AIM To evaluate the effects of sodium alendronate on bone repair in fractures created in appendicular bones. METHODS Wistar rats(n = 36) were allocated into three distinct groups: group C(control), group B1(received 1...AIM To evaluate the effects of sodium alendronate on bone repair in fractures created in appendicular bones. METHODS Wistar rats(n = 36) were allocated into three distinct groups: group C(control), group B1(received 1 mg/kg of alendronate), and group B2(received 3 mg/kg of alendronate). The rats underwent femoral transversal linear fracture surgery using stable internal fixation with a 2.0 mm plate and screw system. Each animal randomly received intraperitoneal applications of sodium alendronate at a dose corresponding to group B1 or B2 three times a week, while the control group received a 0.9% saline solution. Drug administration was performed until euthanasia at 45 d. The femurs were removed and each surgical piece was sent for radiographic, tomographic and microtomographic analysis. Data were submitted to descriptive and inferential statistical analysis(95% confidence interval).RESULTS Quantitative evaluations of bone neoformation did not show differences among the groups in the radiographic(P = 0.341), microtomographic(P = 0.581) and tomographic evaluations(P = 0.171). In the qualitative microtomographic analysis, a smaller distance was observed between the internal bone trabeculae in the groups that used alendronate(P = 0.05). On the other hand, group B2 had a higher amount of bone trabeculae per unit length when compared to the other groups(P = 0.04).CONCLUSION It is likely that the use of alendronate did not have a direct influence on the amount of bone neoformation, however it did influence the bone quality in a dosedependent manner, ultimately affecting the distance and quantity of the trabeculae.展开更多
BACKGROUND Haematogenous osteomyelitis is an extremely rare disease occurring in adults,especially in developed countries.It is clearly a systemic infection,because bacteraemia spreads over proximal and distal long bo...BACKGROUND Haematogenous osteomyelitis is an extremely rare disease occurring in adults,especially in developed countries.It is clearly a systemic infection,because bacteraemia spreads over proximal and distal long bones or paravertebral plexuses,resulting in acute or chronic bone infection and destruction.CASE SUMMARY A 46-year-old Caucasian male was complaining of a left thigh pain.It is known from the anamnesis that the patient developed severe pneumonia three months ago before the onset of these symptoms.The patient was diagnosed with haematogenous osteomyelitis,which developed a turbulent course and required complex combination therapy.The primary pathogen is thought to be Anaerococcus prevotii,which caused pneumonia before the onset of signs of osteomyelitis.Unfortunately,due to the complexity of identifying anaerobes and contributing nosocomial infections,the primary pathogen was not extracted immediately.After the manifestation of this disease,pathological fractures occurred in both femurs,as well as purulent processes in the lungs and molars accompanied.The patient received broad-spectrum antibiotic therapy and countless amounts of orthopaedic and reconstructive surgeries,but no positive effect was observed.The patient underwent osteosynthesis using an Ilizarov’s external fixation apparatus,re-fixations,external AO,debridements,intramedullary osteosynthesis with a silver-coated intramedullary nail,abscessotomies.The right femur healed completely after the pathological fracture and osteomyelitis did not recur.Left femur could not be saved due to non-healing,knee contracture and bone destruction.After almost three years of struggle,it was decided to amputate the left limb,after which the signs of osteomyelitis no longer appeared.CONCLUSION To sum it all up,complicated or chronic osteomyelitis requires surgery to remove the infected tissue and bone.Osteomyelitis surgery prevents the infection from spreading further or getting even worse up to such condition that amputation is the only option left.展开更多
Bone is sensitive to mechanical stimulation and plays a loading-bearing role in the human body.However,regulation of bone biomechanical properties in chronic hypergravity environments is still unclear.In this study,ma...Bone is sensitive to mechanical stimulation and plays a loading-bearing role in the human body.However,regulation of bone biomechanical properties in chronic hypergravity environments is still unclear.In this study,male Wistar rats exposed to chronic hypergravity environments(4g,8g,10g,and 20g)for 4 weeks were set as the hypergravity groups,and rats exposed to the normal gravity as the control group.Morphology parameters and bone remodeling factors were obtained by means of micro-CT,Western blot,and q-PCR.Mechanical properties of femurs were measured utilizing three points bending test and creep test and were fitted into a viscoelastic-viscoplastic constitutive equation.The results indicate osteoporosis occurred in femurs of hypergravity groups.Accordingly,the protein and gene expressions of bone remodeling factors(OPG,RANKL,runx2)in hypergravity groups were significantly different from that in the control group,demonstrating that bone formation level increased and bone resorption level decreased.Meanwhile,mechanical properties of femurs in hypergravity groups showed that Young's modulus of femurs in the 20g group was significantly higher than that in the control group.The viscoelastic-viscoplastic properties of bone tissue were changed in hypergravity environments.Among them,the 8g group was closest to the control group in morphology and mechanical properties.To sum up,the biomechanical response regulation of rat femur under 4-20g chronic hypergravity environments was presented.Hypergravity environments could lead to osteoporosis.The balance between bone formation and bone resorption would be disrupted in hypergravity groups due to bone adaptation.20g environment has a significant effect on elastic modulus on femurs.Due to the difference in biomechanical response of femurs,the viscoelastic-viscoplastic characteristics of femurs have a nonlinear relationship with hypergravity values.Bone tissue was least affected by 8g hypergravity in morphology and mechanical properties.展开更多
With the aging population,intertrochanteric femur fracture in the elderly has become one of the most serious public health issues and a hot topic of research in trauma orthopedics.Due to the limitations of internal fi...With the aging population,intertrochanteric femur fracture in the elderly has become one of the most serious public health issues and a hot topic of research in trauma orthopedics.Due to the limitations of internal fixation techniques and the insufficient mechanical design of nails,the occurrence of complications delays patient recovery after surgical treatment.Design of a proximal femur bionic nail(PFBN)based on Zhang’s N triangle theory provides triangular supporting fixation,which dramatically decreases the occurrence of complications and has been widely used for clinical treatment of unstable intertrochanteric femur fracture worldwide.In this work,we developed an equivalent biomechanical model to analyze improvement in bone remodeling of unstable intertrochanteric femur fracture through PFBN use.The results show that compared with proximal femoral nail antirotation(PFNA)and InterTan,PFBN can dramatically decrease the maximum strain in the proximal femur.Based on Frost’s mechanostat theory,the local mechanical environment in the proximal femur can be regulated into the medium overload region by using a PFBN,which may render the proximal femur in a state of physiological overload,favoring post-operative recovery of intertrochanteric femur fracture in the elderly.This work shows that PFBN may constitute a panacea for unstable intertrochanteric femur fracture and provides insights into improving methods of internal fixation.展开更多
