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Abstract Purpose The purpose of this systematic review is to examine the outcomes, complications, and potential advantages of using anatomical interlocking intramedullary nails (IMN) in the treatment of radius and ulnar shaft diaphyseal fractures in adults. Methods Medline, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched between January 2000 and January 2023. Studies meeting criteria were observational or randomized controlled trials evaluating outcomes in IMN for adult diaphyseal forearm fractures. Standardized data extraction was performed and a quality assessment tool was used to evaluate individual study methodology. Descriptive statistics for interventions, functional outcomes, and complications were reported. Meta-analysis was performed for patient-reported outcome measures and operative time. Results A total of 29 studies involving 1268 patients were included with 764 (60%) undergoing IMN, 21% open reduction and internal fixation (ORIF), and 9% hybrid fixation. There was no significant difference between groups in DASH and Grace–Eversmann scores. Operative time was significantly shorter in IMN compared with ORIF. The DASH scores were: 13.1 ± 6.04 for IMN, 10.17 ± 3.98 for ORIF, and 15.5 ± 0.63 in hybrids. Mean operative time was 65.3 ± 28.7 in ORIF and 50.8 ± 17.7 in IMN. Complication rates were 16.7% in the IMN group, 14.9% in ORIF, and 6.3% in hybrid constructs. There were 11 cases of extensor pollicis rupture in the IMN group. Average IMN pronation and supination were 78.3° ± 7.9° and 73° ± 5.0°, respectively. Average ORIF pronation and supination was 82.15° ± 1.9° and 79.7° ± 4.5°, respectively. Conclusions Similar functional outcomes and complication rates along with shorter operative times can be achieved with IMN compared with ORIF. The use of IMN is promising, however, higher quality evidence is required to assess appropriate indications, subtle differences in range of motion, implant-related complications, and cost-effectiveness. Trail Registration PROSPERO (International Prospective Register of Systematic Reviews) (ID: CRD42022362353). Level of evidence III.

Purpose: Rotational malalignment and leg length discrepancy after intramedullary nailing of femoral shaft are frequent. This study has three objectives: evaluate the rate of femoral rotational malalignment and leg length discrepancy using EOS imaging after antegrade intramedullary nailing of femoral shaft fracture, find a relevant clinical examination to detect malrotation and identified risk factors. Methods: We performed a retrospective single-centre study between January 2014 and January 2022. Fifty-eight patients were clinically and radiographically assessed at a minimum of three months. Results: The femoral rotation of the operated side was significantly greater by a mean of 15.4° in internal rotation compared to the healthy side. There was no statically significant difference for the femoral length (p = 0.08). Conclusion: When using EOS stereography following antegrade intramedullary nailing of post-traumatic diaphyseal femur fractures, a statistically significant difference of more than 15.4° in internal rotation was found for femoral rotation on the operated side compared to the healthy side.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [B. Poirot] Last name [Seynaeve]. Also, kindly confirm the details in the metadata are correct.The last name of the first author was corrected : Given name = B. and last name = Poirot Seynaeve The details in matadata are correct Level of evidence: III. [ABSTRACT FROM AUTHOR]

This review presents the principal features of paediatric femoral shaft fractures including the contemporary management strategies and relevant supporting evidence. The article is an overview of information relevant to clinical practice, in addition to preparation for the FRCS (Orth) examination. [ABSTRACT FROM AUTHOR]

Aims: Distal femoral resection in conventional total knee arthroplasty (TKA) utilizes an intramedullary guide to determine coronal alignment, commonly planned for 5° of valgus. However, a standard 5° resection angle may contribute to malalignment in patients with variability in the femoral anatomical and mechanical axis angle. The purpose of the study was to leverage deep learning (DL) to measure the femoral mechanical-anatomical axis angle (FMAA) in a heterogeneous cohort. Methods: Patients with full-limb radiographs from the Osteoarthritis Initiative were included. A DL workflow was created to measure the FMAA and validated against human measurements. To reflect potential intramedullary guide placement during manual TKA, two different FMAAs were calculated either using a line approximating the entire diaphyseal shaft, and a line connecting the apex of the femoral intercondylar sulcus to the centre of the diaphysis. The proportion of FMAAs outside a range of 5.0° (SD 2.0°) was calculated for both definitions, and FMAA was compared using univariate analyses across sex, BMI, knee alignment, and femur length. Results: The algorithm measured 1,078 radiographs at a rate of 12.6 s/image (2,156 unique measurements in 3.8 hours). There was no significant difference or bias between reader and algorithm measurements for the FMAA (p = 0.130 to 0.563). The FMAA was 6.3° (SD 1.0°; 25% outside range of 5.0° (SD 2.0°)) using definition one and 4.6° (SD 1.3°; 13% outside range of 5.0° (SD 2.0°)) using definition two. Differences between males and females were observed using definition two (males more valgus; p < 0.001). Conclusion: We developed a rapid and accurate DL tool to quantify the FMAA. Considerable variation with different measurement approaches for the FMAA supports that patient-specific anatomy and surgeon-dependent technique must be accounted for when correcting for the FMAA using an intramedullary guide. The angle between the mechanical and anatomical axes of the femur fell outside the range of 5.0° (SD 2.0°) for nearly a quarter of patients. Cite this article: Bone Jt Open 2024;5(2):101–108.

Context: Diaphyseal tibiofibular synostosis (DTS) is a rare pathology with unknown origin especially occurring in intensive sport athletes. No therapeutic guideline has been well established in the literature. Case Presentation: A rare case of DTS in a 26-year-old professional rugby player has been described. A 5-month exhaustive conservative treatment including physiotherapy and oral medication has been achieved but failed. Management and Outcomes: Following the conservative treatment failure, the DTS has been widely removed including the adjacent interosseous membrane, and the patient could return to competition at the same level after 5 months of convalescence. No recurrence has been revealed at a 35-month follow-up at least. Conclusion: In accordance with the literature data and even if the pathophysiology remains obscure, resection of DTS seems to be the adapted treatment to allow and to reduce professional athletes' recovery time at the same sport level. The resection including a part of the tibiofibular interosseous membrane could avoid the occurrence of recurrence. Conservative treatment should be reserved for senior patients with a low sport activity. [ABSTRACT FROM AUTHOR]

