Search Results (617)

Repairing or reconstructing significant bone defects is typically challenging. In the present study, two composite cements were used as scaffolds in a sub-critical femoral defect in rats. A control group and two experimental batches were used to compare the outcomes. This research aimed to investigate the osteogenic potential and toxicological tolerance of the bioproducts through histopathology and computed tomography imaging analysis at 14, 28, 56, and 90 days post-implantation. The biomaterials used in the investigation consisted of a 65% bioactive salinized inorganic filler and a 25% weight organic matrix. The organic part of the biomaterial was composed of Bis-GMA (bisphenol A-glycidyl methacrylate), UDMA (urethane dimethacrylate), HEMA (2-Hydroxyethyl methacrylate), and TEGDMA (triethylene glycol dimethacrylate), while the inorganic filler was composed of silica, barium glass, hydroxyapatite, and fluor aluminosilicate glass. The first findings of this research are encouraging, revealing that there is a slight difference between the groups treated with biomaterials, but it might be an effective approach for managing bone abnormalities. Material C1 exhibited a faster bone defect healing time compared to material C2, where bone fractures occurred in some individuals. It is unclear if the fractures were caused by the presence of the biomaterial C2 or whether additional variables were to blame. By the end of the research, the mice appeared to tolerate the biomaterials without exhibiting any inflammatory or rejection responses. Full article

Proximal humerus fractures (PHFs) are among the most common upper-extremity fractures, with a rising incidence linked to the growing elderly population. Treatment options include non-surgical and surgical methods, but the best approach for geriatric PHFs remains debated. Patient selection for treatment must consider clinical and functional outcomes and the potential complications of surgery. Osteoporosis, a key factor in elderly PHFs, meaning those in patients over 65 years old, often results from low-energy trauma and necessitates treatments that enhance bone healing. Bone cement, such as calcium phosphate, is widely used to improve fracture stability and healing. However, the benefits of surgical fixation with bone cement augmentation (BCA) for elderly PHF patients remain controversial. Hence, in this article, we searched databases including MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science to analyze the evidence on locking plate fixation (LPF) with BCA for proximal humeral fractures. We aim to provide readers with updates concerning the above issues. Full article

Background: Ankle fractures, comprising about 10% of musculoskeletal injuries, pose a significant healthcare burden with an increasing incidence, particularly among an aging population. This study focuses on isolated Danis-Weber type B fractures. Recent trends lean towards surgical intervention for anatomical restoration and quicker recovery, albeit with associated complications. This report aims to assess the safety and efficacy of the NewClip narrow locking plate system with early weight-bearing in treating isolated fibular fractures. Methods: The study includes patients with Danis-Weber type B fractures surgically treated with the NewClip narrow locking plate system. Exclusions involved nondisplaced fractures, open fractures, or those requiring additional fixation. Results: Fifteen patients were enrolled in this study. Minor complications, including wound swelling, were observed in two cases. The Visual Analogue Scale (VAS) for pain exhibited a steady decline postoperatively, with almost complete resolution by the third month. At three months, the FAOS demonstrated excellent results, and a final follow-up at twelve months revealed complete osseous healing without complications. Conclusions: The use of this type of plate in treating isolated fibular fractures with early weight-bearing shows promising results in terms of fracture healing, pain resolution, and functional outcomes, warranting further investigation with larger cohorts. Full article

Lower extremity fractures pose challenges due to prolonged healing times and limited assessment methods. Integrating wearable sensors with machine learning can help overcome these challenges by providing objective assessment and predicting fracture healing. In this retrospective study, data from a gait monitoring insole on 25 patients with closed lower extremity fractures were analyzed. Continuous underfoot loading data were processed to isolate steps, extract metrics, and feed them into three white-box machine learning models. Decision tree and Lasso regression aided feature selection, while a logistic regression classifier predicted days until fracture healing within a 30-day range. Evaluations via 10-fold cross-validation and leave-one-out validation yielded stable metrics, with the model achieving a mean accuracy, precision, recall, and F1-score of approximately 76%. Feature selection revealed the importance of underfoot loading distribution patterns, particularly on the medial surface. Our research facilitates data-driven decisions, enabling early complication detection, potentially shortening recovery times, and offering accurate rehabilitation timeline predictions. Full article