In this editorial,I present my comments on the article by Solarino et al.Conversion hip arthroplasty,which is an optional salvage procedure performed following unsuccessful fixation of intertrochanteric femur fracture...In this editorial,I present my comments on the article by Solarino et al.Conversion hip arthroplasty,which is an optional salvage procedure performed following unsuccessful fixation of intertrochanteric femur fractures in elderly pati-ents,entails more complex processes and higher rates of operative complications than primary arthroplasty.Hence,it is important to consider the appropriateness of the primary treatment choice,as well as the adequacy of nailing fixation for intertrochanteric fractures.This article briefly analyzes the possible factors contributing to the nailing failure of intertrochanteric fractures and attempts to find corresponding countermeasures to prevent fixation failures.It also analyzes the choice of treatment between nailing fixation and primary arthroplasty for intertrochanteric fractures.展开更多
Background: Despite the conservative treatment of tibio-femoral osteoarthritis through realignment osteotomies, the rate of total knee replacements following an osteotomy is increasing. The aim of this study was to id...Background: Despite the conservative treatment of tibio-femoral osteoarthritis through realignment osteotomies, the rate of total knee replacements following an osteotomy is increasing. The aim of this study was to identify the factors associated with the progression of knee osteoarthritis after a medial closing-wedge distal femoral osteotomy. Methods: Hospital-based observational study on 20 patients who underwent a medial closing-wedge distal femoral osteotomy evaluating the progression of osteoarthritis using the Kellgren and Laurence classification. The Wilcoxon test was used to compare the variation in the progressive stage of the Kellgren and Laurence classification of knee osteoarthritis preoperatively and at the final follow up. Univariate analysis made it possible to determine the factors associated with progression. The final significance threshold for statistical tests was set at 5% (p Results: Overall, the mean follow-up of 46 months ± 6.6 months, with a mean age of 43 years (range: 27 - 69 years) and a female predominance (M: F = 3/7). The progression of tibiofemoral osteoarthritis following a medial closing-wedge distal femoral osteotomy is associated with valgus or varum malalignment been a moderate valgus (OR 6.2 [1.5 - 42.7] at 95% CI;p-value = 0.02), a correction of the mechanical deviation angle with a valgus alignment (OR 2.7 [0.9 - 8.3] at 95% CI), and loss of correction (OR 3.8 [1.3 - 11.6] at 95% CI;p -value) for the lateral compartment while varus alignment (OR 1.7 [0.9 - 8.3] 95% CI, p-value = 0.05) and with rupture of the lateral cortex (OR 2.8 [1.7 - 11.5] 95% CI, p-value = 0.02) were those of the medial compartment. Conclusion: Distal femur closing wedge osteotomy does not definitively interrupt the progression of valgus knee osteoarthritis. The factors associated with the progression of this pathology are modifiable. Taking them into account when performing this surgical technique could improve the osteotomy survival curve.展开更多
Introduction: Traumatic hip dislocation associated with femur fracture is a rare and complex injury that occurs in the context of multiple trauma. Public road accidents represent more than 64% of the circumstances (au...Introduction: Traumatic hip dislocation associated with femur fracture is a rare and complex injury that occurs in the context of multiple trauma. Public road accidents represent more than 64% of the circumstances (automobiles 46% and two-wheelers 18%). Objective: Report a rare case of injury association and the speed of treatment (less than 6 hours). Clinical case: 26-year-old patient, victim of a road traffic accident. Admitted to the emergency room one hour after the trauma in a context of severe pain and absolute functional impotence of both pelvic limbs. Clinical examination reveals closed trauma to both pelvic limbs, with deformation of the right thigh, a vicious attitude of the contralateral lower limb in adduction, shortening and medial rotation. Conclusion: This is a rare injury association, which benefited from treatment within less than 6 hours.展开更多
Introduction: Proximal femur fractures are traumatic injuries involving the neck and trochanteric region of the femur. The aim was to identify risk factors for death following proximal femur fractures in elderly patie...Introduction: Proximal femur fractures are traumatic injuries involving the neck and trochanteric region of the femur. The aim was to identify risk factors for death following proximal femur fractures in elderly patients. Patients and methods: This was a prospective, observational, longitudinal study conducted over an 18-month period in the Orthopedics-Traumatology Department of Aristide Le Dantec Hospital in Dakar. We evaluated a total of 93 patients aged at least 60 years with a proximal femur fracture whose date of onset was less than 3 weeks. The identification of risk factors for death took into account socio-demographic, clinical and therapeutic parameters. Results: The number of patients who died was 19 (20.43%). There was no significant difference in mortality according to age, gender or residence. There was no association between admission time and mortality. The association between the number of comorbidities and mortality was significant. The association between mortality and ASA score and type of treatment was highly significant. Operating time had no influence on mortality. Type of anesthesia, on the other hand, did influence mortality. Conclusion: Mortality due to proximal femur fractures in the elderly remains high. In our practice, this mortality was related to the presence of comorbidity, impaired cognitive function, ASA score, type of treatment and type of anesthesia.展开更多
Coronal shear fractures of the femoral neck (CSFF) are the most challenging to treat among proximal femur fractures, directly affecting the life expectancy of patients with osteoporosis. However, an adequate osteosynt...Coronal shear fractures of the femoral neck (CSFF) are the most challenging to treat among proximal femur fractures, directly affecting the life expectancy of patients with osteoporosis. However, an adequate osteosynthesis method has not been elucidated yet. This study investigated the displacement direction of the femoral head fragment and its effect on the bone using finite element method. A finite element model for CSFF was developed from CT image data of a patient with osteoporosis using Mechanical Finder (ver. 11). Subsequently, finite element analyses were performed on six osteosynthesis models under maximum load applied during walking. The compressive stresses, tensile stresses, and compressive strains of each model were examined. The results suggested that the compressive and tensile stress distributions were concentrated on the anterior side of the femoral neck. Compressive strain distribution in the femoral head and neck was concentrated in four areas: at the tip of the blade or lag screw, the anteroinferior side of the blade or lag screw near the fracture site, and the upper right and lower left near the junction of the blade or lag screw and nail. Thus, the distribution of both these stresses revealed that the femoral head fragment was prone to anterior and inferior displacement. Distribution of compressive strains revealed the direction of the stress exerted by the osteosynthetic implant on the bone. The same results were observed in all osteosynthetic implants;thus, the findings could lay the foundation for developing methods for placing osteosynthetic implants less prone to displacement and the osteosynthetic implants themselves. In particular, the study provides insight into the optimal treatment of CSFF.展开更多
