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The field of bone regeneration has primarily focused on investigating fracture healing and nonunion in isolated musculoskeletal injuries. Compared to isolated fractures, which frequently heal well, fractures in patients with multiple bodily injuries (polytrauma) may exhibit impaired healing. While some papers have reported the overall cytokine response to polytrauma conditions, significant gaps in our understanding remain in how fractures heal differently in polytrauma patients. We aimed to characterize fracture healing and the temporal local and systemic immune responses to polytrauma in a murine model of polytrauma composed of a femur fracture combined with isolated chest trauma. We collected serum, bone marrow from the uninjured limb, femur fracture tissue, and lung tissue over 3 weeks to study the local and systemic immune responses and cytokine expression after injury. Immune cell distribution was assessed by flow cytometry. Fracture healing was characterized using microcomputed tomography (microCT), histological staining, immunohistochemistry, mechanical testing, and small angle X-ray scattering. We detected more innate immune cells in the polytrauma group, both locally at the fracture site and systemically, compared to other groups. The percentage of B and T cells was dramatically reduced in the polytrauma group 6 h after injury and remained low throughout the study duration. Fracture healing in the polytrauma group was impaired, evidenced by the formation of a poorly mineralized and dysregulated fracture callus. Our data confirm the early, dysregulated inflammatory state in polytrauma that correlates with disorganized and impaired fracture healing.

INTRODUCTION: Tibial shaft fractures, frequently treated with intramedullary nailing (IMN), are high-risk fractures of nonunion. The effect of intramedullary nail diameter on fracture union reduction remains an area of investigation, with many surgeons anecdotally preferring to place at least a 10-mm tibial nail. We hypothesized that small-caliber nails (SCNs) (diameter ≤9 mm) are safe to use and have no difference in complication rates compared with large-caliber nails (LCNs) (≥10 mm). METHODS: A retrospective study was conducted on patients with tibial shaft fractures undergoing reamed IMN at a level 1 trauma center between 2018 and 2022. Patient and injury characteristics, intramedullary nail diameter, surgical details, and postoperative complication rates were recorded. Nail and intramedullary canal width at the isthmus on coronal radiographs determined the nail-canal ratio. Radiographic coronal and sagittal displacement, angulations between fracture segments, and coronal plane tibial mechanical axis were evaluated on latest radiographs. RESULTS: Among 113 patients, 68 received SCN while 45 received LCN. No difference was observed in the nail-canal ratio between the SCN and LCN groups, indicating that smaller nails were used for smaller canals. No significant demographic differences were noted between groups. LCNs were more prevalent in (AO Foundation/Orthopaedic Trauma Association classification) AO/OTA 42C (P = 0.03) and Gustilo-Anderson type III fractures (P = 0.05). The LCN group had higher rates of revision surgery (20% vs. 5.9%, P = 0.03) and wound dehiscence (8.9% vs. 0%, P = 0.02). Gustilo-Anderson IIIA fractures were independently associated with poorer outcomes overall. Radiographic parameters were comparable between groups. CONCLUSIONS: Small-diameter and large-diameter reamed intramedullary nails can be effective in treating tibial shaft fractures. Nail-canal ratios and alignment were similar between the two groups, suggesting that surgeons should not feel obligated to ream to a 10-mm nail in a smaller patient with a well-reduced fracture.

PURPOSE: To describe U-type sacral fracture characteristics amenable to percutaneous sacral screw fixation. METHODS: U-type sacral fractures were identified from a trauma registry at a level 1 trauma center from 2014 to 2020. Patient demographics, injury mechanism, fracture characteristics, and fixation construct were retrospectively retrieved. Associations between fracture pattern and surgical fixation were identified. RESULTS: 82 U-type sacral fractures were reviewed. Six treated with lumbopelvic fixation (LPF) and 76 were treated with percutaneous sacral screws (PSS) alone. Patients receiving LBF had greater sacral fracture displacement in coronal, sagittal, and axial planes compared to patients receiving PSS alone (P

Objective: This study aimed to evaluate the effectiveness of biomaterials in bone healing of critical bone defects created by piezoelectric surgery in rat calvaria. Method and materials: Histomorphologic analysis was performed to assess bone regeneration and tissue response. Fifty animals were randomized into five groups with one of the following treatments: Control group (n = 10), spontaneous blood clot formation with no bone fill; BO group (Bio-Oss, Geistlich Pharma; n = 10), defects were filled with bovine medullary bone substitute; BF group (Bonefill, Bionnovation; n = 10), defects were filled with bovine cortical bone substitute; hydroxyapatite group (n = 10), defects were filled with hydroxyapatite; calcium sulfate group (n = 10), defects were filled with calcium sulfate. Five animals from each group were euthanized at 30 and 45 days. The histomorphometry calculated the percentage of the new bone formation in the bone defect. Results: All data obtained were evaluated statistically considering P < .05 as statistically significant. The results demonstrated the potential of all biomaterials for enhancing bone regeneration. The findings showed no statistical differences between all the biomaterials at 30 and 45 days including the control group without bone grafting. Conclusion: In conclusion, the tested biomaterials presented an estimated capacity of osteoconduction, statistically nonsignificant between them. In addition, the selection of biomaterial should consider the specific clinical aspect, resorption rates, size of the particle, and desired bone healing responses. It is important to emphasize that in some cases, using no bone filler might provide comparable results with reduced cost and possible complications questioning the very frequent use of ridge presentation procedures. [ABSTRACT FROM AUTHOR]

Fracture healing complications increase with age, with higher rates of delayed unions and nonunions and an associated increase in morbidity and mortality in older adults. Macrophages have a dynamic role in fracture healing, and we have previously demonstrated that age-related changes in macrophages are associated with attenuated fracture repair in old mice. Here, we provide a single cell characterization of the immune cells involved in the early phase of fracture healing. We show that there were multiple transcriptionally distinct macrophage subpopulations present simultaneously within the healing tissue. Fracture healing was attenuated in old mice compared to young, and macrophages from the fracture callus of old mice demonstrated a pro-inflammatory phenotype compared to young. Interestingly, Trem2 expression was decreased in old macrophages compared to young. Young mice lacking Trem2 demonstrated attenuated fracture healing and inflammatory dysregulation similar to old mice. Trem2 dysregulation has previously been implicated in other age-related diseases, but its role in fracture healing is unknown. This work provides a robust characterization of the macrophage subpopulations involved in fracture healing, and further reveals the important role of Trem2 in fracture healing and may be a potential driver of age-related inflammatory dysregulation. Future work may further examine macrophages and Trem2 as potential therapeutic targets for management of fracture repair in older adults.