Background: The humerus, being the largest bone of the upper limb, relies on a well-established blood supply system for its nourishment and healing processes, particularly in cases of fractures. The presence and characteristics of the nutrient foramen play a crucial role in determining the effectiveness of orthopedic surgical interventions and the healing outcome of fractured bones. Understanding the quantitative and qualitative aspects of the nutrient foramen in the humerus is essential for orthopedic surgeons to minimize the risk of vascular injury during surgical procedures and optimize fracture healing. Methods: This analytical observational study examined 160 dry humeri (80 right and 80 left) of unknown genders obtained from the anatomy department of a medical college over a three-year period. Bones with previous damage, healed fractures, congenital anomalies, and significant pathological changes were excluded. The nutrient foramina were identified, and their quantity, position, location, and orientation were examined using magnification. The foraminal index (FI) was calculated to determine the location of the nutrient foramen relative to different segments of the humerus. Osteometric measurements were conducted using appropriate tools, and statistical analysis was performed using Microsoft Excel. Results: The majority (91.25%) of humeri exhibited a solitary nutrient foramen, while a small percentage displayed two (3.75%) or three (1.25%) foramina. Most nutrient foramina were located on the anteromedial surface (89.02%) of the humerus, primarily in the middle one-third segment (86.58%). The mean total length of the humerus was approximately 30.11 cm, with the nutrient foramina situated at an average distance of 16.65 cm from the proximal end. The consistent foraminal index (55.53%) indicated a uniform distribution pattern of nutrient foramina along the length of the humerus. Conclusion: This study provides valuable insights into the quantity, orientation, and position of the nutrient foramen in the humerus. The findings underscore the importance of understanding the vascular anatomy of the humerus for orthopedic surgical planning and fracture management. Orthopedic surgeons can use this knowledge to minimize the risk of vascular injury during surgical procedures and optimize fracture healing outcomes, ultimately improving patient care and treatment efficacy. [ABSTRACT FROM AUTHOR]

The bone defect, characterized by the undesired loss of bone material, can arise from postinfection cavities, lesion therapy, or fractures, presenting a complex and challenging healing process. This condition is influenced by various contributing factors. Long bones are categorized into three segments (epiphysis, metaphysis, and diaphysis) under the Universal Long Bone Defect Classification. This study aimed to determine differences in the healing process of bone defects based on the position of the defect. Conducted on 60 male Wistar rats (12 weeks old, weighing 250-300 mg), the experiment includes two groups: Group A (30 animals with metaphyseal defects) and Group B (30 animals with diaphyseal defects). Each group was divided into smaller subgroups, each consisting of 6 animals, based on designated observation days: H0, 5, 10, 17, and 25. This arrangement led to the formation of ten groups in total. The assessment involves osteogenesis markers and defect area measurement from radiographs, revealing higher values for osteoblasts and osteoclasts in Group B, except for Group A chondrocytes which exhibit higher values. Additionally, the lesion area in Group B is smaller. Statistical analysis confirms these differences, leading to the conclusion that bone defects in the diaphyseal area exhibit faster healing compared to the epiphyseal or metaphyseal regions. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to define the ideal surgical treatment option for distal humerus fractures by comparing different surgical techniques. Material and methods: Seventy-one patients with distal humerus diaphysis fractures who were treated between 2015 and 2020 were retrospectively investigated,. The patients were operated on with the posterior approach of open reduction and plate-screw osteosynthesis (Group A), plated with the minimal invasive technique (Group B), operated on using the lateral approach (Group C) and treated with an external fixator (Group D). Age, gender, mechanism of fracture, fracture type and AO class, applied surgical method, additional injuries, duration of operation, amount of bleeding, amount of fluoroscopy used, length of hospital stay, radiological angular values, union time, complications, and clinical examination findings of the patients were examined retrospectively and the differences between the mentioned surgical methods were investigated. Results: Blood loss was significantly less in Groups C and D (p

This study investigated differences in the fibular diaphyseal curvature between prehistoric Jomon hunter–gatherers and modern Japanese people. A total of 115 skeletal remains of 40 individuals from the Late/Final Jomon period (approximately 4300–2500 years BP) and 75 modern Japanese individuals were included in the analysis. The degree of anteroposterior and mediolateral diaphyseal curvature was measured based on digital photographs taken from the frontal and sagittal planes at every 5% diaphyseal region between the range of 20–80% of the fibular length. Fibular diaphyseal curvature was compared between both populations and sexes, and the correlation between fibular diaphyseal curvature with diaphyseal cross-sectional morphology and body size variables were confirmed. The results showed significant differences in the anteroposterior diaphyseal curvature between the Jomon and modern Japanese populations, and a significantly curved anterior direction was noted for Jomon males and females, compared with modern Japanese males and females. On the contrary, little populational difference was noted in terms of mediolateral diaphyseal curvature. The curvature of the fibular diaphysis showed less correlation with body size variables. Moreover, anteroposterior diaphyseal curvatures were correlated with diaphyseal robustness and had low correlation with diaphyseal shape. A relationship between anteroposterior curvature and diaphyseal cross-sectional morphology, an indicator of habitual activity, was confirmed. This suggests that the fibular curvature is possibly influenced by mechanical loading from daily activities as well. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives: Evaluate bone healing time, consolidation, and the complication rate between the minimally invasive plate osteosynthesis and open reduction with plate osteosynthesis in humeral diaphyseal fractures with an intact wedge (AO 12B2). Methods: A retrospective study was carried out between 2016 and 2020. The medical records and radiographs of 18 patients were analyzed, and data were collected regarding the time of consolidation, age, sex, plate size, number of screws, complications such as iatrogenic injury damage to the radial nerve, material failure, and postoperative infection. Results: No statistically significant differences were observed in the variables of age, sex, plate size, and number of screws used or in the RUSHU index (Radiographic Union Score for Humeral fractures). There were no postoperative infections, material failure, or need for reoperation, nor cases of secondary radial nerve injury. After one year, all patients had a consolidation index analyzed by RUSHU >11. Conclusion: both techniques showed similar results, with a high consolidation rate and low rates of complications or iatrogenic damage to the radial nerve. Evidence level III; Retrospective comparative study .