Adult patients with developmental dysplasia of the hip develop secondary osteoarthritis and eventually end up with total hip arthroplasty(THA) at younger age. Because of altered anatomy of dysplastic hips, THA in thes...Adult patients with developmental dysplasia of the hip develop secondary osteoarthritis and eventually end up with total hip arthroplasty(THA) at younger age. Because of altered anatomy of dysplastic hips, THA in these patients represents technically demanding procedure. Distorted anatomy of the acetabulum and proximal femur together with conjoined leg length discrepancy present major challenges during performing THA in patients with developmental dysplasia of the hip. In addition, most patients are at younger age, therefore, soft tissue balance is of great importance(especially the need to preserve the continuity of abductors) to maximise postoperative functional result. In this paper we present a variety of surgical techniques availablefor THA in dysplastic hips, their advantages and disadvantages. For acetabular reconstruction following techniques are described: Standard metal augments(prefabricated), Custom made acetabular augments(3D printing), Roof reconstruction with vascularized fibula, Roof reconstruction with pedicled iliac graft, Roof reconstruction with autologous bone graft, Roof reconstruction with homologous bone graft, Roof reconstruction with auto/homologous spongious bone, Reinforcement ring with the hook in combination with autologous graft augmentation, Cranial positioning of the acetabulum, Medial protrusion technique(cotyloplasty) with chisel, Medial protrusion technique(cotyloplasty) with reaming, Cotyloplasty without spongioplasty. For femoral reconstruction following techniques were described: Distraction with external fixator, Femoral shortening through a modified lateral approach, Transtrochanteric osteotomies, Paavilainen osteotomy, Lesser trochanter osteotomy, Double-chevron osteotomy, Subtrochanteric osteotomies, Diaphyseal osteotomies, Distal femoral osteotomies. At the end we present author's treatment method of choice: for acetabulum we perform cotyloplasty leaving only paper-thin medial wall, which we break during acetabular cup impacting. For femoral side first we peel of all rotators and posterior part of gluteus medius and vastus lateralis from greater trochanter on the very thin flake of bone. This method allows us to adequately shorten proximal femoral stump, with possibility of additional resection of proximal femur. Furthermore, several advantages and disadvantages of this procedure are also discussed.展开更多
To study the effect of titanium alloy cage on the treatment of the ischemic necrosis of femoral head in dog, the model of the ischemic necrosis of femoral head was made with the liquid nitrogen in 15 hybrid adult dogs...To study the effect of titanium alloy cage on the treatment of the ischemic necrosis of femoral head in dog, the model of the ischemic necrosis of femoral head was made with the liquid nitrogen in 15 hybrid adult dogs. The titanium alloy cage made of a hollow cylinder was driven into the subchondral bone of necrotic femoral head via central channel. The dogs were divided into 3 groups, each group was sacrificed 3, 6, 12 weeks after the operation respectively. No collapse of femoral head was observed after the operation. The position of the cages was good on radiograph. Microscopically, the cancellous bone of necrotic femoral head rebuilt gradually and grew into cage. After 12 weeks of creeping substitution, the cancellous bone filled up the hollow cavity and holes of the cages. It is concluded that the titanium alloy cage can provide structural support for the subchondral bone and prevent collapse and can be used for the treatment of the ischemic necrosis of femoral head.展开更多
AIM To review and report functional outcomes, complications,and survivorship associated with total knee arthroplasty(TKA) in the treatment of post-traumatic arthritis(PTA).METHODS We conducted a systematic review acco...AIM To review and report functional outcomes, complications,and survivorship associated with total knee arthroplasty(TKA) in the treatment of post-traumatic arthritis(PTA).METHODS We conducted a systematic review according to the PRISMA guidelines. We searched PubMed, Cochrane Library, and SCOPUS in December 2015 for Englishlanguage clinical research studies, both prospective and retrospective, examining the use of TKA for the treatment of PTA. All relevant articles were accessed in full. The manual search included references of retrieved articles.We extracted data on patients' demographics and clinical outcomes, including preoperative diagnosis and pre- and post-operative functional scores. We summarized the data and reported the results in tables and text.RESULTS Sixteen studies, four prospective and ten retrospective,examined patients who underwent TKA for PTA due to fractures of the proximal tibia, patella, and/or distal femur. Eleven studies utilized the Knee Society Scores criteria to assess functional outcomes. All studies utilizing these criteria reported an improvement in functional and knee scores of patients following TKA. Further, studies reported an increased range of motion(ROM) and reduction of pain following surgery. The most commonly reported complications with TKA included infection, stiffness, wound complications, intraoperative rupture of tendons, and osteolysis/polyethylene wear. The overwhelming majority of these complications occurred within the first two years following surgery. Six studies examined the survivorship of TKA with subsequent revision for any reason as an endpoint. Compared to patients with osteoarthritis, patients with PTA required more revisions, the majority for polyethylene wear.CONCLUSION Although associated with higher complication rates,TKA is an effective treatment for PTA, as it improves ROM, pain and functional outcomes.展开更多
Total femoral replacement(TFR) is a salvage arthroplasty procedure used as an alternative to lower limb amputation. Since its initial description in the mid-20^(th) century, this procedure has been used in a variety o...Total femoral replacement(TFR) is a salvage arthroplasty procedure used as an alternative to lower limb amputation. Since its initial description in the mid-20^(th) century, this procedure has been used in a variety of oncologic and non-oncologic indications. The most compelling advantage of TFR is the achievement of immediate fixation which permits early mobilization. It is anticipated that TFR will be increasingly performed as the rate of revision arthroplasty rises worldwide. The existing literature is mainly composed of a rather heterogeneous mix of retrospective case series and a wide assortment of case reports. Numerous TFR prostheses are currently available and the surgeon must understand the unique implications of each implant design. Long-term functional outcomes are dependent on adherence to proper technique and an appropriate physical therapy program for postoperative rehabilitation. Revision TFR is mainly performed for periprosthetic infection and the severe femoral bone loss associated with aseptic revisions. Depending on the likelihood of attaining infection clearance, it may sometimes be advisable to proceed directly to hip disarticulation without attempting salvage of the TFR. Other reported complications of TFR include hip joint instability, limb length discrepancy, device failure, component loosening, patellar maltracking and delayed wound healing. Further research is needed to better characterize the long-term functional outcomes and complications associated with this complex procedure.展开更多
Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The ...Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics. Surgeries aimed at improving the biology, such as vascularized fibula grafting, have good success rates but require high levels of expertise and substantial resources. A popular surgical treatment aimed at improving the biomechanics-valgus intertrochanteric osteotomyoptimizes conditions for fracture healing by converting shear forces across the fracture site into compressive forces. Numerous variations of this surgical procedure have been developed and successfully applied in clinical practice. As a result, the proximal femoral orientation for obtaining a good functional outcome has evolved over the years, and the present concept of altering the proximal femoral anatomy as little as possible has arisen. This technical objective supports attaining union as well as a good functional outcome, since excessive valgus can lead to increased joint reaction forces. This review summarizes the historical and current literature on valgus intertrochanteric osteotomy treatment of nonunion neck of femur, with a focus on factors predictive of good functional outcome and potential pitfalls to be avoided as well as controversies surrounding this procedure.展开更多