Fractures continue to be a global economic burden as there are currently no osteoanabolic drugs approved to accelerate fracture healing. In this study, we aimed to develop an osteoanabolic therapy which activates the Wnt/β-catenin pathway, a molecular driver of endochondral ossification. We hypothesize that using an mRNA-based therapeutic encoding β-catenin could promote cartilage to bone transformation formation by activating the canonical Wnt signaling pathway in chondrocytes. To optimize a delivery platform built on recent advancements in liposomal technologies, two FDA-approved ionizable phospholipids, DLin-MC3-DMA (MC3) and SM-102, were used to fabricate unique ionizable lipid nanoparticle (LNP) formulations and then tested for transfection efficacy both in vitro and in a murine tibia fracture model. Using firefly luciferase mRNA as a reporter gene to track and quantify transfection, SM-102 LNPs showed enhanced transfection efficacy in vitro and prolonged transfection, minimal fracture interference and no localized inflammatory response in vivo over MC3 LNPs. The generated β-cateninGOF mRNA encapsulated in SM-102 LNPs (SM-102-β-cateninGOF mRNA) showed bioactivity in vitro through upregulation of downstream canonical Wnt genes, axin2 and runx2. When testing SM-102-β-cateninGOF mRNA therapeutic in a murine tibia fracture model, histomorphometric analysis showed increased bone and decreased cartilage composition with the 45 μg concentration at 2 weeks post-fracture. μCT testing confirmed that SM-102-β-cateninGOF mRNA promoted bone formation in vivo, revealing significantly more bone volume over total volume in the 45 μg group. Thus, we generated a novel mRNA-based therapeutic encoding a β-catenin mRNA and optimized an SM-102-based LNP to maximize transfection efficacy with a localized delivery.

BACKGROUND: In the skeleton, various endogenous or exogenous stimuli cause imbalance in bone metabolism, leading to changes in bone mass and bone strength, which in turn cause a series of bone-related diseases such as osteoarthritis and osteoporosis. In this process, Forkhead box transcription factor O1 (FoxO1) plays an important role, and FoxO1 can regulate bone metabolism by regulating oxidative stress, cell proliferation, differentiation and apoptosis. OBJECTIVE: This paper focuses on FoxO1, and by summarizing its upstream and downstream regulatory mechanisms, it provides new ideas for the future treatment of bone-related diseases. METHODS: The search terms “FoxO1, Bone” were used for literature retrieval in CNKI and WanFang Databases, and the search terms “FoxO1, Bone, Skeleton” were used in PubMed and Web of Science databases. The old, repetitive, poor quality and irrelevant papers were excluded, and 56 papers were finally included for review and analysis. RESULTS AND CONCLUSION: (1) FoxO1 promotes the differentiation of bone marrow mesenchymal stem cells into osteoblasts by increasing the expression of runt-related transcription factor 2, alkaline phosphatase and osteocalcin, and transforms bone marrow mesenchymal stem cells from lipogenic differentiation to osteogenic differentiation by inhibiting peroxisome proliferator-activated receptor γ, thereby increasing bone formation. In addition, FoxO1 may also affect bone formation by increasing the number of osteoblasts. (2) Inhibition of FoxO1 in bone marrow mononuclear macrophages can reduce the expression of macrophage colony-stimulating factor, receptor activator of nuclear factor-κB ligand and nuclear factor of activated T cells 1, promote the expression of FoxO1 in osteoclasts, and thus inhibit osteoclast differentiation. In addition, direct activation of FoxO1 also inhibits osteoclast differentiation and weakens osteoclast activity. (3) Upregulation of FoxO1 in chondrocytes can regulate chondrocyte homeostasis, protect chondrocytes from oxidative stress, and promote the expression of autophagy related genes and the secretion of proteoglycan 4 by chondrocytes. (4) This paper details the molecular mechanism of FoxO1 regulation in different bone cells in detail, and elaborates the key role of FoxO1 in the treatment of bone-related diseases more comprehensive and deeply, providing new ideas for the treatment of osteoarthritis, osteoporosis, delayed fracture healing and other bone-related diseases. [ABSTRACT FROM AUTHOR]

BACKGROUND: Pelvic fractures encompass a range of types, and the utilization of a pelvic reduction frame for restoration often lacks a systematic repositioning method. Instead, it relies on the operator's experience in conjunction with fluoroscopic findings, which can lead to uncertainty and non-reproducibility. OBJECTIVE: To investigate the clinical efficacy of combining computer-simulated repositioning techniques with a pelvic reduction frame for the treatment of anteroposterior compression-III pelvic fractures. METHODS: A retrospective analysis was conducted on 19 patients with anteroposterior compression-III pelvic fractures who underwent preoperative repositioning via computer simulation and intraoperative repositioning with the assistance of a pelvic reduction frame between January 2018 and December 2021. Among them, 7 cases were fixed with double plate in anterior ring and 12 cases were fixed with single plate combined with anterior subcutaneous internal fixation (INFIX). All patients received posterior ring fixation with two sacroiliac screws. Operative duration, intraoperative reduction time, the frequency of intraoperative fluoroscopy use, blood loss, and follow-up duration were documented. These data were utilized to monitor fracture healing time and postoperative complications. Fracture reduction quality was evaluated according to the Matta scale, and the Majeed Pelvic Function Score was employed to assess patient function during the final follow-up. RESULTS AND CONCLUSION: (1) Surgery was successfully completed in all 19 patients. The anterior ring was secured with double plates in 7 cases, while a single plate combined with INFIX was utilized in 12 cases. The posterior ring was stabilized with two sacroiliac screws, specifically targeting the S1 and S2 cones. (2) The operation duration ranged from 74 to 147 minutes, with a mean of (101.63±19.55) minutes. Intraoperative repositioning took place over a period of 26 to 41 minutes, with a mean of (38.11±3.31) minutes. The number of intraoperative fluoroscopies conducted ranged from 35 to 81, with a mean of (62.68±13.11) times. Intraoperative bleeding volumes varied from 60 to 130 mL, with a mean of (85.37±20.57) mL. (3) All the patients were diligently monitored for a duration of 12 to 26 months. Fracture healing was observed within a time frame of 12 to 20 weeks, with a mean of (16.37±2.50) weeks. (4) The evaluation according to Matta's criteria one day post-surgery revealed excellent outcomes in 14 cases and good outcomes in 5 cases. At the final follow-up, the Majeed function score indicated excellent results in 16 cases and good results in 3 cases. (5) Two patients experienced localized fat liquefaction phenomena, characterized by redness, swelling, and oozing at the incision site, which gradually resolved with proactive dressing changes. None of the patients encountered complications such as internal fixation loosening, loss of fracture reduction, or nerve injuries post-surgery. It is concluded that the combined approach of using computer-simulated repositioning techniques in conjunction with pelvic reduction frames for the treatment of anteroposterior compression-III pelvic fractures has advantages in enhancing repositioning efficiency and improving pelvic function. [ABSTRACT FROM AUTHOR]