We discuss several variants of the metaphyseal and diaphyseal bone surfaces that may be misleading in clinical practice. They include metaphyseal stripes, spiculated metaphyseal cortex, cortical desmoid, laminated lateral supracondylar ridge, cortical vascular canals, variations in shape or lucency of normal tuberosities, cortical thickening of normal ridges, and well-organized undulated hyperostosis at the proximal phalanges. [ABSTRACT FROM AUTHOR]

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Summary: A 4‐week‐old Warmblood foal presented with a rapidly growing firm mass on the dorsomedial aspect of the distal left third metacarpal bone. The initial examination revealed no pain on palpation or associated lameness. Radiography demonstrated a solitary expansile large osseous cyst‐like lesion with a coarse intra‐luminal trabecular pattern associated with the cortical bone. Computed tomographic imaging was performed prior to surgery and revealed a monostotic, eccentric, diaphyseal and likely periosteal nonaggressive osseous lesion. A transcutaneous surgical approach was used to excise the mass followed by curettage of the parent bone. The foal recovered uneventfully and no re‐occurrence of the mass was noted after 12 months. Histopathology of the mass revealed a reactive process consisting of trabecular bone, haemosiderophages, granulation tissue and mesenchymal tissue proliferation consistent with an aneurysmal bone cyst. Aneurysmal bone cysts should be included in the differential diagnosis of rapidly growing masses on long bones in foals and are amenable to surgical resection. [ABSTRACT FROM AUTHOR]

The microstructure of limb skeletal bones is closely related to ontogenetic age, localised skeletal growth dynamics, biomechanical modes of bone load, and possible taxonomic differences. This is important for the investigation of the problematic issues of ontogenetic changes in the compact bone tissue of domestic ducks. The purpose of the study was to compare the microstructure of the mid-diaphysis of the humerus and femur bones of Blagovarsky cross ducks, depending on age and gender. The material for research was the tubular bones of the thoracic (humerus) (n = 72) and pelvic (femur) (n = 72) limbs of Blagovarsky cross ducks aged 1 day, 10, 20, 30, 90, 196, 268, 341 and 483 days of postnatal ontogenesis of both sexual groups (females and males of 36 ducks each), a total of 72 ducks. The timing of the selection of ducks coincided with the technological cycle of their cultivation. Histological sections with a thickness of 5-10 microns were obtained, which were dyed with hematoxylin Karatsi and eosin, and according to Van Gieson for connective tissue differentiation. Morphometry determined the quantitative indicators of compact bone tissue in the middle of the diaphysis of tubular bones: the diameter of the diaphysis, the thickness of the periosteum, compact bone tissue, the diameter of osteons and central channels of osteons (Havers channels). It was discovered that the growth of the humerus and femur bones in length and thickness is completed on the 196th day of the postnatal period of ontogenesis in both female and male ducks. It was established that medullary (cerebral) bone tissue (1.01 ± 0.10 mm) appears from the femoral endostus of females, which is formed on the 196th day of the postnatal period of ontogenesis (the beginning of sexual maturity of females) and is further observed in intensive periods of their egg production on 268 and 341 days (2.43 ± 0.56 and 2.55 ± 0.62 mm, respectively), and disappears on the 483rd day (0.20 ± 0.03 mm) when the duck is not laying eggs. This study for the first time determined the age dynamics of morphometric parameters of microstructures of compact bone tissue of the humerus and femur and established their sex differences in ducks of the Blagovarsky cross. The results of comparative morphology studies are necessary for determining the age, sex, and species of birds based on the microstructure of compact bone tissue in the middle of the diaphysis of tubular bones, and for the ability to differentiate changes in the occurrence of limb pathologies in poultry

Fracture related infection (FRI) may be a devastating complication of open tibial shaft fractures. We sought to determine if antibiotic bead pouch, negative pressure wound therapy, or negative pressure wound therapy over antibiotic beads as the initial coverage method for type IIIB open tibial shaft fractures is associated with risk of FRI. Retrospective cohort study with radiograph and chart review of patients aged ≥16 years with isolated, displaced, extra-articular, Gustilo-Anderson type IIIB open diaphyseal AO/OTA 42 tibial fractures requiring rotational or free tissue transfer for soft tissue coverage at one Level 1 trauma center between 2007 and 2020. An association of dressing applied at the first surgical debridement (application of antibiotic bead pouch, negative pressure wound therapy, or combined therapy) with a primary outcome of FRI requiring debridement or amputation was analyzed by multivariable logistic regression considering demographic, injury, and treatment characteristics. 113 patients met eligibility criteria. Median follow-up was 33 months (interquartile range 5–88). 41 patients were initially treated with NPWT, 59 with ABP, and 13 with ABP+NPWT at the initial surgical debridement. 39 (35%) underwent subsequent debridement or amputation for FRI. One amputation occurred in the ABP group for refractory deep surgical site infection (p = 0.630). Initial wound management with an antibiotic bead pouch versus either negative pressure wound therapy alone or negative pressure wound therapy combined with an antibiotic bead pouch was associated with lower odds of debridement or amputation for FRI (β = -1.08, 95% CI -2.00 to -0.17, p = 0.02). In our retrospective analysis, antibiotic bead pouch for initial coverage of type IIIB open tibial shaft fractures requiring flap coverage was associated with a lower risk of FRI requiring debridement or amputation than negative pressure wound therapy applied with or without antibiotic beads. A prospective clinical trial is warranted. [ABSTRACT FROM AUTHOR]

Osteosarcoma is the most frequent primary malignant tumor at the level of the bone system, characterized by the formation of osteoid from tumor cells. Its central location is the metaphysis of the long bones; however, the proximal part of the tibia is also one of the most affected, with 50% to 60% of the cases. This work aims to present a case study of a male patient diagnosed with fusocellular osteosarcoma located in the diaphysis and proximal epiphysis of the tibia who showed signs and symptoms three months before the evaluation, secondary to a trauma located in his lower limb. From the imaging point of view, an image suggestive of a metaphyseal tumor lesion that extended to the epiphysis and medullary canal was observed. The histopathological and imaging study concluded that the patient presented a grade II fusocellular osteosarcoma in the right proximal tibia, which merited surgical management and chemotherapy with an excellent clinical response. The importance of scientific and biomedical advances is evidenced, allowing better control of these diseases and treatment that generates better conditions for post-surgical rehabilitation and life expectancy. [ABSTRACT FROM AUTHOR]