AIM To report the clinical and radiographic results of titanium elastic nail(TEN) in diaphyseal femoral fractures of children below age of six years.METHODS A retrospective analysis of 27 diaphyseal femoral fractures ...AIM To report the clinical and radiographic results of titanium elastic nail(TEN) in diaphyseal femoral fractures of children below age of six years.METHODS A retrospective analysis of 27 diaphyseal femoral fractures in children younger than six years treated with TEN between 2005 and 2015 was conducted. Patients were immobilized in a cast for 5 wk and the nails were removed from 6 to 12 wk after surgery. Twenty-four cases were clinically and radiographically re-evaluated using the Flynn's scoring criteria, focusing on: Limb length discrepancy, rotational deformity, angulation, hip and knee range of motion(ROM), functional status, complications, and parent's satisfaction.RESULTS Sixteen males and eight females with a mean age of 3.2 years at the time of treatment were re-evaluated at an average follow-up of 58.9 mo. No cases of delayed union were observed. The mean limb lengthening was 0.3 cm. Four cases experienced limb lengthening greater than 1 cm and always minor than 2 cm. Twelve point five percent of the cases showed an angulation < 10°. Complete functional recovery(hip and knee ROM, ability to run and jump on the operated limb) occurred in 95.7% of cases. Complications included two cases of superficial infection of the TEN entry point, one case of refracture following a new trauma, and one TEN mobilization. According to the Flynn's scoring criteria, excellent results were obtained in 79.2% of patients and satisfactory results in the remaining 20.8%, with an average parent's satisfaction level of 9.1/10.CONCLUSION TEN is as a safe, mini-invasive and surgeon-friendly technique and, considering specific inclusion criteria, it represents a useful and efficacy option for the treatment of diaphyseal femoral fractures even in patients younger than six years of age.展开更多
The number of revision total hip arthroplasties is expected to rise as the indications for arthroplasty will expand due to the aging population. The prevalence of extensive proximal femoral bone loss is expected to in...The number of revision total hip arthroplasties is expected to rise as the indications for arthroplasty will expand due to the aging population. The prevalence of extensive proximal femoral bone loss is expected to increase subsequently. The etiology of bone loss from the proximal femur after total hip arthroplasty is multifactorial. Stress shielding, massive osteolysis, extensive loosening and history of multiple surgeries consist the most common etiologies. Reconstruction of extensive bone loss of the proximal femur during a revision hip arthroplasty is a major challenge for even the most experienced orthopaedic surgeon. The amount of femoral bone loss and the bone quality of the remaining metaphyseal and diaphyseal bone dictate the selection of appropriate reconstructive option. These include the use of impaction allografting, distal press-fit fixation, allograft-prosthesis composites and tumor megaprostheses. This review article is a concise review of the current literature and provides an algorithmic approachfor reconstruction of different types of proximal femoral bone defects.展开更多
In order to observe the feature of age-related marrow conversion and maturation of epiphyseal cartilage and analyze the distribution of red and yellow marrow in the proximal femur at STIR MR imaging, STIR and T1 weigh...In order to observe the feature of age-related marrow conversion and maturation of epiphyseal cartilage and analyze the distribution of red and yellow marrow in the proximal femur at STIR MR imaging, STIR and T1 weighted MR imaging of the proximal femur in 52 subjects, aged 4 months to 25 years old, were retrospectively analyzed for the distribution and appearance of red and yellow marrow. The subjects with no known bone marrow abnormalities were divided into 6 age groups. The signal intensity of the marrow in the proximal epiphysis, proximal metaphysis, proximal diaphysis, distal diaphysis and greater trochanter was compared with the signal intensity and homogeneity of surrounding muscle and fat and graded by two observers. The results showed that the conversion of hematopoietic marrow in the proximal femur followed a well-defined sequence, occurring first in the proximal epiphysis, followed by the distal diaphysis, and then greater trochanter and metaphysis. STIR in combination with T1-weighted imaging could display clearly the origin of ossification center and the course of conversion from red to yellow marrow in proximal epiphysis and greater trochanter. STIR imaging showed that the marrow conversion in proximal metaphysic began below epiphyseal plate and intertrochanter. The site of red yellow was distributed in weight-bearing axis by 20 years of age. The marrow conversion of diaphysis was from distal end to proximal end, and the consequence of conversion was that distal diaphysis contained yellow marrow but proximal diaphysis partly red marrow connected with the red marrow of metaphysic. The epiphyseal cartilage had different characters of signal-intensity with age in STIR sequence. The distribution of red marrow in STIR imaging was more close to that of anatomy than T1-weighted imaging. It was concluded that STIR could dynamically display the feature of morrow conversion and the development of epiphyseal cartilage and accurately reveal the age-related distribution of red and yellow marrow on STIR imaging in the proximal femur.展开更多
Purpose: The purpose of the present controlled cross-sectional study was to investigate proximal femur and whole-body bone mineral density(BMD), as well as bone turnover profile, in lifelong trained elderly male footb...Purpose: The purpose of the present controlled cross-sectional study was to investigate proximal femur and whole-body bone mineral density(BMD), as well as bone turnover profile, in lifelong trained elderly male football players and young elite football players compared with untrained age-matched men.Methods: One hundred and forty healthy, non-smoking men participated in the study, including lifelong trained football players(FTE, n = 35)aged 65—80 years, elite football players(FTY, n = 35) aged 18—30 years, as well as untrained age-matched elderly(UE, n = 35) and young(UY,n = 35) men. All participants underwent a regional dual-energy X-ray Absorptiometry(DXA) scan of the proximal femur and a whole-body DXA scan to determine BMD. From a resting blood sample, the bone turnover markers(BTMs) osteocalcin, carboxy-terminal type-1 collagen crosslinks(CTX-1), procollagen type-1 amino-terminal propeptide(P1NP), and sclerostin were measured.Results: FTE had 7.3%—12.9% higher(p < 0.05) BMD of the femoral neck, wards, shaft, and total proximal femur in both legs compared to UE,and 9.3%—9.7% higher(p < 0.05) BMD in femoral trochanter in both legs compared to UY. FTY had 24.3%—37.4% higher(p < 0.001) BMD in all femoral regions and total proximal femur in both legs compared to UY. The whole-body DXA scan confirmed these results, with FTE showing similar whole-body BMD and 7.9% higher(p < 0.05) leg BMD compared to UY, and with FTY having 9.6% higher(p < 0.001) wholebody BMD and 18.2% higher(p < 0.001) leg BMD compared to UY. The plasma concentration of osteocalcin, CTX-1, and P1NP were 29%,53%, and 52% higher(p < 0.01), respectively, in FTY compared to UY.Conclusion: BMD of the proximal femur and whole-body BMD are markedly higher in lifelong trained male football players aged 65—80 years and young elite football players aged 18—30 years compared to age-matched untrained men. Elderly football players even show higher BMD in femoral trochanter and leg BMD than untrained young despite an age difference of 47 years.展开更多
Fractures of femur proximal extremity(FFPE)are the most common fragility fractures requiring hospitalization,with a high risk of mortality,low independence in the activities of daily living and severe consequences on ...Fractures of femur proximal extremity(FFPE)are the most common fragility fractures requiring hospitalization,with a high risk of mortality,low independence in the activities of daily living and severe consequences on healthrelated quality of life.Timing for surgery has a key role in the management of elderly patients with FFPE as recommended by the Australian and New Zealand guidelines and the National Institute for Health and Care Excellence guidelines.Early surgery(within 48 h from hospital admission)allows significant benefits in terms of lower rates of postoperative complications and risk of death and can provide better functional outcomes.Therefore,time for surgery could be considered as a comorbidity marker.The choice between conservative or surgical approach surprisingly seems to be still not strongly supported by available literature,but it seems that both 30 d and 1 year risk of mortality is higher with the conservative treatment rather than with surgery.In light of these considerations,the optimization of FFPE management care is mandatory to improve functional outcomes and to reduce sanitary costs.Albeit it is widely accepted that transdisciplinary approach to patients suffering from FFPE is mandatory to optimize both short-term and long-term outcomes,the feasibility of a comprehensive approach in clinical practice is still a challenge.In particular,the large variability of figures involved could be considered both a resource and an additional disadvantage taking into account the difficulty to coordinate multidisciplinary approach covering care in all settings.Therefore,the aim of the present article was to summarize current evidence supporting transdisciplinary management of patients with FFPE,highlighting the benefits,feasibility and limitations of this approach.展开更多