BACKGROUND: Types II, IIA, and III of Hangman fractures often require surgical treatment, and the selection of surgical methods is controversial. Current surgeries have shortcomings such as incomplete reduction and malunion after surgery. In the early stage, our team used C2-3 lag screws combined with a bucking bar. Intermittent pushing of the C2 vertebral body in the oropharynx has achieved satisfactory clinical results. However, the preliminary studies included few samples and lacked a control group for comparison. OBJECTIVE: To compare the clinical efficacy of posterior C2-3 fixation combined with the bucking bar technique and posterior C2-3 fixation alone in the treatment of unstable Hangman fractures. METHODS: The clinical and imaging data of 55 patients with unstable Hangman fractures who underwent posterior C2-3 internal fixation in Affiliated Hospital of Southwest Medical University were retrospectively analyzed. According to the surgical plan, the patients were divided into two groups. Among them, 23 patients received posterior cervical C2-3 internal fixation combined with the bucking bar technique (group A), and 32 patients received simple posterior C2-3 internal fixation (group B). Operation time, intraoperative blood loss, complications, pain visual analog scale score, neck disability index, American Spinal Injury Association classification, and patient satisfaction (Odom's classification) preoperation and during follow-up were compared between the two groups. The changes in C2-3 displacement and angulation and other imaging indicators were compared at each observation time point. RESULTS AND CONCLUSION: (1) There was no statistically significant difference in operation time, intraoperative blood loss, and postoperative complications between the two groups (P > 0.05). (2) The neck pain visual analog scale and neck disability index scores of the two groups of patients at the final follow-up were significantly improved compared with those before surgery (P < 0.05). The Odom standard classification showed that 21 cases (91%) in group A were excellent and 29 cases (91%) were excellent and good in group B. There was no statistically significant difference in the clinical efficacy indicators between the two groups (all P > 0.05). (3) There was no significant difference in C2-3 angulation and displacement between the two groups before operation (P > 0.05). Postoperation and at the last follow-up, the angle and displacement of C2-3 in both groups were significantly smaller than before surgery, and the difference was statistically significant (P < 0.01). There was no statistically significant difference in the above indicators after surgery and at the last follow-up (P > 0.05). After surgery and at the last follow-up, the displacement and angle of C2-3 in group A were significantly smaller than those in group B (P < 0.05). (4) At the last followup, no patients in group A had residual deformity, and 4 cases (13%, 4/32) in group B had residual deformity. (5) Therefore, posterior C2-3 fixation combined with transoral bucking bar technology may be beneficial to the reduction and stabilization of the vertebral body, reduces malunion, and can achieve better reduction. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare the short-term efficacy of plate combined with Suture tape versus plate combined with headless compression screw in the treatment of Lisfranc injury with comminuted fractures of the 1st and 2nd proximal metatarsal bones. METHODS: A retrospective analysis was performed on 48 patients with Lisfranc injury due to comminuted fractures of the 1st and 2nd proximal metatarsal bones in Seventh Department of Orthopedics, Dongguan Hospital of Traditional Chinese Medicine from January 2019 to June 2022. Among them, 25 were fixed with plate combined with Suture tape (observation group) and 23 were fixed with plate combined with headless compression screw (control group). Preoperative classification was performed according to Myerson classification system based on preoperative imaging data. Postoperative follow-up was performed according to fracture healing time, visual analog scale, and American Orthopaedic Foot and Ankle Society (AOFAS) criteria to assess the recovery of foot functions. Postoperative complications were compared and analyzed between the two groups. RESULTS AND CONCLUSION: (1) All cases completed the operation successfully and obtained follow-up in the two groups. The postoperative follow-up time of the two groups was 12-36 months, with a mean of (18.0±5.42) months. (2) There were no significant differences in operation time and intraoperative blood loss between the two groups (P > 0.05). (3) The fracture healing time of observation group was slightly longer than that of control group (P < 0.05). (4) After 3, 6, and 12 months of follow-up, the visual analog scale score of the observation group was significantly lower than that of the control group (P < 0.05). (5) At 6 and 12 months after operation, AOFAS score of foot function in the observation group was significantly improved compared with the screw group at various time points after operation (P < 0.05), and was significantly higher than that before operation (P < 0.05). (6) The postoperative complications were 1 case of traumatic arthritis in the observation group and 1 case of incision infection, 1 case of screw fracture, and 2 cases of traumatic arthritis in the control group. There was no significant difference between the two groups (P > 0.05), considering the correlation with a small sample size. (7) It is indicated that as for the surgical method of Lisfranc injury with comminuted fractures of the 1st and 2nd proximal metatarsal bones, the application of plate combined with Suture tape internal fixation has a reliable effect in the treatment of Lisfranc joint injury, which can improve the function of the foot joint of patients, and has the advantages of less surgical trauma, fewer postoperative complications, and lower risk of long-term iatrogenic traumatic arthritis. Compared with headless compression screw, it is more beneficial to the recovery of foot function. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis aimed to evaluate the impact of photobiomodulation therapy (PBMT) on fracture healing in animal models. Following PRISMA guidelines, an electronic search was conducted in PubMed/MEDLINE, Scopus, Embase, and Web of Science databases without date or language restrictions. Animal studies evaluating the effect of PBMT on the healing of complete fractures were included. SYRCLE's risk of bias assessment tool was used for quality appraisal. Meta-analysis and sensitivity analysis were performed for selected outcome measures using Stata version 16, with a significance level of 0.05. Of 1,656 studies, 27 met eligibility criteria. Rabbits and rats were used in 17 and 10 studies, respectively. The tibia was the most common site of fracture, followed by the femur, mandible, and radius. The most frequently used emitters were 780 nm LASER, followed by 808 nm and 830 nm LASER. LEDs were used in comparison to LASERs in three studies and solely in one study. The most frequent energy density and power density were 4 J/cm2 and 100 mW/cm2, respectively. Radiography, histology, mechanical testing, and spectroscopy were the most common assessment methods of fracture healing. While most studies reported PBMT's positive effect on fracture healing, meta-analysis found no significant impact on maximum fracture force or Raman peaks of hydroxyapatite, indicating no significant influence on mineralization (P > 0.05). Although PBMT shows potential for enhancing fracture healing in animal models, meta-analysis showed that it has no effect on maximum force of fracture or Raman peaks of hydroxyapatite. Registration: The protocol of this systematic review was registered on PROSPERO with the ID CRD42024514398. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the clinical efficacy of arthroscopy-assisted absorbable screw combined with Kirschner wire internal fixation in the treatment of Sanders type III displaced intra-articular calcaneal fractures. Methods: Eighty patients diagnosed with Sanders type III displaced intra-articular calcaneal fractures and treated at Dongguan Hospital of Guangzhou University of Chinese Medicine in China from December 2020 to June 2023 were enrolled in this study. According to treatment protocol, these patients were divided into the A group (n = 40), which underwent subtalar arthroscopic reduction combined with absorbable screw and Kirschner wire internal fixation, and the H group (n = 40), which received hollow screw internal fixation via a modified tarsal sinus incision. Intraoperative metrics, including intraoperative blood loss and operation time, were comparatively analysed. Postoperative functional improvement, including parameters such as fracture healing time, pre- and postoperative Visual Analog Scale (VAS), American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS), Maryland Foot Score (MFS), Tegner scores and radiological parameters such as Böhler's angle, Gissane's angle and calcaneus height and width, was also evaluated. The incidence and nature of postoperative complications were analysed. Results: (1) No significant differences in intraoperative blood loss, operation time and postoperative fracture healing time were observed between the two groups (P > 0.05). (2) Postoperative follow-ups revealed significant improvements in VAS scores, AOFAS ankle–hindfoot scores, MFS scores and Tegner scores in both groups (P < 0.05). Compared with the H group, the A group demonstrated significantly superior AOFAS ankle–hindfoot and MFS scores at 3 and 12 months post operation and Tegner scores at 12 months post operation and at the last follow-up (P < 0.05). No significant differences in postoperative VAS scores were found between the two groups (P > 0.05). (3) Significant postoperative improvements were noted in Böhler's angle, Gissane's angle and calcaneal dimensions (P < 0.05), with no significant intergroup differences during follow-up (P > 0.05). (4) The patients in the A group returned to sports activities earlier (7.23 ± 3.4 months) than those in the H group (9.28 ± 3.99 months). (5) The A group exhibited a lower incidence of postoperative complications, with one case of traumatic arthritis (2.5%, 1/40) compared with four cases of peroneal tendonitis (10%, 4/40) in the H group (P < 0.05). Conclusion: Arthroscopy-assisted absorbable screw combined with Kirschner wire internal fixation provides effective and satisfactory outcomes in terms of internal fixation, foot function and radiological improvements for Sanders type III displaced intra-articular calcaneal fractures. This approach is associated with a low incidence of postoperative complications and a quick return to sports activities. It may potentially obviate the need for secondary surgery for implant removal. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Background: The unique anatomy and biomechanics of the distal humerus make distal humeral shaft fractures a significant challenge in orthopedic surgery. Conventional posterior surgical approaches are associated with risks such as iatrogenic radial nerve injury and increased soft tissue trauma. Objective: This study aimed to assess the clinical efficacy of an inverted PHILOS plate using an anterior minimally invasive percutaneous approach for treating distal humeral shaft fractures. Methods: We enrolled 32 patients with distal humeral shaft fractures. The surgical technique involved an anterior minimally invasive percutaneous application of an inverted PHILOS plate. Outcome measures included operative time, intraoperative blood loss, incision length, fracture healing time, and functional scores (Constant-Murley and Mayo Elbow Performance Scores). Postoperative complications, including nerve injury and nonunion, were documented. Results: The mean operative time was 1.69 ± 0.66 h, with a median blood loss of 50 ml (IQR: 50–100 ml). The mean incision length was 10.9 ± 1.78 cm, and the mean time to fracture healing was 11.2 ± 3.68 weeks. Functional outcomes were satisfactory, with a mean Constant shoulder score of 92.69 ± 6.6 and a mean Mayo Elbow Performance Score of 91.4 ± 8.04. No instances of iatrogenic nerve injury or nonunion were observed. Conclusion: The anterior minimally invasive percutaneous approach using an inverted PHILOS plate is an effective method for treating distal humeral shaft fractures. This technique minimizes soft tissue damage, reduces the risk of iatrogenic radial nerve injury, and ensures reliable fracture stabilization, thus offering a promising alternative to conventional posterior approaches. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis represents a salient metabolic bone disorder. Histone demethylase plays a vital role in bone development and homeostasis. This study explored the mechanism of histone demethylase KDM5A affecting osteoporotic fracture healing via the miR-495/SKP2/Runx2 axis. Methods: The murine model of osteoporotic fracture was established. The bone mineral density, maximum elastic stress, and maximum load were tested. The relative trabecular bone volume, bone trabecular thickness, and trabecular number at the proximal end of tibia were detected. The histopathological changes of femur tissues and bone microstructure were observed. Expressions of KDM5A and osteogenic factors were detected. The cell proliferation, alkaline phosphatase activity, and calcified nodules were measured. The binding relationships between KDM5A and miR-495 promoter, and miR-495 and SKP2 were verified. The interaction between SKP2 and Runx2 was detected. The ubiquitination level of Runx2 and the stability of Runx2 protein were detected. Results: KDM5A was highly expressed in the murine model of osteoporotic fracture. Interference of KDM5A expression facilitated fracture healing in osteoporotic mice. KDM5A downregulated miR-495 expression by promoting the H3K4me3 methylation of the miR-495 promoter. Inhibition of miR-495 reversed the effect of KDM5A silencing on osteoblast proliferation, differentiation, and mineralization. miR-495 facilitated osteoblast proliferation, differentiation, and mineralization by targeting SKP2. SKP2 suppressed Runx2 expression through ubiquitination degradation. Inhibition of Runx2 reversed the promoting effect of SKP2 silencing on osteogenic differentiation. Conclusion: KDM5A attenuated the inhibition of miR-495 on SKP2 and promoted the ubiquitination degradation of Runx2 protein by SKP2, thereby repressing osteoblast differentiation and retarding osteoporotic fracture healing. [ABSTRACT FROM AUTHOR]