Background. The excessive weight of a patient creates certain complications in the course of the disease, which are caused by an increase in the load on the biomechanical structure. The bones of the lower leg will experience significant torsional loads. Such loads are the most dangerous, as they represent a complex combination of bending, stretching and compression loads. The purpose was to conduct a comparative analysis of the stressstrain state of models with a tibial fracture in the lower third of the diaphysis under the influence of torsional load with different options of osteosynthesis and depending on the patient’s weight. Materials and methods. A fracture in the lower third of the tibia and three types of osteosynthesis were simulated using an external fixation device, a bone plate, and an intramedullary rod. The torque of 7 and 12 Nm was applied to the tibial plateau. Results. An intramedullary rod provides a minimum stress level in the fracture zone under torsional load. Osteosynthesis with a bone plate does not provide significant stress reductions in any of the tibial areas, except for the fixing screws, where the stresses are zero. As for the values of stresses on the elements of metal structures, in this case a bone plate looks better than other structures. External fixation device and an intramedullary rod provide a reduction in stress values in the fracture zone significantly below the level for an intact bone. In the distal part, stress level is lowest in the model with a bone plate osteosynthesis. In the proximal part of the tibia, stresses exceeding the parameters of the model with an intact bone occur when using an intramedullary rod. The lowest stresses occur in a bone plate. The same happens around the fixing screws and rods when using a bone plate, where stresses are at the lowest level compared to other structures. Conclusions. The stress levels in the fracture zone are highest when using a bone plate; at the same time, the stress levels on the metal structure and fixing screws are at the lowest level. Osteosynthesis with the help of external fixation device ensures a fairly low level of stresses in the fracture zone, but the disadvantage is a high level of stresses in the proximal part of the tibia. The stress values in the fracture zone and in the proximal tibia are lowest when using osteosynthesis with an intramedullary rod, but in the distal part, the stresses are at the highest level among all options of osteosynthesis. Thus, according to the criterion of the stress value in the fracture zone, osteosynthesis using an intramedullary rod is the most effective for diaphyseal fractures of the tibia in the lower third. A bone plate appears to be least effective. [ABSTRACT FROM AUTHOR]

Compensatory growth (CG) is accelerated growth that occurs when food availability increases after food restriction. This rapid growth may be associated with sublethal consequences. In this study, we investigated the effects of food restriction and subsequent realimentation and CG on bone structure in juvenile green turtles (Chelonia mydas). Turtles were fed ad libitum food for 12 weeks (AL), restricted food for 12 weeks (R), or restricted food for 5 weeks followed by ad libitum food for 7 weeks (R-AL). R-AL turtles demonstrated partial CG via enhanced food conversion efficiency (FCE) upon realimentation. After the 12th week, gross morphology (GM), microarchitecture, and mineralization of the right humerus of each turtle were analyzed. Many GM measurements (including proximal and maximal bone lengths, bone widths, and shaft thickness), most measurements of bone microarchitecture (excluding cortical and trabecular thickness and trabecular separation), and all mineralization measurements were labile in response to intake. We examined the possibility that changes in nutrient allocation to bone structure during realimentation facilitated CG in previously food-restricted turtles. Restoration of bone lengths was prioritized over restoration of bone widths during CG. Furthermore, restoration of trabecular number, connectivity density, and bone volume fraction was prioritized over restoration of cortical bone volume fraction. Finally, diaphyseal bone mineralization was partially restored, whereas no restoration of epiphyseal bone mineralization occurred during CG. Shifts in nutrient allocation away from certain bone attributes during food restriction that were not rectified when food availability increased probably provided an energy surplus that enhanced the conversion of food to growth and thus powered the CG response. Our study revealed how resource allocation to various bone attributes is prioritized as nutritional conditions change during development. These "priority rules" may have detrimental consequences later in life, indicating that conservation of green turtle foraging grounds should be given high priority. [ABSTRACT FROM AUTHOR]

Aims In this study, we aimed to explore surgical variations in the Femoral Neck System (FNS) used for stable fixation of Pauwels type III femoral neck fractures. Methods Finite element models were established with surgical variations in the distance between the implant tip and subchondral bone, the gap between the plate and lateral femoral cortex, and inferior implant positioning. The models were subjected to physiological load. Results Under a load of single-leg stance, Pauwels type III femoral neck fractures fixed with 10 mm shorter bolts revealed a 7% increase of the interfragmentary gap. The interfragmentary sliding, compressive, and shear stress remained similar to models with bolt tips positioned close to the subchondral bone. Inferior positioning of FNS provided a similar interfragmentary distance, but with 6% increase of the interfragmentary sliding distance compared to central positioning of bolts. Inferior positioning resulted in a one-third increase in interfragmentary compressive and shear stress. A 5 mm gap placed between the diaphysis and plate provided stability comparable to standard fixation, with a 7% decrease of interfragmentary gap and sliding distance, but similar compressive and shear stress. Conclusion Finite element analysis with FNS on Pauwels type III femoral neck fractures revealed that placement of the bolt tip close to subchondral bone provides increased stability. Inferior positioning of FNS bolt increased interfragmentary sliding distance, compressive, and shear stress. The comparable stability of the fixation model with the standard model suggests that a 5 mm gap placed between the plate and diaphysis could viably adjust the depth of the bolt. Cite this article: Bone Joint Res 2022;11(2):102–111.

This work presents the newly updated csg-toolkit package for GNU Octave, a user-friendly virtual osteology software that can compute and visualize the diaphyseal cross-sectional geometric (CSG) properties of the long bones of the lower and upper limbs. The CSG properties of the diaphysis have been extensively used for mechanical loading studies and have recently shown promising results in research topics of forensic anthropology, such as skeletal activity markers, sex estimation, and osteometric sorting. The csg-toolkit optimizes the computation of the CSG properties by integrating existing 3D technologies and novel computational geometry methods in osteology, so that they can be embedded in forensic applications. This new version supports a number of additional options regarding the computation and visualization of those properties, such as placement customization for the cross-sections, automatic registration and identification of the specific bone model and its alignment points, and visual inspection of the cross-sections upon generation. Additional improvements have been made that minimize the effort and time needed for analyzing a long bone. The csg-toolkit is a reliable alternative to the traditional Latex Cast Method. Overall, the csg-toolkit provides a simple, flexible, and computationally accurate method for 3D virtual long bone analysis and its free and open-source implementation can facilitate the utilization of cross-sectional geometry in forensic contexts.