Objective: To assess the curative effect of the stage II femoral head necrosis treated by arthroscopy assisted lesion clearance, bone graft and titanium rod support. Methods: All the patients (including 58 patients 74...Objective: To assess the curative effect of the stage II femoral head necrosis treated by arthroscopy assisted lesion clearance, bone graft and titanium rod support. Methods: All the patients (including 58 patients 74 hips) were diagnosed as stage II femoral head necrosis according to the ARCO staging system during 2003-2013. In these patients, 15 hips were stage IIA, 34 hips were stage IIB and 25 hips were stage IIC. Located by C-arm and assisted by arthroscopy, minimally-invasive percutaneous pulp core decompression and lesion clearance within the femoral head were accurately performed, and then, the OAM composite of autologous bone marrow was implanted and the femoral head was supported using the titanium rod. Follow-up including the pain score, the Harris hip score and X-ray observation for disease progression were achieved at 6, 12, 24 and 36 months postoperatively, Kaplan-Meier survival curve was used for the survival analysis. Result: The VAS score and the Harris score after operation were better THRAn THRAt of before the surgery, the difference had statistical significance (p Conclusion: Arthroscopy assisted lesion clearance, bone graft and titanium rod support to treat the stage II osteonecrosis of the femoral head are effective and can prevent the femoral head from collapsing. But for stage IIC patients who had a history of the use of hormone, this surgery should be chosen carefully because the outcome is always very poor.展开更多
文摘AIM To evaluate the effects of sodium alendronate on bone repair in fractures created in appendicular bones. METHODS Wistar rats(n = 36) were allocated into three distinct groups: group C(control), group B1(received 1 mg/kg of alendronate), and group B2(received 3 mg/kg of alendronate). The rats underwent femoral transversal linear fracture surgery using stable internal fixation with a 2.0 mm plate and screw system. Each animal randomly received intraperitoneal applications of sodium alendronate at a dose corresponding to group B1 or B2 three times a week, while the control group received a 0.9% saline solution. Drug administration was performed until euthanasia at 45 d. The femurs were removed and each surgical piece was sent for radiographic, tomographic and microtomographic analysis. Data were submitted to descriptive and inferential statistical analysis(95% confidence interval).RESULTS Quantitative evaluations of bone neoformation did not show differences among the groups in the radiographic(P = 0.341), microtomographic(P = 0.581) and tomographic evaluations(P = 0.171). In the qualitative microtomographic analysis, a smaller distance was observed between the internal bone trabeculae in the groups that used alendronate(P = 0.05). On the other hand, group B2 had a higher amount of bone trabeculae per unit length when compared to the other groups(P = 0.04).CONCLUSION It is likely that the use of alendronate did not have a direct influence on the amount of bone neoformation, however it did influence the bone quality in a dosedependent manner, ultimately affecting the distance and quantity of the trabeculae.
文摘BACKGROUND Haematogenous osteomyelitis is an extremely rare disease occurring in adults,especially in developed countries.It is clearly a systemic infection,because bacteraemia spreads over proximal and distal long bones or paravertebral plexuses,resulting in acute or chronic bone infection and destruction.CASE SUMMARY A 46-year-old Caucasian male was complaining of a left thigh pain.It is known from the anamnesis that the patient developed severe pneumonia three months ago before the onset of these symptoms.The patient was diagnosed with haematogenous osteomyelitis,which developed a turbulent course and required complex combination therapy.The primary pathogen is thought to be Anaerococcus prevotii,which caused pneumonia before the onset of signs of osteomyelitis.Unfortunately,due to the complexity of identifying anaerobes and contributing nosocomial infections,the primary pathogen was not extracted immediately.After the manifestation of this disease,pathological fractures occurred in both femurs,as well as purulent processes in the lungs and molars accompanied.The patient received broad-spectrum antibiotic therapy and countless amounts of orthopaedic and reconstructive surgeries,but no positive effect was observed.The patient underwent osteosynthesis using an Ilizarov’s external fixation apparatus,re-fixations,external AO,debridements,intramedullary osteosynthesis with a silver-coated intramedullary nail,abscessotomies.The right femur healed completely after the pathological fracture and osteomyelitis did not recur.Left femur could not be saved due to non-healing,knee contracture and bone destruction.After almost three years of struggle,it was decided to amputate the left limb,after which the signs of osteomyelitis no longer appeared.CONCLUSION To sum it all up,complicated or chronic osteomyelitis requires surgery to remove the infected tissue and bone.Osteomyelitis surgery prevents the infection from spreading further or getting even worse up to such condition that amputation is the only option left.
基金the Chinese National Natural Science Foundation(No.12072235,No.12002388,No.11432016)the Science Foundation of PAPF Logistics University(WHB202004).
文摘Bone is sensitive to mechanical stimulation and plays a loading-bearing role in the human body.However,regulation of bone biomechanical properties in chronic hypergravity environments is still unclear.In this study,male Wistar rats exposed to chronic hypergravity environments(4g,8g,10g,and 20g)for 4 weeks were set as the hypergravity groups,and rats exposed to the normal gravity as the control group.Morphology parameters and bone remodeling factors were obtained by means of micro-CT,Western blot,and q-PCR.Mechanical properties of femurs were measured utilizing three points bending test and creep test and were fitted into a viscoelastic-viscoplastic constitutive equation.The results indicate osteoporosis occurred in femurs of hypergravity groups.Accordingly,the protein and gene expressions of bone remodeling factors(OPG,RANKL,runx2)in hypergravity groups were significantly different from that in the control group,demonstrating that bone formation level increased and bone resorption level decreased.Meanwhile,mechanical properties of femurs in hypergravity groups showed that Young's modulus of femurs in the 20g group was significantly higher than that in the control group.The viscoelastic-viscoplastic properties of bone tissue were changed in hypergravity environments.Among them,the 8g group was closest to the control group in morphology and mechanical properties.To sum up,the biomechanical response regulation of rat femur under 4-20g chronic hypergravity environments was presented.Hypergravity environments could lead to osteoporosis.The balance between bone formation and bone resorption would be disrupted in hypergravity groups due to bone adaptation.20g environment has a significant effect on elastic modulus on femurs.Due to the difference in biomechanical response of femurs,the viscoelastic-viscoplastic characteristics of femurs have a nonlinear relationship with hypergravity values.Bone tissue was least affected by 8g hypergravity in morphology and mechanical properties.
基金supported by the National Natural Science Foundation of China(32130052,82072447,and 82272578)the Fundamental Research Funds for the Central Universities,Nankai University(730-C02922112 and 730-DK2300010314).