Background: Diaphyseal femoral fractures in children older than 5 years and before adolescence are usually treated surgically. The literature describes several surgical techniques; however, we present an additional minimally invasive technique that combines the use of elastic intramedullary nails and a uniplanar external fixator as an optional solution for managing more complex cases. Method: This was a retrospective review of four children aged 9–12 years who suffered from unstable diaphyseal femoral fractures and were admitted to our institution. Results: We treated four children between the years 2021 and 2023. All patients underwent closed reduction of their fractures and fixation with an elastic intramedullary nail and an external fixator. Full radiographic fracture healing with acceptable alignment was achieved in all patients. The minimum clinical follow-up was 1.5 years. No major complications were observed, and all patients achieved full clinical recovery as well as proper limb alignment and length. Conclusions: Fixation of complex diaphyseal femoral fractures using a combination of internal and external fixation is a simple technique that avoids the need for extensive soft tissue exposure while also promoting fracture stability and maintenance of bone length and rotation. This method can be incorporated into the armamentarium of orthopedic surgeons as an additional solution for addressing more challenging cases. [ABSTRACT FROM AUTHOR]

Purposes: The purpose of this study is to evaluate the clinical outcomes of combining 3D printing technology with customized metal plates in the treatment of complex acetabular fractures. Methods: A retrospective study was conducted on 42 patients with complex acetabular fractures treated at our hospital between September 1, 2020 and May 31, 2022. The patients were divided into two groups: the conventional group and the 3D printing group, with 21 individuals in each group.The conventional group underwent surgery using traditional surgical techniques, with appropriate bending and adjustment of the metal plates during the procedure. In the 3D printing group, preoperative 3D printing technology was utilized to create a physical model of the fracture, and individualized metal plates were customized based on the model after virtual reduction. Comparison was made between the two groups of patients regarding surgical approach, operative time, instrument handling time, intraoperative blood loss, number of fluoroscopy scans, fracture healing time, quality of fracture reduction postoperatively, hip joint function at 12 months postoperatively, and occurrence of complications during the follow-up period. Results: The 3D printing group showed significantly shorter surgical time (124.76±12.89 minutes vs. 174.05±12.51 minutes), instrument operation time (44.57±5.32 minutes vs. 62.9±7.47 minutes), intraoperative blood loss (337.38±51.95 mL vs. 545.24±74.39 mL), and intraoperative fluoroscopy frequency (8.25±1.18 times vs. 10.52±1.6 times) compared to the conventional group (P<0.001). The postoperative fracture reduction quality in the 3D printing group was good in 95.24% (20/21) of cases, significantly higher than the 61.90% (13/21) in the conventional group (P = 0.02). The excellent and good hip function rate in the 3D printing group was 90.48% (19/21), which was also significantly higher than 57.14% (12/21) in the conventional group (P = 0.01). No significant difference was observed between the two groups in fracture healing time (13.95±1.07 weeks vs. 13.81±1.17 weeks) and complication rate (9.52% vs. 28.57%) (P = 0.14; P = 0.24). Conclusion: The application of 3D printing technology in conjunction with individualized customization of metal plates for the treatment of complex acetabular fractures can shorten surgical and instrument handling time, reduce intraoperative blood loss, and improve the quality of fracture reduction as well as the recovery of hip joint function.These results provide new insights and technical support for the treatment of complex acetabular fractures. [ABSTRACT FROM AUTHOR]

Background: Fracture healing is commonly evaluated through physical examination and radiographic results. However, these methods rely on the surgeons' subjective experience, without including the objective biomechanical properties of the bony callus. This paper presents an innovative method for measuring the callus stiffness in vivo to evaluate fracture healing, further instructing surgeons to remove external fixator safely. Methods: A novel dynamic axial load-share ratio (D-LS) index and its associated measuring system was introduced, including the system's composition (hexapod and insole modules), theoretical model, and method for D-LS measurement. From Jan 2022 to May 2024, 36 patients with tibial shaft fracture treated by Taylor Spatial Frame were evaluated in this prospective study. Once the patient had reached clinical bone healing conditions, the in vivo D-LS measurement was conducted. The patients' demographic data, clinical outcomes, particularly D-LS value and refracture rate were recorded. Results: At a mean follow-up of 16.50 ± 5.79 months, a total of 36 patients completed the final follow-up. Fixators were removed with an average of 24.81 ± 4.51 weeks. The result of hexapod module's precision examination were maximum errors of 3.72 N, 3.31 N and 2.68 N in x-, y- and z-axis, respectively. The measuring process took an average system installation time of 15.42 ± 4.88 min. Two patients (5.56%) reported fracture site pain. Each patient's D-LS was determined after three rounds of measurement. The average D-LS value was 15.58 ± 2.77% (range, 9.60–20.52%). None of the 36 patients reported refracture at the last follow-up. Conclusions: The novel D-LS measurement system can measure the dynamic forces of lower limb for patients with external fixator in vivo. An objective biomechanical indicator of the regenerate callus was provided by the D-LS. The D-LS measurement is a complement to standard radiological assessment only after radiologically confirmed bone union. Measuring the D-LS in vivo could indicate whether the callus healing is sufficient in external fixation, and 15.6% (average) was recommended as a reference D-LS value for safe fixator removal. [ABSTRACT FROM AUTHOR]

Fracture is a disease in which the continuity of bone is interrupted or the integrity of bone is destroyed due to various reasons. It can be life-threatening when severe fractures occur. The RNA-seq datasets related to 'fracture' were screened and the common differentially expressed genes (DEGs) were determined. Protein-protein interaction network was constructed to identify hub genes. The fracture mice model was constructed and HE staining was performed to observe the histological characteristics of fracture. The expression of inflammatory factors and hub genes were evaluated by ELISA and qRT-PCR. CCK-8 assay, flow cytometry and Alizarin Red S staining were performed to evaluate the effects of fibrillin2(FBN2) on viability, apoptosis and mineralization of MC3T3E1 cells, respectively. Western blot was executed to measure expression of osteogenic markers (ALP and RUNX2). A total of 78 common DEGs were screened from GSE157460 and GSE152677 datasets. FBN2 was down-regulated in fracture and identified as the hub gene. In fracture mice, the thickness of the compact bone decreased in Day 1, accompanied by callus and woven bone formation, filled with a large number of osteoblasts, while IL-1β, IL-6 and TNF-α levels were increased. FBN2 enhanced cell viability and mineralization, suppresses apoptosis of MC3T3E1 cells, and facilitated the expression of ALP and RUNX2. Meanwhile, the knockdown of FBN2 demonstrated opposing trends. Through bioinformatics analysis, FBN2 was identified as the hub gene in fracture, and FBN2 promoted the proliferation, mineralization, and differentiation of osteoblasts, thereby accelerating fracture healing. [ABSTRACT FROM AUTHOR]