Background: Metaphyseal fixation for endoprosthetic reconstruction after bone tumor resection is difficult due to the short residual bone length and reverse funnel shape of the metaphysis. In the current study, 3D-printed axial compressive endoprosthesis (ACE) with a short stem and intramedullary axial compressive mechanism is proposed to improve metaphyseal fixation. The rationales of ACE are that 1) intramedullary axial compress enhances the stability of endoprosthesis and facilitates bone ingrowth at the osteotomy site; 2) 3D printed porous metallic surface at osteotomy surface and stem allows bone ingrowth to achieve osseointegration.Methods: A biomechanical study was performed to explore the initial stability using Sawbones. A diaphysis and metaphyseal segmental defect were created and four fixation structures were simulated: 1) ACE; 2) ACE + lateral plate; 3) stem prosthesis + unilateral plate; 4) stem prosthesis + bilateral plates. Bending and torsional stiffness were determined with a material testing machine. The relationship between the torque of the compression nut and the axial compression force of the bone-implant surface was measured using a round gasket load sensor.Results: ACE + lateral plate was the stiffest in the bending test (sagittal 324.3 ± 110.8 N/mm, coronal 307.7 ± 8.7 N/mm). ACE + lateral plate and stem prosthesis + bilateral plates had the highest torsional stiffness (10.9 ± 1.3 Nm/° and 10.7 ± 0.2 Nm/° respectively). The bending stiffness of ACE was equivalent to stem prosthesis + bilateral plates (sagittal 196 ± 10 N/mm vs. 200 ± 7 N/mm, coronal 197 ± 14 N/mm vs. 209 ± 3 N/mm), but the torsional stiffness of ACE was inferior to stem prosthesis + bilateral plates (6.1 ± 1.3 Nm/° vs. 10.7 ± 0.2 Nm/°). Stem prosthesis + unilateral plate was the least stiff both in bending and torsion. The relationship between torque (T/Nm) and axial pressure (F/N) was F = 233.5T.Conclusion: The axial compressive design of ACE enhances primary stability and facilitates osseointegration, which provides an alternative option of metaphyseal fixation for endoprosthetic reconstruction.

Aim: Determination of the target criteria of physical rehabilitation and the optimal time of their implementation depending on the methods of fixation of fractures of the humeral diaphysis. Materials and methods: The results of treatment of 59 patients with diaphyseal humeral fractures have been studied. All patients underwent extra- or intramedullary osteosynthesis. Results: In the absence of satisfactory stability of fracture fixation (Group A), passive movements and no active movements are recommended, especially in the presence of free bone fragments that serve as a site for muscle insertion (Group A1). The presence of free fragments with stable fixation (Groups B1 and B2) determined the possibility of active adduction and abduction movements of the shoulder. Complexes of physical rehabilitation exercises with the exclusion or prohibition of active rotational movements have been chosen for patients of Groups C1 and C2. Conclusions: The proposed system of distribution of physical load during the rehabilitation period according to the “ABC” type provides a biomechanically based approach to the rehabilitation process. [ABSTRACT FROM AUTHOR]

Division of the growing long bone into individual basic parts, that is, diaphysis, metaphysis, physes and epiphyses, has become generally accepted and used. However, the origin of these terms is almost unknown. Therefore, we have analyzed the literature in order to identify their sources. The terms epiphysis and apophysis have been used since the time of Hippokrates, although with different meanings. During the time of Galen, the term apophysis was used to describe all types of bone processes, and epiphyses denoted articular ends. The term diaphysis denoting the middle cylindrical part of the long bone was used for the first time by Heister in 1717. The first to use the term metaphysis was Theodor Kocher in his books on gunshot wounds and on bone inflammation of 1895. On the basis of Kocher's study, Lexer published a radiological study of the vascular supply to bones in which he defined metaphyseal blood vessels as a separate group supplying a particular part of the long bone. The epiphyseal growth plate had no particular name from the time of its first description in 1836. During the second half of 19th century, this structure acquired different names. The term "physis" was therefore introduced in 1964 by the American radiologist Rubin in order to label the growth structure between metaphysis and epiphysis clearly. One year later, the term physis also appeared in the radiological literature, and during the following decades it spread in the orthopedic literature., (© 2024 The Authors. Clinical Anatomy published by Wiley Periodicals LLC on behalf of American Association of Clinical Anatomists and British Association of Clinical Anatomists.)

Magnesium (Mg), as a biodegradable material, is a promising candidate for orthopedic surgery. Long-bone fractures usually occur in cancellous-bone-rich epiphysis at each end or the cortical-rich diaphysis in the center, with different bone healing processes. Little is known about the differences in results between the two regions when applying Mg implants. Therefore, this study aimed to compare the biodegradation and osteogenesis of Mg implants in a rat model's epiphysis and diaphysis of the long bone. Twelve male Sprague Dawley rats underwent Mg rod implantation in the distal femoral epiphyses and tibial diaphyses. Every three weeks for up to twelve weeks, degradation behavior, gas evolution, and new bone formation were measured by micro CT. Histomorphology was analyzed by Hematoxylin and Eosin, Villanueva bone staining, and TRAP staining for osteoclastogenesis evaluations. Micro-CT analysis showed statistically significant higher new bone formation in the epiphysis group than in the diaphysis group, which correlated with a lower gas volume. Histological analysis showed higher osseointegration of Mg implants in the epiphyseal region than in the diaphyseal region. The magnesium implant's osteoclastogenesis-inhibiting properties were shown in the surrounding areas in both the cortical bone of the diaphysis and the cancellous bone of the epiphysis. Our findings show the differences in the magnesium implant's osteogenesis and biodegradation in the epiphysis and the diaphysis. These dissimilarities indicate a better response of the epiphyseal region to the Mg implants, a promising biomaterial for orthopedic surgery applications. [ABSTRACT FROM AUTHOR]