文摘With the aging population,intertrochanteric femur fracture in the elderly has become one of the most serious public health issues and a hot topic of research in trauma orthopedics.Due to the limitations of internal fixation techniques and the insufficient mechanical design of nails,the occurrence of complications delays patient recovery after surgical treatment.Design of a proximal femur bionic nail(PFBN)based on Zhang’s N triangle theory provides triangular supporting fixation,which dramatically decreases the occurrence of complications and has been widely used for clinical treatment of unstable intertrochanteric femur fracture worldwide.In this work,we developed an equivalent biomechanical model to analyze improvement in bone remodeling of unstable intertrochanteric femur fracture through PFBN use.The results show that compared with proximal femoral nail antirotation(PFNA)and InterTan,PFBN can dramatically decrease the maximum strain in the proximal femur.Based on Frost’s mechanostat theory,the local mechanical environment in the proximal femur can be regulated into the medium overload region by using a PFBN,which may render the proximal femur in a state of physiological overload,favoring post-operative recovery of intertrochanteric femur fracture in the elderly.This work shows that PFBN may constitute a panacea for unstable intertrochanteric femur fracture and provides insights into improving methods of internal fixation.
文摘In this editorial,I present my comments on the article by Solarino et al.Conversion hip arthroplasty,which is an optional salvage procedure performed following unsuccessful fixation of intertrochanteric femur fractures in elderly pati-ents,entails more complex processes and higher rates of operative complications than primary arthroplasty.Hence,it is important to consider the appropriateness of the primary treatment choice,as well as the adequacy of nailing fixation for intertrochanteric fractures.This article briefly analyzes the possible factors contributing to the nailing failure of intertrochanteric fractures and attempts to find corresponding countermeasures to prevent fixation failures.It also analyzes the choice of treatment between nailing fixation and primary arthroplasty for intertrochanteric fractures.
文摘Background: Despite the conservative treatment of tibio-femoral osteoarthritis through realignment osteotomies, the rate of total knee replacements following an osteotomy is increasing. The aim of this study was to identify the factors associated with the progression of knee osteoarthritis after a medial closing-wedge distal femoral osteotomy. Methods: Hospital-based observational study on 20 patients who underwent a medial closing-wedge distal femoral osteotomy evaluating the progression of osteoarthritis using the Kellgren and Laurence classification. The Wilcoxon test was used to compare the variation in the progressive stage of the Kellgren and Laurence classification of knee osteoarthritis preoperatively and at the final follow up. Univariate analysis made it possible to determine the factors associated with progression. The final significance threshold for statistical tests was set at 5% (p Results: Overall, the mean follow-up of 46 months ± 6.6 months, with a mean age of 43 years (range: 27 - 69 years) and a female predominance (M: F = 3/7). The progression of tibiofemoral osteoarthritis following a medial closing-wedge distal femoral osteotomy is associated with valgus or varum malalignment been a moderate valgus (OR 6.2 [1.5 - 42.7] at 95% CI;p-value = 0.02), a correction of the mechanical deviation angle with a valgus alignment (OR 2.7 [0.9 - 8.3] at 95% CI), and loss of correction (OR 3.8 [1.3 - 11.6] at 95% CI;p -value) for the lateral compartment while varus alignment (OR 1.7 [0.9 - 8.3] 95% CI, p-value = 0.05) and with rupture of the lateral cortex (OR 2.8 [1.7 - 11.5] 95% CI, p-value = 0.02) were those of the medial compartment. Conclusion: Distal femur closing wedge osteotomy does not definitively interrupt the progression of valgus knee osteoarthritis. The factors associated with the progression of this pathology are modifiable. Taking them into account when performing this surgical technique could improve the osteotomy survival curve.
文摘Introduction: Traumatic hip dislocation associated with femur fracture is a rare and complex injury that occurs in the context of multiple trauma. Public road accidents represent more than 64% of the circumstances (automobiles 46% and two-wheelers 18%). Objective: Report a rare case of injury association and the speed of treatment (less than 6 hours). Clinical case: 26-year-old patient, victim of a road traffic accident. Admitted to the emergency room one hour after the trauma in a context of severe pain and absolute functional impotence of both pelvic limbs. Clinical examination reveals closed trauma to both pelvic limbs, with deformation of the right thigh, a vicious attitude of the contralateral lower limb in adduction, shortening and medial rotation. Conclusion: This is a rare injury association, which benefited from treatment within less than 6 hours.
文摘Introduction: Proximal femur fractures are traumatic injuries involving the neck and trochanteric region of the femur. The aim was to identify risk factors for death following proximal femur fractures in elderly patients. Patients and methods: This was a prospective, observational, longitudinal study conducted over an 18-month period in the Orthopedics-Traumatology Department of Aristide Le Dantec Hospital in Dakar. We evaluated a total of 93 patients aged at least 60 years with a proximal femur fracture whose date of onset was less than 3 weeks. The identification of risk factors for death took into account socio-demographic, clinical and therapeutic parameters. Results: The number of patients who died was 19 (20.43%). There was no significant difference in mortality according to age, gender or residence. There was no association between admission time and mortality. The association between the number of comorbidities and mortality was significant. The association between mortality and ASA score and type of treatment was highly significant. Operating time had no influence on mortality. Type of anesthesia, on the other hand, did influence mortality. Conclusion: Mortality due to proximal femur fractures in the elderly remains high. In our practice, this mortality was related to the presence of comorbidity, impaired cognitive function, ASA score, type of treatment and type of anesthesia.
文摘Coronal shear fractures of the femoral neck (CSFF) are the most challenging to treat among proximal femur fractures, directly affecting the life expectancy of patients with osteoporosis. However, an adequate osteosynthesis method has not been elucidated yet. This study investigated the displacement direction of the femoral head fragment and its effect on the bone using finite element method. A finite element model for CSFF was developed from CT image data of a patient with osteoporosis using Mechanical Finder (ver. 11). Subsequently, finite element analyses were performed on six osteosynthesis models under maximum load applied during walking. The compressive stresses, tensile stresses, and compressive strains of each model were examined. The results suggested that the compressive and tensile stress distributions were concentrated on the anterior side of the femoral neck. Compressive strain distribution in the femoral head and neck was concentrated in four areas: at the tip of the blade or lag screw, the anteroinferior side of the blade or lag screw near the fracture site, and the upper right and lower left near the junction of the blade or lag screw and nail. Thus, the distribution of both these stresses revealed that the femoral head fragment was prone to anterior and inferior displacement. Distribution of compressive strains revealed the direction of the stress exerted by the osteosynthetic implant on the bone. The same results were observed in all osteosynthetic implants;thus, the findings could lay the foundation for developing methods for placing osteosynthetic implants less prone to displacement and the osteosynthetic implants themselves. In particular, the study provides insight into the optimal treatment of CSFF.