Background: The surgical treatment of bony non-unions is traditionally performed with additional bone grafts when atrophic and/or stronger implants when hypertrophic. In the case of the clavicle shaft, however, in our experience, a more controversial method where no additional bone graft is needed leads to equally good consolidation rates, independent of the non-union morphology. This method requires the meticulous anatomical reconstruction of the initial fracture and fixation according to the AO principle of relative stability. Methods: A retrospective review following the STROBE guidelines was performed on a consecutive cohort of all patients who received surgical treatment of a midshaft clavicle non-union at the Medical Center of the University of Freiburg between January 2003 and December 2023. Patients were identified using a retrospective systematical query in the Hospital Information System (HIS) using the International Statistical Classification of Diseases and Related Health Problems Version 10 (ICD-10) codes of the German Diagnosis Related Groups (G-DRG). Two groups were formed to compare the consolidation rates of patients who received additional bone grafting from the iliac crest with those of patients who did not. A 3.5 mm reconstruction LCP plate was used in all patients. Consolidation rates were evaluated using follow-up radiographs and outcomes after material removal with a mean follow-up of 31.5 ± 44.3 months (range 0–196). Results: Final data included 50 patients, predominantly male (29:21); age: 46.0 ± 13.0 years, BMI 26.1 ± 3.7. Autologous bone grafts from the iliac crest were used in 38.0% (n = 19), while no bone addition was used in 62.0% (n = 30). Six patients were lost to follow-up. Radiological consolidation was documented after a mean of 15.1 ± 8.0 months for the remaining 44 patients. Consolidation rates were 94.4% (n = 17) in patients for whom additional bone grafting was used and 96.2% (n = 25) in patients for whom no graft was used. There was no relevant difference in the percentage of atrophic or hypertrophic non-unions between both groups (p = 0.2425). Differences between groups in the rate of consolidation were not significant (p = 0.7890). The complication rate was low, with 4.5% (n = 2). Conclusions: Independent of the non-union morphology, non-unions of the clavicle midshaft can be treated successfully with 3.5 mm locking reconstruction plates without the use of additional bone grafting in most cases. Full article

Background and Objectives: Osteoporotic vertebral compression fractures (OVCFs) are prevalent among the elderly, often leading to significant pain, morbidity, and mortality. Effective management of underlying osteoporosis is essential to prevent subsequent fractures. This study aimed to compare the clinical and radiographic outcomes of teriparatide and denosumab treatments in patients with OVCFs to determine their relative effectiveness in improving patient outcomes. Materials and Methods: This retrospective study included 78 patients diagnosed with an acute thoracolumbar OVCF who received either teriparatide (35 patients) or denosumab (43 patients) within three months of a fracture. Clinical outcomes were assessed using the visual analog scale (VAS) for back pain, Oswestry disability index (ODI), and EQ-5D quality of life scores at baseline, 6 months, and 12 months. Bone mineral density (BMD) and radiographic outcomes were evaluated initially and at 12 months post-treatment. Results: Both treatment groups demonstrated significant improvements in VAS, ODI, and EQ-5D scores over 12 months. No significant differences were observed between the teriparatide and denosumab groups in terms of clinical outcomes or radiographic measurements at any time point. Fracture union and BMD improvements were similarly observed in both groups. The teriparatide group had a lower baseline BMD, but this did not affect the overall outcomes. Conclusions: Both teriparatide and denosumab are effective in improving clinical and radiographic outcomes in patients with OVCFs. Despite concerns about denosumab’s potential to hinder fracture healing, our study found no significant differences between the two treatments. These findings support the use of denosumab for early treatment of OVCFs to prevent subsequent fractures without compromising fracture healing. Further prospective studies are needed to confirm these results. Full article