Background: Non-union in non-operatively managed humeral shaft fractures are associated with significant morbidity. Hence, developing a robust system that could help with early diagnosis is important. We aimed to evaluate the validity of the Radiographic Union Score for HUmeral fractures (RUSHU) at 6 weeks (RUSHU-6) and test whether a RUSHU at 12 weeks (RUSHU-12) would be a better predictor of non-union. Methods: We retrospectively reviewed all non-operatively managed humeral diaphyseal fractures from 2012 to 2018. Statistical analysis was used to determine the cut-off RUSHU-12 and evaluate the effect of RUSHU-6 and RUSHU-12 on non-union prediction. Results: In sum, 32 patients had radiographs at 6 weeks post-injury, 27 of which also had radiographs at 12 weeks. A RUSHU cut-off of 9 was the best predictor of non-union at 12 weeks. Only RUSHU-12 had a statistically significant influence predicting non-union (P = 0.011) and there was a significant correlation (P = 0.003) between score progression from RUSHU-6 to RUSHU-12 and the development of non-union. Discussion: A RUSHU-12 of <9 and a low score progression between 6 and 12 weeks suggest superior predictive value in determining the likelihood of non-union. Further validation in the form of a large multicentred study is however required. [ABSTRACT FROM AUTHOR]

PurposeUnstable femoral shaft fractures (UFSFs) in children aged 5–11 years remain challenging due to their intrinsic instability. The aim of this study was to evaluate the clinical and radiographic outcomes of UFSF in children aged 5 to 11 years managed by the combined use of ESIN and temporary EF.MethodsChildren with UFSF (long oblique and comminuted) treated by ESIN and temporary EF were retrospectively reviewed. Sex, age at injury, side involved, type of fracture, presence or absence of associated lesions or neurovascular complications, type of treatment, time from trauma to surgery, duration of surgery, radiation exposure and length of postoperative immobilization were collected from the medical charts. Radiological and functional outcomes were evaluated according to Beaty's and Flynn's criteria, respectively.ResultsA total of 28 consecutive patients with closed or open (Gustilo type I or II) UFSF were reviewed (18 boys and 10 girls). The mean age at injury was 8.7 ± 1.6 years (range, 5–11); the average weight was 38.1 ± 7.6 kg (range, 26–55). The mean hospital stay was 3.7 ± 1.4 days (range, 2–7), and the mean time to EF and ESIN removal was 6.5 ± 1.1 weeks (range, 4–8) and 9.4 ± 1.6 months (range, 6–12), respectively. Twenty-seven out of 28 patients had excellent radiographic outcomes according to Beaty's criteria, and 24/28 had excellent functional outcomes according to Flynn's criteria. Overall, 4 complications (14.3%) were recorded. No statistically significant correlation was found between complication rates and sex, age, weight or fracture characteristics (P < 0.05).ConclusionsThe combined use of ESIN and temporary EF provides good clinical and radiological outcomes in children with UFSF aged between 5 and 11 years, with a reduced complication rate.

The microstructure of limb skeletal bones is closely related to ontogenetic age, localised skeletal growth dynamics, biomechanical modes of bone load, and possible taxonomic differences. This is important for the investigation of the problematic issues of ontogenetic changes in the compact bone tissue of domestic ducks. The purpose of the study was to compare the microstructure of the mid-diaphysis of the humerus and femur bones of Blagovarsky cross ducks, depending on age and gender. The material for research was the tubular bones of the thoracic (humerus) (n = 72) and pelvic (femur) (n = 72) limbs of Blagovarsky cross ducks aged 1 day, 10, 20, 30, 90, 196, 268, 341 and 483 days of postnatal ontogenesis of both sexual groups (females and males of 36 ducks each), a total of 72 ducks. The timing of the selection of ducks coincided with the technological cycle of their cultivation. Histological sections with a thickness of 5-10 microns were obtained, which were dyed with hematoxylin Karatsi and eosin, and according to Van Gieson for connective tissue differentiation. Morphometry determined the quantitative indicators of compact bone tissue in the middle of the diaphysis of tubular bones: the diameter of the diaphysis, the thickness of the periosteum, compact bone tissue, the diameter of osteons and central channels of osteons (Havers channels). It was discovered that the growth of the humerus and femur bones in length and thickness is completed on the 196th day of the postnatal period of ontogenesis in both female and male ducks. It was established that medullary (cerebral) bone tissue (1.01 ± 0.10 mm) appears from the femoral endostus of females, which is formed on the 196th day of the postnatal period of ontogenesis (the beginning of sexual maturity of females) and is further observed in intensive periods of their egg production on 268 and 341 days (2.43 ± 0.56 and 2.55 ± 0.62 mm, respectively), and disappears on the 483rd day (0.20 ± 0.03 mm) when the duck is not laying eggs. This study for the first time determined the age dynamics of morphometric parameters of microstructures of compact bone tissue of the humerus and femur and established their sex differences in ducks of the Blagovarsky cross. The results of comparative morphology studies are necessary for determining the age, sex, and species of birds based on the microstructure of compact bone tissue in the middle of the diaphysis of tubular bones, and for the ability to differentiate changes in the occurrence of limb pathologies in poultry [ABSTRACT FROM AUTHOR]

Treatment of humerus fractures is divided into operative and non-operative treatment Fractures of the diaphysis of the humerus heal well. Surgeons today have many opportunities to treat them. The decision on the type of treatment to be applied depends on the location of the fracture, the existence of associated injuries, the age and the general condition of the patient. Non-operative treatment is most often applied, although there are fractures in which surgical intervention is necessary in order to perform healing and prevent complications. Non-operative treatment of fractures of the diaphysis of the humerus gives good results, with little angulation and minimal or no shortening of the arm. Adequate repositioning, appropriate plaster immobilization and regular X-rays heal the fracture within the allotted time. Disciplined early physical therapy in terms of circular movements prevents shoulder contracture and allows later physical therapy to last significantly shorter. Non-operative treatment lasts from 7-11,5 weeks.