文摘Adult patients with developmental dysplasia of the hip develop secondary osteoarthritis and eventually end up with total hip arthroplasty(THA) at younger age. Because of altered anatomy of dysplastic hips, THA in these patients represents technically demanding procedure. Distorted anatomy of the acetabulum and proximal femur together with conjoined leg length discrepancy present major challenges during performing THA in patients with developmental dysplasia of the hip. In addition, most patients are at younger age, therefore, soft tissue balance is of great importance(especially the need to preserve the continuity of abductors) to maximise postoperative functional result. In this paper we present a variety of surgical techniques availablefor THA in dysplastic hips, their advantages and disadvantages. For acetabular reconstruction following techniques are described: Standard metal augments(prefabricated), Custom made acetabular augments(3D printing), Roof reconstruction with vascularized fibula, Roof reconstruction with pedicled iliac graft, Roof reconstruction with autologous bone graft, Roof reconstruction with homologous bone graft, Roof reconstruction with auto/homologous spongious bone, Reinforcement ring with the hook in combination with autologous graft augmentation, Cranial positioning of the acetabulum, Medial protrusion technique(cotyloplasty) with chisel, Medial protrusion technique(cotyloplasty) with reaming, Cotyloplasty without spongioplasty. For femoral reconstruction following techniques were described: Distraction with external fixator, Femoral shortening through a modified lateral approach, Transtrochanteric osteotomies, Paavilainen osteotomy, Lesser trochanter osteotomy, Double-chevron osteotomy, Subtrochanteric osteotomies, Diaphyseal osteotomies, Distal femoral osteotomies. At the end we present author's treatment method of choice: for acetabulum we perform cotyloplasty leaving only paper-thin medial wall, which we break during acetabular cup impacting. For femoral side first we peel of all rotators and posterior part of gluteus medius and vastus lateralis from greater trochanter on the very thin flake of bone. This method allows us to adequately shorten proximal femoral stump, with possibility of additional resection of proximal femur. Furthermore, several advantages and disadvantages of this procedure are also discussed.
基金a grant from the National Natural Sciences Foundation of China (No. 30170945)
文摘To study the effect of titanium alloy cage on the treatment of the ischemic necrosis of femoral head in dog, the model of the ischemic necrosis of femoral head was made with the liquid nitrogen in 15 hybrid adult dogs. The titanium alloy cage made of a hollow cylinder was driven into the subchondral bone of necrotic femoral head via central channel. The dogs were divided into 3 groups, each group was sacrificed 3, 6, 12 weeks after the operation respectively. No collapse of femoral head was observed after the operation. The position of the cages was good on radiograph. Microscopically, the cancellous bone of necrotic femoral head rebuilt gradually and grew into cage. After 12 weeks of creeping substitution, the cancellous bone filled up the hollow cavity and holes of the cages. It is concluded that the titanium alloy cage can provide structural support for the subchondral bone and prevent collapse and can be used for the treatment of the ischemic necrosis of femoral head.
文摘AIM To review and report functional outcomes, complications,and survivorship associated with total knee arthroplasty(TKA) in the treatment of post-traumatic arthritis(PTA).METHODS We conducted a systematic review according to the PRISMA guidelines. We searched PubMed, Cochrane Library, and SCOPUS in December 2015 for Englishlanguage clinical research studies, both prospective and retrospective, examining the use of TKA for the treatment of PTA. All relevant articles were accessed in full. The manual search included references of retrieved articles.We extracted data on patients' demographics and clinical outcomes, including preoperative diagnosis and pre- and post-operative functional scores. We summarized the data and reported the results in tables and text.RESULTS Sixteen studies, four prospective and ten retrospective,examined patients who underwent TKA for PTA due to fractures of the proximal tibia, patella, and/or distal femur. Eleven studies utilized the Knee Society Scores criteria to assess functional outcomes. All studies utilizing these criteria reported an improvement in functional and knee scores of patients following TKA. Further, studies reported an increased range of motion(ROM) and reduction of pain following surgery. The most commonly reported complications with TKA included infection, stiffness, wound complications, intraoperative rupture of tendons, and osteolysis/polyethylene wear. The overwhelming majority of these complications occurred within the first two years following surgery. Six studies examined the survivorship of TKA with subsequent revision for any reason as an endpoint. Compared to patients with osteoarthritis, patients with PTA required more revisions, the majority for polyethylene wear.CONCLUSION Although associated with higher complication rates,TKA is an effective treatment for PTA, as it improves ROM, pain and functional outcomes.
文摘Total femoral replacement(TFR) is a salvage arthroplasty procedure used as an alternative to lower limb amputation. Since its initial description in the mid-20^(th) century, this procedure has been used in a variety of oncologic and non-oncologic indications. The most compelling advantage of TFR is the achievement of immediate fixation which permits early mobilization. It is anticipated that TFR will be increasingly performed as the rate of revision arthroplasty rises worldwide. The existing literature is mainly composed of a rather heterogeneous mix of retrospective case series and a wide assortment of case reports. Numerous TFR prostheses are currently available and the surgeon must understand the unique implications of each implant design. Long-term functional outcomes are dependent on adherence to proper technique and an appropriate physical therapy program for postoperative rehabilitation. Revision TFR is mainly performed for periprosthetic infection and the severe femoral bone loss associated with aseptic revisions. Depending on the likelihood of attaining infection clearance, it may sometimes be advisable to proceed directly to hip disarticulation without attempting salvage of the TFR. Other reported complications of TFR include hip joint instability, limb length discrepancy, device failure, component loosening, patellar maltracking and delayed wound healing. Further research is needed to better characterize the long-term functional outcomes and complications associated with this complex procedure.
文摘Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics. Surgeries aimed at improving the biology, such as vascularized fibula grafting, have good success rates but require high levels of expertise and substantial resources. A popular surgical treatment aimed at improving the biomechanics-valgus intertrochanteric osteotomyoptimizes conditions for fracture healing by converting shear forces across the fracture site into compressive forces. Numerous variations of this surgical procedure have been developed and successfully applied in clinical practice. As a result, the proximal femoral orientation for obtaining a good functional outcome has evolved over the years, and the present concept of altering the proximal femoral anatomy as little as possible has arisen. This technical objective supports attaining union as well as a good functional outcome, since excessive valgus can lead to increased joint reaction forces. This review summarizes the historical and current literature on valgus intertrochanteric osteotomy treatment of nonunion neck of femur, with a focus on factors predictive of good functional outcome and potential pitfalls to be avoided as well as controversies surrounding this procedure.
文摘AIM To report the clinical and radiographic results of titanium elastic nail(TEN) in diaphyseal femoral fractures of children below age of six years.METHODS A retrospective analysis of 27 diaphyseal femoral fractures in children younger than six years treated with TEN between 2005 and 2015 was conducted. Patients were immobilized in a cast for 5 wk and the nails were removed from 6 to 12 wk after surgery. Twenty-four cases were clinically and radiographically re-evaluated using the Flynn's scoring criteria, focusing on: Limb length discrepancy, rotational deformity, angulation, hip and knee range of motion(ROM), functional status, complications, and parent's satisfaction.RESULTS Sixteen males and eight females with a mean age of 3.2 years at the time of treatment were re-evaluated at an average follow-up of 58.9 mo. No cases of delayed union were observed. The mean limb lengthening was 0.3 cm. Four cases experienced limb lengthening greater than 1 cm and always minor than 2 cm. Twelve point five percent of the cases showed an angulation < 10°. Complete functional recovery(hip and knee ROM, ability to run and jump on the operated limb) occurred in 95.7% of cases. Complications included two cases of superficial infection of the TEN entry point, one case of refracture following a new trauma, and one TEN mobilization. According to the Flynn's scoring criteria, excellent results were obtained in 79.2% of patients and satisfactory results in the remaining 20.8%, with an average parent's satisfaction level of 9.1/10.CONCLUSION TEN is as a safe, mini-invasive and surgeon-friendly technique and, considering specific inclusion criteria, it represents a useful and efficacy option for the treatment of diaphyseal femoral fractures even in patients younger than six years of age.