Background: Alpha-melanocyte-stimulating-hormone (α-MSH) has been identified as a new anti-inflammatory treatment compound in rheumatoid arthritis (RA) and other inflammatory diseases. However, its direct effect on bone cell differentiation or on bone regeneration, which is an inflammatory process, too, has not been investigated, yet. Bone tissue is significantly affected in inflammatory joint diseases. Additionally, inflammatory signaling is essential -in bone regeneration during fracture healing. Therefore, we evaluated the impact of α-MSH-treatment on bone forming cells in an inflammatory setting in vitro and as a treatment approach in a murine fracture healing model in vivo. Methods: The influence of α-MSH treatment and melanocortin-receptor expression patterns was investigated in vitro in the presence of either IL-1β or/and TNF-α as an inflammatory stimulus. Osteoblast cell function was evaluated by analyzing proliferation and mineralisation capacities. Using quantitative real time PCR, we analyzed mRNA expression of receptors. To explore the impact of α-MSH on bone regeneration in vivo, treatment with α-MSH or NaCl (control) was performed in a murine fracture-healing model using a closed femur fracture stabilized with an intramedullary implant (female, n = 6–8 mice per group). Results: α-MSH-treatment did not impair either proliferation nor mineralisation of osteoblastic cells under native or inflammatory conditions (no significant differences found). All four melanocortin receptor-molecules were expressed in murine osteoblastic cells but in very limited amounts and this did not change upon treatment with inflammatory cytokines or α-MSH or both at the same time. Callus formation in fractured femurs of α-MSH-treated mice was slightly delayed at day 14 post fracture with regard to less cartilage formation (NaCl: 19.9%; α-MSH: 13.5%) and soft tissue remodeling (NaCl: 15.2%; α-MSH: 19.5%) but these results were not significantly different and fracture healing overall occurred in a regular way. Conclusion: α-MSH has no negative impact on bone or bone-forming cells in native, inflammatory, or regenerative contexts. We can conclude from our results, that treatment of inflammatory diseases using α-MSH does not interfere significantly with bone regeneration in a murine fracture model and therefore treatment with α-MSH could be continued without negative effects on bone formation and bone regeneration in patients. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Acetabular roof was a crucial structure for maintaining the stability of hip joint; however, its important role was not especially emphasized in the Letournel-Judet classification system. Acetabular roof was segmented into the roof column and roof wall in Three-column classification and fracture in this area alone was defined as A3 injury. The purpose of this study was to explore the characteristics and surgical strategy of A3 injury. Methods: Patients with roof column/wall fractures received surgical management from January 2015 to 2019 January at nine level-1 trauma centers were retrospectively analyzed. Fracture data, surgical incision, operation time, blood loss, fracture healing and relevant complications were recorded to explore fracture characteristics and appropriate surgical strategy. Reduction quality was assessed based on postoperative radiographic examination. Merle d'Aubigné score was used to assess the functional outcome during the follow-up. Results: A total of 60 patients met the inclusion criteria in this study. Mean operation time was 112.83±21.77 min, and mean intraoperative blood loss was 396.67±182.00 ml. Satisfactory reduction quality was obtained in 49 cases (81.67%). All fractures healed well at an average mean of 3.07 months. Satisfactory outcomes were obtained in 46 cases (76.67%), and mean Merle d'Aubigné score was 15.53±1.33 points at the final follow-up. Reduction quality and functional outcome showed no statistical difference in three subtypes (P<0.05). Reduction quality and functional outcome presented positive correlation in three subtype fractures (P<0.05). The complication rate was 11.67% (7/60) in this study. Conclusion: The injury mechanism of A3 injury was the direct impaction from femoral head on acetabular roof. Reduction and fixation of A3 injury were technique demanding, and poor prognosis may be accompanied even treated by experienced surgeons. Appropriate surgical strategies (Table 5) based on fracture characteristics in three subtypes of A3 injury were the premise of accepted prognosis. [ABSTRACT FROM AUTHOR]

Background: The selection of an implant is a critical factor in the surgical treatment of patella fractures due to the risk of various complications, such as non-union, implant failure, and irritation. The present study evaluated and compared the biomechanical strength of headless cannulated screws about screw length using the tension band wiring technique. Methods: Forty-eight sawbone patellas with transverse fractures were divided into three fixation groups based on the screw length used in tension band wiring. Overall, three different fixation groups were determined: Group 1 (recessed headless cannulated screw fixation), Group 2 (full-length headless cannulated screw fixation), and Group 3 (protruding headless cannulated screw fixation). A setup was used to simulate a knee with a flexion angle of 60 degrees. Specimens underwent biomechanical testing under axial traction (static test) and cyclic loading (dynamic test). Displacements at 300 Newtons (N), loads at 2 millimetres (mm) displacement, and failure loads were documented for each sample in the static test. In the dynamic test protocol, 10,000 repetitive cycles were performed under physiological load between 100 and 300 N, and final displacements were recorded. Results: There were significant differences in the loads achieved at 2 mm displacement levels, and Group 3 demonstrated lower force values compared to other constructs in the static test (P = 0.003). All groups revealed similar displacements at 300 N and failure load values under axial traction. In the dynamic test, Group 3 had significantly higher fracture displacement under cyclic loading compared to the other specimens (P = 0.006). Conclusions: This study found headless cannulated screws for transverse patella fracture fixation provide sufficient stability; however, protruding headless screws reduce the fixation strength. Recessed or full-length screws may improve stability and bony healing, potentially preventing complications in patella fractures. Level of evidence: Biomechanical study N/A. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the efficiency of a minimally invasive technique for correcting malunions of extra-articular metacarpal fractures, followed by percutaneous fixation using a cemented K-wire frame. Methods: From January 2018 to January 2022, 31 patients (31 malunions of extra-articular metacarpal fractures) were treated. The mean age of the patients was 32 years (range, 21–52 years). There were 25 fifth, 4 fourth, 1 third, and 1 second metacarpal malunion. Range of motion of the fingers was assessed based on the total active motion scoring system of American Society for Surgery of the Hand. Range of motion of the joint was graded as excellent (85–100%), good (70–84%), fair (50–69%), and poor (< 50%) by comparing to the opposite uninjured finger. The aesthetic appearance of the hand was evaluated based on the 10-cm visual analogue scale. Patient satisfaction was assessed using the Short Assessment of Patient Satisfaction (0–10, very dissatisfied; 11–18, dissatisfied; 19–26, satisfied; and 27–28, very satisfied). Results: Bone healing was achieved in all patients after a mean of 5.4 weeks (range, 4–10 weeks). The mean follow-up period was 27 months (range, 24–33 months). The mean preoperative total active motion scale was 233° (range, 185°–288°), and the postoperative scale was 263° (range, 235°–290°). There were 8 excellent, 19 good, and 1 fair result. There were 15 very satisfied and 13 satisfied with the results. The mean preoperative aesthetic appearance of the hand was 7 cm (range, 5–8 cm), and the postoperative appearance was 10 cm (range, 9–10 cm). Conclusion: The minimally invasive technique is effective for correcting extra-articular malunions of metacarpal fractures. Rigid fixation allows fracture healing and early joint motion of the injured hand. The technique improves hand function, patient satisfaction, and aesthetic appearance. Level of evidence: Therapeutic study, Level IVa. [ABSTRACT FROM AUTHOR]