Background: The fibula is a long bone located at the lateral aspect of the leg. Its diaphysis is principally nourished by one or more nutrient arteries entering the shaft through an opening referred to as the nutrient foramen. The present findings on the morphometrics of the foramen may be helpful to forensic experts, radiologists and clinicians for diagnosis and management of various bony conditions. Materials and Methods: This was a descriptive cross sectional study conducted on fifty dry adult human fibulae collected at the Department of Anatomy, Chitwan Medical College from June to September 2020. Total fibular length along with the number and location of all nutrient foramina present were recorded. Foraminal index of the fibula was calculated as well. Results: The study revealed that the average length of Nepalese fibulae was 34.1 ± 1.9 cm. Eighty-eight percent fibula had a single nutrient foramen, 4 % had two and 8 % had none. The most common location was between the medial crest and posterior border (63%, in fibula with single foramen), followed by the medial crest (30%) and between the medial crest and interosseous border (7%). The average foraminal index was 44.01 ± 7.9 % with a range of 34.9 to 65.7 %. Conclusion: Single nutrient foramen located at the middle third on posterior aspect was the most common finding. Regional data on the number and location of the foramina would be useful to forensic experts and clinicians for various diagnostic and treatment purposes.

We carried out a prospective randomized study to compare the clinical and radiological results of metacarpal diaphyseal fractures treated with retrograde intramedullary headless cannulated screws (IHCS) and plates. Fractures were fixed with IHCS in 34 patients (37 metacarpals) and locked miniplates in 35 patients (40 metacarpals). The mean age was 33 years (range 18–61) in the IHCS group and 32 years (range 17–68) in plate group. All patients were followed up for 1 year. All fractures in the IHCS group united but there was one nonunion in the plate group. At final follow-up, there was no significant difference between the groups in total active movement, visual analogue pain score, Disabilities of the Arm, Shoulder, and Hand score and grip strength, although the study was not sufficiently powered to exclude differences with certainty. IHCS is a safe and fast technique that is a good alternative to plate fixation in metacarpal diaphyseal fractures. Level of evidence: I [ABSTRACT FROM AUTHOR]

Giant cell tumor (GCT) is an aggressive osteolytic lesion mostly affecting the meta-epiphyses of long bones at skeletal maturity. Occurrence of the GCT in diaphysis is a rare entity in adult and exceptionally rare in pediatric population. This is the only third diaphyseal case reported in pediatric population. We report a case of recurrent diaphyseal GCT in a skeletally immature patient of 15-year-old male at the right radius after previous resection with plate and screw fixation. Upon optimal investigations, en-bloc resection of the tumor with radial resection and ulna centralization with wrist arthrodesis was done for a campanacci stage III GCT. The patient had an uneventful recovery without recurrence for 2 years and 2 months following surgery. The main challenge relies on accurate diagnosis due to uncommon location that hinders adequate treatment plan, therefore diagnosis should be solely based on histopathology findings. [ABSTRACT FROM AUTHOR]

Introduction: Treatment of long bone defects is a challenging problem in orthopedics that requires a robust and comprehensive classification system to guide diagnosis and management. The Universal Long Bone Defect Classification (ULBDC) is an alphanumeric system detailing the size and location of the defect. It is designed to describe the bone defect and indicate the appropriate treatment for both diaphyseal and articular long bones defects. Methods: The location, size, and morphology of the bone defect are the main criteria used in the treatment of both extra-articular and intra-articular bone defects. The proposed classification system utilizes the following nomenclature for both periarticular defects and diaphyseal defects: location (bone and segment) and morphology (type, group, and subgroup). Discussion: The ULBDC is based the same principles of coding as the "gold standard" AO/OTA Fractures Classification system with alpha-numeric coding "from simple to complex." The choice of treatment method depends on the type, group, and subgroup of the defect as described. The principles of treatment of diaphyseal defects, as well as the principles of treatment of extra-articular fractures, are based on the restoration of the alignment, length, and rotation of the segment. Bone shortening and deformity are considered bone defects because their treatment requires the use of the same principles (osteotomies, bone grafting, bone transport, or combination of these methods) as treating real bone defects. Conclusion: The proposed classification is an attempt to classify all types of long bone defects and its use in clinical practice and research will allow for optimal and standardized treatments for the various types of bone defects to improve the treatment outcomes. [ABSTRACT FROM AUTHOR]

Background Minimally invasive plate osteosynthesis (MIPO) corresponds to the modern principles of "biological" fixation as it implies closed reduction and plate insertion causing minimal iatrogenic trauma. However, the lack of direct visualization increases the risk of damage to important anatomical structures. Purpose To develop recommendations in the use of MIPO for diaphyseal fractures of the humerus from anterolateral approaches to prevent possible complications and improve the results. Methods 16 shoulders of fresh cadavers were included in the study. In all cases, MIPO was performed with a straight plate (10–12 holes) and screws (2 proximal and 2 distal) using two anteriolateral approaches. Complete revision of the shoulder area was carried out in order to determine the accuracy of plate location and the relationship between the implant, neurovascular structures and bone landmarks. Results No damage or compression of the neurovascular and tendomuscular humerus structures was revealed. The average distance from the acromion to n. axillaris was 5.8 ± 0.66 mm (range from 4.9 to 6.9 mm). The average distance from the lateral epicondyle of the humerus to n. musculocutaneus was 56.5 ± 4.66 mm (from 49 to 63 mm). We observed the difference in location at the extreme pronation (5.1 ± 0.33 mm, from 4.5 to 5.7 mm) and supination positions of the forearm (5.8 ± 0.6 mm, from 5.1 to 6.1 mm) measuring the distance between the edge of the plate and n. radialis. The average distance between the distal medial edge of the plate and a. brachialis, n. medianus was 17.1 ± 2.7 mm (from 13 to 21 mm). Conclusions Based on the obtained data, we offer MIPO recommendations for anterolateral accesses in diaphyseal fractures of the humerus. Compliance with the proposed recommendations will reduce the risk of iatrogenic damage and improve the results of humeral fractures treatment.