文摘The number of revision total hip arthroplasties is expected to rise as the indications for arthroplasty will expand due to the aging population. The prevalence of extensive proximal femoral bone loss is expected to increase subsequently. The etiology of bone loss from the proximal femur after total hip arthroplasty is multifactorial. Stress shielding, massive osteolysis, extensive loosening and history of multiple surgeries consist the most common etiologies. Reconstruction of extensive bone loss of the proximal femur during a revision hip arthroplasty is a major challenge for even the most experienced orthopaedic surgeon. The amount of femoral bone loss and the bone quality of the remaining metaphyseal and diaphyseal bone dictate the selection of appropriate reconstructive option. These include the use of impaction allografting, distal press-fit fixation, allograft-prosthesis composites and tumor megaprostheses. This review article is a concise review of the current literature and provides an algorithmic approachfor reconstruction of different types of proximal femoral bone defects.
文摘In order to observe the feature of age-related marrow conversion and maturation of epiphyseal cartilage and analyze the distribution of red and yellow marrow in the proximal femur at STIR MR imaging, STIR and T1 weighted MR imaging of the proximal femur in 52 subjects, aged 4 months to 25 years old, were retrospectively analyzed for the distribution and appearance of red and yellow marrow. The subjects with no known bone marrow abnormalities were divided into 6 age groups. The signal intensity of the marrow in the proximal epiphysis, proximal metaphysis, proximal diaphysis, distal diaphysis and greater trochanter was compared with the signal intensity and homogeneity of surrounding muscle and fat and graded by two observers. The results showed that the conversion of hematopoietic marrow in the proximal femur followed a well-defined sequence, occurring first in the proximal epiphysis, followed by the distal diaphysis, and then greater trochanter and metaphysis. STIR in combination with T1-weighted imaging could display clearly the origin of ossification center and the course of conversion from red to yellow marrow in proximal epiphysis and greater trochanter. STIR imaging showed that the marrow conversion in proximal metaphysic began below epiphyseal plate and intertrochanter. The site of red yellow was distributed in weight-bearing axis by 20 years of age. The marrow conversion of diaphysis was from distal end to proximal end, and the consequence of conversion was that distal diaphysis contained yellow marrow but proximal diaphysis partly red marrow connected with the red marrow of metaphysic. The epiphyseal cartilage had different characters of signal-intensity with age in STIR sequence. The distribution of red marrow in STIR imaging was more close to that of anatomy than T1-weighted imaging. It was concluded that STIR could dynamically display the feature of morrow conversion and the development of epiphyseal cartilage and accurately reveal the age-related distribution of red and yellow marrow on STIR imaging in the proximal femur.
文摘Purpose: The purpose of the present controlled cross-sectional study was to investigate proximal femur and whole-body bone mineral density(BMD), as well as bone turnover profile, in lifelong trained elderly male football players and young elite football players compared with untrained age-matched men.Methods: One hundred and forty healthy, non-smoking men participated in the study, including lifelong trained football players(FTE, n = 35)aged 65—80 years, elite football players(FTY, n = 35) aged 18—30 years, as well as untrained age-matched elderly(UE, n = 35) and young(UY,n = 35) men. All participants underwent a regional dual-energy X-ray Absorptiometry(DXA) scan of the proximal femur and a whole-body DXA scan to determine BMD. From a resting blood sample, the bone turnover markers(BTMs) osteocalcin, carboxy-terminal type-1 collagen crosslinks(CTX-1), procollagen type-1 amino-terminal propeptide(P1NP), and sclerostin were measured.Results: FTE had 7.3%—12.9% higher(p < 0.05) BMD of the femoral neck, wards, shaft, and total proximal femur in both legs compared to UE,and 9.3%—9.7% higher(p < 0.05) BMD in femoral trochanter in both legs compared to UY. FTY had 24.3%—37.4% higher(p < 0.001) BMD in all femoral regions and total proximal femur in both legs compared to UY. The whole-body DXA scan confirmed these results, with FTE showing similar whole-body BMD and 7.9% higher(p < 0.05) leg BMD compared to UY, and with FTY having 9.6% higher(p < 0.001) wholebody BMD and 18.2% higher(p < 0.001) leg BMD compared to UY. The plasma concentration of osteocalcin, CTX-1, and P1NP were 29%,53%, and 52% higher(p < 0.01), respectively, in FTY compared to UY.Conclusion: BMD of the proximal femur and whole-body BMD are markedly higher in lifelong trained male football players aged 65—80 years and young elite football players aged 18—30 years compared to age-matched untrained men. Elderly football players even show higher BMD in femoral trochanter and leg BMD than untrained young despite an age difference of 47 years.
文摘Fractures of femur proximal extremity(FFPE)are the most common fragility fractures requiring hospitalization,with a high risk of mortality,low independence in the activities of daily living and severe consequences on healthrelated quality of life.Timing for surgery has a key role in the management of elderly patients with FFPE as recommended by the Australian and New Zealand guidelines and the National Institute for Health and Care Excellence guidelines.Early surgery(within 48 h from hospital admission)allows significant benefits in terms of lower rates of postoperative complications and risk of death and can provide better functional outcomes.Therefore,time for surgery could be considered as a comorbidity marker.The choice between conservative or surgical approach surprisingly seems to be still not strongly supported by available literature,but it seems that both 30 d and 1 year risk of mortality is higher with the conservative treatment rather than with surgery.In light of these considerations,the optimization of FFPE management care is mandatory to improve functional outcomes and to reduce sanitary costs.Albeit it is widely accepted that transdisciplinary approach to patients suffering from FFPE is mandatory to optimize both short-term and long-term outcomes,the feasibility of a comprehensive approach in clinical practice is still a challenge.In particular,the large variability of figures involved could be considered both a resource and an additional disadvantage taking into account the difficulty to coordinate multidisciplinary approach covering care in all settings.Therefore,the aim of the present article was to summarize current evidence supporting transdisciplinary management of patients with FFPE,highlighting the benefits,feasibility and limitations of this approach.
文摘Objective: To assess the curative effect of the stage II femoral head necrosis treated by arthroscopy assisted lesion clearance, bone graft and titanium rod support. Methods: All the patients (including 58 patients 74 hips) were diagnosed as stage II femoral head necrosis according to the ARCO staging system during 2003-2013. In these patients, 15 hips were stage IIA, 34 hips were stage IIB and 25 hips were stage IIC. Located by C-arm and assisted by arthroscopy, minimally-invasive percutaneous pulp core decompression and lesion clearance within the femoral head were accurately performed, and then, the OAM composite of autologous bone marrow was implanted and the femoral head was supported using the titanium rod. Follow-up including the pain score, the Harris hip score and X-ray observation for disease progression were achieved at 6, 12, 24 and 36 months postoperatively, Kaplan-Meier survival curve was used for the survival analysis. Result: The VAS score and the Harris score after operation were better THRAn THRAt of before the surgery, the difference had statistical significance (p Conclusion: Arthroscopy assisted lesion clearance, bone graft and titanium rod support to treat the stage II osteonecrosis of the femoral head are effective and can prevent the femoral head from collapsing. But for stage IIC patients who had a history of the use of hormone, this surgery should be chosen carefully because the outcome is always very poor.