Background: The surgical management of complex proximal tibia shaft fractures that extend into the joint remains a difficult challenge. The existing body of literature outlines a variety of reduction and fixation strategies, ranging from traditional double-plate constructs, with or without the use of minifragment plates, to fragment-specific plates combined with intramedullary nails, nail–plate combinations, and circular frames. In patients with severely compromised soft tissues, conventional internal fixation techniques can elevate the risk of complications. Nail–plate combinations have emerged as a preferred solution for addressing tibia shaft fractures with proximal intra-articular extension. Nonetheless, these techniques demand meticulous attention to prevent further displacement or splitting of the plateau perimeter during IM nail insertion. In this study, we report a series of three patients presenting with complex proximal tibia plateau fractures with diaphyseal extension. We aim to demonstrate potential benefits of a novel nail–plate combination construct and to provide technical features to this approach using a "hoop stress" plate circling the tibial plateau perimeter prior the insertion of a suprapatellar tibia IM nail. Patient population and surgical technique: Our series entails three young patients presenting with complex proximal tibia fracture (AO 41-C3) following high-energy trauma. Definitive fixation of these injuries was performed using the "umbrella technique." The approach involves placement of a circumferentially precontoured minifragment plate under the patellar tendon to brace around the anteromedial and anterolateral perimeters of the tibial plateau closing the fracture split. This allows reconstruction of its perimeter, while maintaining and preventing displacement forces during suprapatellar nail insertion. Key clinical and radiological outcome measures included: pain, wound complications, function (standing/walking distance), range of motion, muscle strength, use of crutches, and radiological signs of bone healing, limb alignment and discrepancy, summarized with the modified "HSS knee score". Results: Our series showed highly favorable results, reporting "Good and Excellent—HSS knee scores" (> 80 points). All fractures healed within a six-month postoperative period, and most importantly no evidence of limb deformity and/or discrepancy was observed. Furthermore, no other secondary clinical complications manifested within the first year of follow-up. Conclusion: This novel "umbrella technique" should be considered in complex situations where soft tissues around the knee are significantly compromised that can preclude traditional constructs. This technique is useful for protecting the tibial plateau perimeter when selecting nail–plate combination. Our fixation strategy, dubbed the "umbrella technique," entails an anterior minifragment hoop plate to mitigate hoop stress around the plateau facilitating suprapatellar nail insertion without losing the already reconstructed perimeter. This innovative nail–plate combination offers biomechanical advantages to these complex fracture patterns. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

Osteoporotic fractures represent a significant public health challenge in the context of an aging global population, with the rising prevalence of osteoporosis intensifying the demand for effective fracture treatment. Restoring the structure and function of bone tissue damaged by osteoporosis-induced defects remains a critical issue in clinical practice. In recent years, bioactive metallic materials such as magnesium, zinc, and strontium have gained considerable attention due to their exceptional mechanical properties, biocompatibility, and biodegradability, positioning them as promising materials for osteoporotic fracture repair. This review systematically explored the biological mechanisms, application advancements, and associated challenges of magnesium, zinc, and strontium in fracture healing. Key topics included their roles in promoting osteoblast proliferation and differentiation, inhibiting osteoclast activity, and modulating the bone microenvironment. Additionally, this review examined the optimization strategies for their clinical application, such as their integration into bone scaffolds, the functionalization of conventional materials, and the synergistic effects between different metals. Finally, this review analyzed the current progress and unresolved issues in this field, offering a forward-looking perspective on the clinical potential of bioactive metallic materials in precision treatment of osteoporotic fractures. [ABSTRACT FROM AUTHOR]

BACKGROUND: The healing of mandibular fractures after rigid internal fixation is influenced by many factors, including the material of the bone plate, fracture site, and bone density of the patient. However, there are relatively few studies on the relationship between the stability of mandibular fracture fixation in different bone qualities and they lack a scientific basis. OBJECTIVE: To analyze the stability of fixation of mandibular fractures with different bone qualities with bioabsorbable plates and miniature titanium plates by finite element analysis. METHODS: Three-dimensional finite element models of class I-IV mandibular fractures were developed according to the bone quality classification method proposed by ZARB and LEKHOLM. The fractures at the median mandibular symphysis, mandibular body, and mandibular angle were simulated under different bone qualities. Bioabsorbable bone grafting plates (or miniature titanium plates) were placed at each fracture site for fixation and to simulate the state of healthy side occlusion. Finite element analysis on the model was used to analyze the relative displacement of the fracture segments and the stress distribution of fixators. RESULTS AND CONCLUSION: (1) The maximum stress value during fixation with titanium plates increased gradually with the increase of bone class, in which the maximum stress value of titanium plates was the highest in the mandibular body class IV bone group, which was 382.74 MPa and 96.11 MPa in the miniature titanium plate and bioabsorbable plate groups. The results for mandibles of the same bone type showed that the maximum stress value of titanium plates was much higher than that of bioabsorbable plates. (2) For fractures of the median middle of the mandible in types III and IV, the displacement of the fracture breaks at the fixation site was large and exceeded the limiting value of bone healing (> 150 μm), regardless of whether the fixation was performed with a miniature titanium plate or a bioabsorbable plate. For type IV mandibular fractures, the fracture end displacement in the bioabsorbable plate group exceeded the healing limit value, and the fracture end displacement in the miniature titanium plate group was close to the healing limit value. Under the same bone quality and fracture site, the fracture displacement of the miniature titanium plate group was smaller than that of the bioabsorbable plate group. (3) The results showed that the strength and stiffness of the two internal fixations were sufficient to support bone healing of fractures at three sites of the types I-IV mandible, and the fixation stability of the bioabsorbable plate was almost the same as that of the miniature titanium plate, which could provide early healing conditions for fractures. Mandibular bone type should be taken into consideration in the treatment of mandibular fracture. The higher the mandibular bone grade, the worse the stability of fracture fixation, and the more likely the complications such as poor bone healing will occur after surgery. [ABSTRACT FROM AUTHOR]

