration(GBR)membranes,are discussed in detail.Zn-based BMs with a moderate degradation rate and superior mechanical properties for GBR membranes show great potential for clinical translation.Fe-based BMs have a relatively low degradation rate and insoluble degradation products,which greatly limit their application and clinical translation.Furthermore,we proposed potential future research directions for BMs in the oral and maxillofacial regions,including 3D printed BM bone scaffolds,surface modification for BMs GBR membranes,and BMs containing hydrogels for cartilage regeneration,soft tissue regeneration,and nerve regeneration.Taken together,the progress made in the development of BMs in oral and maxillofacial regions has laid a foundation for further clinical translation.

Treatment of distal clavicle fracture with distal radius volar locking compression plate

Objective: To observe the early clinical outcomes of the internal fixation with distal radius volar locking compression plate (LCP) in treatment of distal clavicle fracture.Methods: Six patients with unilateral distal clavicle fractures, identified as type Ⅱ according to Neer classification system, including 4 males and 2 females, were treated with open reduction and internal fixation using a distal radius volar LCP. Bone union was evaluated by routine X-ray radiography, and shoulder joint function were assessed by Constant score system.Results: All fractures achieved bone union at 6 to 8 weeks postoperatively, and Constant scores ranged from 95 to 100 at the postoperative 10 to 12 weeks.Conclusion: Fixation of distal clavicle fracture with distal radius volar LCP demonstrates excellent effects of bone union with rarely early complications, thus providing a new technique to treat distal clavicle fracture.

教学与医疗兼顾 临床与科研双丰——记本刊副总编辑姜保国教授

姜保国,《中国骨与关节杂志》副总编辑。医学博士、教授、博士生导师。