Material extrusion (MEX) additive manufacturing has successfully fabricated assembly-free structures composed of different materials processed in the same manufacturing cycle. Materials with different mechanical properties can be employed for the fabrication of bio-inspired structures (i.e., stiff materials connected to soft materials), which are appealing for many fields, such as bio-medical and soft robotics. In the present paper, process parameters and 3D printing strategies are presented to improve the interfacial adhesion between carbon fiber-reinforced nylon (CFPA) and thermoplastic polyurethane (TPU), which are extruded in the same manufacturing cycle using a multi-material MEX setup. To achieve our goal, a double cantilever beam (DCB) test was used to evaluate the mode I fracture toughness. The results show that the application of a heating gun (assembled near the nozzle) provides a statistically significant increase in mean fracture toughness energy from 12.3 kJ/m² to 33.4 kJ/m². The underlying mechanism driving this finding was further investigated by quantifying porosity at the multi-material interface using an X-ray computed tomography (CT) system, in addition to quantifying thermal history. The results show that using both bead ironing and the hot air gun during the printing process leads to a reduction of 24% in the average void volume fraction. The findings from the DCB test and X-ray CT analysis agree well with the polymer healing theory, in which an increased thermal history led to an increased fracture toughness at the multi-material interface. Moreover, this study considers the thermal history of each printed layer to correlate the measured debonding energy with results obtained using the reptation theory. Full article

The paleopathological literature notably lacks the description and analysis of distal humeral fractures and their associated complications. The objectives of this study were (1) to evaluate a distal humerus fracture associated with cubitus valgus observed in the articulated right elbow of an adult male buried in the Santa Caterina Friary site in Barcelona, dating back to the modern period (15th to early 16th century), and (2) to contribute to the valorization of bioarcheological heritage. Employing macroscopic and radiographic studies, the injury was assessed. The results indicated a healed antemortem fracture, probably associated with a fall. In the AO/OTA classification, it corresponds to type 13C1.1 (complete articular fracture, articular simple, metaphyseal simple, above the transcondylar axis), accompanied by a coronoid process fracture due to anterior trochlear dislocation impact (O’Driscoll type 1 classification: transverse fracture of the distal apophysis with involvement of the sublime tubercle). This fracture, resulting in a 28° cubitus valgus and significant elbow changes, infers community support in healing and highlights the socio-economic dynamics of guilds and adaptive strategies to physical adversities. This study is one of the first to describe cubitus valgus in a historical Spanish population, offering a comprehensive view of the complexities, physical adversities, and adaptive strategies employed by individuals following an elbow fracture. Full article

Background: Distal forearm fractures were defined as distal radius fractures with concomitant distal ulna fractures, except ulna styloid fractures. Distal forearm fractures are common among geriatric populations, particularly those with osteoporosis. Conventionally, distal forearm fractures are reduced by a double incision approach; however, malreduction and instability of the distal radioulnar joint were not uncommon. We introduced a modified volar dual window approach to treat the distal forearm fracture and evaluate the functional outcomes and complications. Methods: From January 2020 to June 2023, 13 patients with distal forearm fractures underwent open reduction by the modified dual window approach with locking plate fixation. After surgery, splints were applied for two weeks, and the patients underwent postoperative hand therapy for three months. The mean Quick Disabilities of the Arm, Shoulder, and Hand scores, range of motions, grip strength, postoperative radiographic parameters, and complications data were collected. Results: The mean follow-up period was 12.1 months, and the mean age was 52.3 years. Average wrist flexion was 67°, extension 69°, pronation 81°, and supination 79°. Grip strength was 28.3 ± 11.5 kg, which was 88% of the uninjured opposite side. The Visual Analog Scale score during activities was recorded as 0.5 ± 0.9. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 14 ± 11.5. The postoperative radiographic parameters were as follows: radial height: 10.8 ± 1.7 mm, radial inclination: 22.6 ± 3.7°, volar tilting: 4.0 ± 3.9°, and ulnar variance: −0.4 ± 1.4 mm. All the patients achieved bone union at the final follow-up. Two patients underwent ulnar implant removal due to irritation symptoms. Neither infection, nor neurovascular injury, nor malreduction developed in these patients. Conclusions: The modified volar dual window approach can achieve good wrist function and distal forearm fracture reduction without increasing neurovascular or wound healing complications. This method is an alternative approach for distal forearm fracture, especially in comminuted distal ulna fracture or distal radioulnar joint incongruity. Full article