Abstract Background This study was designed to evaluate the clinical outcomes of patients with diaphysis malignant tumors of femur and tibia treated with microwave ablation (MWA) in situ. Methods Retrospective study of 32 patients with diaphysis malignant bone tumors of femur or tibia have been treated by microwave ablation. Instead of en bloc resection, hyperthermia ablation in situ was carried out followed by strengthen procedure. The patients were followed up for a period ranging from 36 to 180 months. Results Twenty-five patients survived over 3 years and all of the patients alive have a satisfactory functional and cosmetic limb. The postoperative survival rate of MWA group was significantly higher than the amputation group in consecutive inclusions. Conclusions MWA is a feasible and effective surgical method for limb salvage operation and it might offer an innovative and distinctive therapeutic alternative for diaphysis malignant bone tumors, which avoiding osteotomy or prosthesis replacement. Level of evidence Level IV, clinical cohort study

Background: Forearm diaphyseal fractures constitute around 6% of all other children's fractures. Despite conservative management is proven and gold standard but still operative management is on rise. Aims and Objective: The aim of this study was to evaluate the outcome in conservative and surgical management of both-bone forearm fractures in children. Materials and Methods: This prospective study was conducted in children aged 3–12 years. Clinical and radiological features, time for union, angular correction over a period of management, and functional outcome were assessed. Data were entered and analyzed with Epi Info software. Results: There were 48 males (72.7%) and 18 (27.3%) females, with a mean age of 85 months (±29.7). In the present study, 34 (51.2%) at middle third was the most common site of diaphyseal fracture followed by distal third 28 (42.2) and proximal one-third. Conclusion: Fractures treated conservatively had greater healing potential and faster healing, whereas functional outcome was comparable in both conservatively and surgically treated patients.

ABSTRACT Introduction Humerus shaft fractures may be treated conservatively or surgically. In 2.5% to 13% of cases, nonunion is observed, and it leads to severe pain and morbidity. Plate osteosynthesis has become popular in the treatment of nonunion of the humeral shaft. In this study, we compared the clinical outcomes of patients with humerus shaft nonunion whom we treated with single- or double-plate fixation. Materials and Methods Fifty-three patients diagnosed with aseptic humeral shaft nonunion and treated with plate fixation were included in the study. Patients were evaluated according to the number of plates (single vs. double plates). The two groups were subjected to statistical evaluation according to their clinical and radiographical results. Results The average age of the patients was 53 years (range: 1-86); 28 (52.8%) were female and 25 (47.2%) were male. The union rate was 90.32% for single plate and 90.91% for double plate fixation. There was no statistically significant difference between single and double plates in the clinical and radiographical results (union time, union rate, Q-DASH score) (p > 0.05). There was a significant correlation between age and union times / Q-DASH scores according to the Spearman correlation test (p < 0.05). Transient radial nerve neuropraxia developed in 2 patients and 1 patient suffered from an infection that was treated with debridement and antibiotic therapy. Conclusion In our study, similar good results were obtained with single and double plates. In treatment of humeral shaft nonunions, a second plate is not needed if enough stability is provided with single plate fixation. Level of evidence III, Retrospective comparative study.

The primary aim was to identify patient and injury factors independently associated with humeral diaphyseal fracture nonunion after nonoperative management. The secondary aim was to determine the effect of management (operative/nonoperative) on nonunion. From 2008-2017, a total of 734 humeral shaft fractures (732 consecutive skeletally mature patients) were retrospectively identified from a trauma database. Follow-up was available for 663 fractures (662 patients, 90%) that formed the study cohort. Patient and injury characteristics were recorded. There were 523 patients (79%) managed nonoperatively and 139 (21%) managed operatively. Outcome (union/nonunion) was determined from medical records and radiographs. The median age at injury was 57 (range 16-96) years and 54% (n = 359/662) were female. Median follow-up was 5 (1.2-74) months. Nonunion occurred in 22.7% (n = 119/524) of nonoperatively managed injuries. Multivariate analysis demonstrated preinjury nonsteroidal anti-inflammatory drugs (NSAIDs; odds ratio [OR] 20.58, 95% confidence interval [CI] 2.12-199.48; P =.009) and glenohumeral arthritis (OR 2.44, 95% CI 1.03-5.77; P =.043) were independently associated with an increased risk of nonunion. Operative fixation was independently associated with a lower risk of nonunion (2.9%, n = 4/139) compared with nonoperative management (OR for nonoperative/operative management 9.91, 95% CI 3.25-30.23; P <.001). Based on these findings, 5 patients would need to undergo primary operative fixation in order to avoid 1 nonunion. Preinjury NSAIDs and glenohumeral arthritis were independently associated with nonunion following nonoperative management of a humeral diaphyseal fracture. Operative fixation was the independent factor most strongly associated with a lower risk of nonunion. Targeting early operative fixation to at-risk patients may reduce the rate of nonunion and the morbidity associated with delayed definitive management. [ABSTRACT FROM AUTHOR]

Ewing‐like adamantinoma (EAD) is a rare bone tumor. It remains unclear whether EAD belongs to adamantinoma, Ewing sarcoma (ES), or an independent category. Herein, we present a case of femoral sarcoma previously diagnosed as EAD in a 26‐year‐old woman. We observed amplified EWSR1 and NFATC2 fusion signals using fluorescence in situ hybridization. Prompted by its unique radiological features, we reviewed the current literature on skeletal EWSR1‐NFATC2 sarcoma (ENS) and EAD. In addition to the similar histological features, we found that both ENS and EAD displayed similar characteristic radiological features, such as the tendency to occur in the diaphysis of long bones, cortical expansion and buttressing‐type thickening, and bone surface involvement with saucer‐like erosion without cortical destruction. We believe that these unique radiological features were related to its indolent behavior. Altogether, it is possible that previously reported EAD cases may be neither ES nor the classic adamantinoma but ENS. Further studies are needed to clarify the relationship between EAD and ENS. [ABSTRACT FROM AUTHOR]

Summary: Bone stroma contributes to the regulation of osteogenesis and hematopoiesis but also to fracture healing and disease processes. Mesenchymal stromal cells from bone (BMSCs) represent a heterogenous mixture of different subpopulations with distinct molecular and functional properties. The lineage relationship between BMSC subsets and their regulation by intrinsic and extrinsic factors are not well understood. Here, we show with mouse genetics, ex vivo cell differentiation assays, and transcriptional profiling that BMSCs from metaphysis (mpMSCs) and diaphysis (dpMSCs) are fundamentally distinct. Fate-tracking experiments and single-cell RNA sequencing indicate that bone-forming osteoblast lineage cells and dpMSCs, including leptin receptor-positive (LepR+) reticular cells in bone marrow, emerge from mpMSCs in the postnatal metaphysis. Finally, we show that BMSC fate is controlled by platelet-derived growth factor receptor β (PDGFRβ) signaling and the transcription factor Jun-B. The sum of our findings improves our understanding of BMSC development, lineage relationships, and differentiation.