Rhodiola rosea, a long-lived herbaceous plant from the Crassulaceae group, contains the active compound salidroside, recognized as an adaptogen with significant therapeutic potential for bone metabolism. Salidroside promotes osteoblast proliferation and differentiation by activating critical signaling pathways, including bone morphogenetic protein-2 and adenosine monophosphate-activated protein kinase, essential for bone formation and growth. It enhances osteogenic activity by increasing alkaline phosphatase activity and mineralization markers, while upregulating key regulatory proteins including runt-related transcription factor 2 and osterix. Additionally, salidroside facilitates angiogenesis via the hypoxia-inducible factor 1-alpha and vascular endothelial growth factor pathway, crucial for coupling bone development with vascular support. Its antioxidant properties offer protection against bone loss by reducing oxidative stress and promoting osteogenic differentiation through the nuclear factor erythroid 2-related factor 2 pathway. Salidroside has the capability to counteract the negative effects of glucocorticoids on bone cells and prevents steroid-induced osteonecrosis. Additionally, it exhibits multifaceted anti-inflammatory actions, notably through the inhibition of tumor necrosis factor-alpha and interleukin-6 expression, while enhancing the expression of interleukin-10. This publication presents a comprehensive review of the literature on the impact of salidroside on various aspects of bone tissue metabolism, emphasizing its potential role in the prevention and treatment of osteoporosis and other diseases affecting bone physiology. Full article

Nitroimidazoles comprise a class of broad-spectrum anti-microbial drugs with efficacy against parasites, mycobacteria, and anaerobic Gram-positive and Gram-negative bacteria. Among these drugs, metronidazole (MTZ) is commonly used with other antibiotics to prevent infection in open fractures. However, the effect of MTZ on bone remains understudied. In this paper, we evaluated six nitroimidazole drugs for their impact on osteoblast differentiation and identified MTZ as having the highest osteogenic effect. MTZ enhanced bone regeneration at the femur osteotomy site in osteopenic ovariectomized (OVX) rats at the human equivalent dose. Moreover, in OVX rats, MTZ significantly improved bone mass and strength and improved microarchitecture compared to the vehicle-treated rats, which was likely achieved by an osteogenic mechanism attributed to the stimulation of the Wnt pathway in osteoblasts. To mitigate the reported neurological and genotoxic effects of MTZ, we designed an injectable sustained-release in situ gel formulation of the drug that improved fracture healing efficacy by 3.5-fold compared to oral administration. This enhanced potency was achieved through a significant increase in the circulating half-life and bioavailability of MTZ. We conclude that MTZ exhibits osteogenic effects, further accentuated by our sustained-release delivery system, which holds promise for enhancing bone regeneration in open fractures. Full article

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

Background: Pediatric forearm fractures represent a substantial proportion of childhood injuries, requiring effective and minimally invasive treatments. Our study investigated the mid-term outcomes of biodegradable poly-L-lactide-co-glycolide (PLGA) intramedullary implants in managing diaphyseal forearm fractures in children. Methods: A follow-up cohort study was conducted with 38 patients treated with PLGA implants. Control examinations were performed one year post-operation, assessing bone healing through radiographic evaluations and functional outcomes using injured and uninjured limb range of motion (ROM) comparisons. Scarring was evaluated employing the Vancouver Scar Scale (VSS), and satisfaction via a questionnaire. Results: Children were predominantly female (76.4%), with a mean age of 9.71 (SD: 2.69) years. Effective fracture stabilization and bone healing were found in all patients, with a minor reduction (mean difference of −1.5°, p = 0.282) in elbow flexion on the operated side (139.3°) compared to the intact (140.8°). Elbow extension presented negligible average changes (0.2°, p = 0.098). Forearm movements were slightly reduced on the operated side (mean pronation: 80.8° vs. 83.7°, p = 0.166; average supination: 83.5° vs. 85.7°, p = 0.141). Wrist palmar flexion and dorsiflexion showed no significant differences. VSS ratings indicated minimal scarring (mean guardian and doctor scores were 1.13 and 0.55, respectively, p = 0.020), and all patients reported satisfaction with the treatment outcomes. Conclusions: Biodegradable implants are effective for pediatric forearm fractures, providing stable bone healing while preserving functional ROM with minimal scarring and high patient satisfaction. PLGA proved to be a viable alternative to traditional metal implants, eliminating secondary removal surgeries. Full article

Background: The healing potential of a fracture is determined by mechanical and biological factors. Simulation-based workflows can help assess these factors to assist in predicting non-unions. The aim of this study was the introduction of two use cases for a novel patient-specific simulation workflow based on clinically available information. Methods: The used software is an extension of the “Ulm Bone Healing model” and was applied in two cases with non-union development after fracture fixation to show its principal feasibility. The clinical and radiographic information, starting from initial treatment, were used to feed the simulation process. Results: The simulation predicted non-union development and axial deviation in a mechanically driven non-union. In the case of a biological non-union, a slow, incomplete healing course was correctly identified. However, the time offset in callus bridging was discordant between the simulation and the distinctly slower healing response in the clinical case. Conclusions: The simulation workflow presented in the two clinical use cases allowed for the identification of fractures at risk for impending non-union immediately after the initial fixation based on available clinical and radiographic information. Further validation in a large non-union cohort is needed to increase the model’s precision, especially in biologically challenging cases, and show its validity as a screening instrument. Full article

Carbon fiber reinforced polymer (CFRP) composites are renowned for their exceptional mechanical properties, with applications in industries such as automotive, aerospace, medical, civil, and beyond. Despite these merits, a significant challenge in CFRPs lies in their repairability and maintenance. This study, for the first time, delves into the processing and self-healing capability of aromatic thermosetting co-polyester vitrimer-based carbon fiber composites through mechanical testing. Vitrimers are an emerging class of thermosetting polymers, which, owing to their exchangeable covalent bonds, enable the re-formation of bonds across cracks. The specific vitrimer chosen for this study is an aromatic thermosetting co-polyester (ATSP). The mechanical properties of samples were analyzed initially through three-point bending (3PB) testing at room temperature before and after healing (by curing samples for 2 h at 280 °C). Samples were also 3PB tested at 100 °C to analyze their mechanical properties at an elevated temperature for comparison to the samples tested at room temperature. To investigate the fracture properties, optical microscopy images of samples were taken after 3PB tests, which were analyzed to observe crack initiation and crack growth behavior. Through load–displacement curves from double cantilever beam (DCB) mechanical testing, the Mode I crack initiation fracture toughness values of self-healed composites and control composites were calculated to evaluate healing efficiency in ATSP CFRP composites cured at 280 °C for 2 h. Scanning electron microscopy (SEM) showed a similar surface morphology of cracks before and after self-healing. Micro-computed tomography (CT) X-ray imaging confirmed that the healed samples closely resembled the as-fabricated ones, with the exception of some manufacturing voids, caused by outgassing in the initial healing cycle. This research demonstrated the ability for the in situ repair of ATSP CFRPs by restoring the fracture toughness to values comparable to the pristine composite (~289 J/m²). Full article