Bone fracture healing is a complex physiological process influenced by biomechanical and biomolecular factors. Mechanical stability is crucial for successful healing, and disruptions can lead to delayed healing or nonunion. Bone commonly heals itself through secondary fracture healing, which is governed by the mechanical strain at the fracture site. To investigate these phenomena, a validated methodology for capturing the mechanoregulatory process in specimen‐specific models of fracture healing could provide insight into the healing process. This study implemented a prognostic healing simulation framework to predict healing trajectories based on mechanical stimuli. Sixteen sheep were subjected to a 3 mm transverse tibial mid‐shaft osteotomy, stabilized with a custom plate, and equipped with displacement transducer sensors to measure interfragmentary motion over 8 weeks. Computed tomography scans were used to create specimen‐specific bone geometries for finite element analysis. Virtual mechanical testing was performed iteratively to calculate strains in the callus region, which guided tissue differentiation and consequently, healing. The predicted healing outcomes were compared to continuous in vivo sensor data, providing a unique validation data set. Healing times derived from the in vivo sensor and in silico sensor showed no significant differences, suggesting the potential for these predictive models to inform clinical assessments and improve nonunion risk evaluations. This study represents a crucial step towards establishing trustworthy computational models of bone healing and translating these to the preclinical and clinical setting, enhancing our understanding of fracture healing mechanisms. Clinical significance: Prognostic bone fracture healing simulation could assist in non‐union diagnosis and prediction. [ABSTRACT FROM AUTHOR]

Hyperbaric oxygen therapy (HBOT) is a therapeutic modality that enhances tissue oxygenation by delivering 100% oxygen at pressures greater than 1 absolute atmosphere. In recent years, HBOT has shown considerable potential in the treatment of bone diseases. While excess oxygen was once thought to induce oxidative stress, recent studies indicate that when administered within safe limits, HBOT can notably promote bone healing and repair. Extensive basic research has demonstrated that HBOT can stimulate the proliferation and differentiation of osteoblasts and encourage bone angiogenesis. Furthermore, HBOT has been shown to exert a beneficial influence on bone metabolism by modulating the inflammatory response and redox status. These mechanisms are closely related to core issues of bone biology. Specifically, in the context of fracture healing, bone defect repair, and conditions such as osteoporosis, HBOT targets the key bone signaling pathways involved in bone health, thereby exerting a therapeutic effect. Several clinical studies have demonstrated the efficacy of HBOT in improving bone health. However, the optimal HBOT regimen for treating various bone diseases still requires further definition to expand the indications for its clinical application. This paper outlines the mechanisms of HBOT, focusing on its antioxidant stress, promotion of bone vascularization, and anti-inflammatory properties. The paper also describes the application of HBOT in orthopedic diseases, thereby providing a scientific basis for the development of precise and personalized HBOT treatment regimens in clinical orthopedics. [ABSTRACT FROM AUTHOR]

Purpose: To describe our clinical and functional experience in treating distal femur fractures using double helical plating with immediate full weight-bearing. Method: A retrospective, unicentric, case series study, based on data from patients with distal femur fractures who underwent surgery between 1 November 2019 and 31 January 2024. All patients who had a distal femur fracture and fulfil the criterion of previous ambulation were surgically treated using a standard lateral plate plus a helical moulded medial plate osteosynthesis through a MIPO technique with immediate full weight-bearing. We assessed length of surgery, blood loss during surgery, ambulation at 48 h after surgery; and at 6 months: clinical ('excellent' ambulation) and functional success (motion and malalignment), mortality and radiological outcome. A descriptive analysis was performed. Results: Seventy-three patients were diagnosed with distal femur fracture, of which 68 (7 men, 61 women, with a median age of 84 (range, 50–99) years old) were included in the study. Median length of surgery was 132 (range, 69–235) min, median blood loss during surgery was − 2.2 (range, 0.2–5) g/dL. At 4 days, all (100%) patients ambulated. At 6 months, clinical and functional success were 59.68% (95% CI 47.3–71.0%) and 98.38% (95% CI 91.4–99.7%), respectively; 6 (8.8%, 95% CI 4.1–17.9%) patients died, all the remaining had an excellent/good radiological assessment. Conclusion: Double helical plating for treating distal femur fractures is a stable and minimally invasive osteosynthesis technique, which enables immediately full weight-bearing with a minimum risk of secondary displacement or fixation failure. This technique could be considered as a good option for the fixation of distal femur fractures in frail patients. [ABSTRACT FROM AUTHOR]

Introduction: Aseptic nonunion is prevalent in orthopedic practice, causing persistent pain and functional impairment. Humeral shaft fractures, accounting for 3–5% of all fractures, have nonunion rates of 2–33% in nonoperative and 5–10% in surgical management. This study, the largest case series on operative management of aseptic humeral shaft nonunion (AHSN), treated with plate osteosynthesis. Materials and methods: This retrospective study, conducted at a referral center in eastern India, included 132 patients with aseptic humeral shaft nonunion from May 2002 to April 2012 and May 2015 to December 2020. Patients aged 20–70 years with nonunion more than 6 months post-trauma were included. Exclusions were open fractures, infections, gap nonunions, pathologic fractures, and concomitant upper limb injuries. Surgical techniques involved excising fibrous and unhealthy tissue, compressing the nonunion site, decorticating, shingling, autologous bone grafting, and stable fixation with dynamic or locking compression plates. Outcomes were assessed using Quick DASH, VAS, Constant Shoulder score at a minimum follow-up of 24 months. Results: The study included 132 patients, 84 males and 48 females, with a mean age of 42.3 years. Fractures were due to high-energy trauma in 78 cases and low-energy trauma in 54 cases. All patients with atrophic type of AHSN received autologous bone grafts and plating techniques. Quick DASH scores improved from 77 to 5 on average. Constant Shoulder score improved from 22 to 88 and VAS score improved from 6.7 to 1.3. Union was achieved in 21 weeks on an average, with minimal complications. Despite variations in time intervals, treatments, and follow-up durations, consistent management strategies emphasize stable fixation, bone grafts, and careful management of complications to achieve high union rates and satisfactory outcomes. Complications included seven infections, one failure needed refixation and two case of transient radial nerve palsy. Conclusion: Absolute stability using plate with or without autologous bone grafting for aseptic humeral shaft nonunion results in high union rates and satisfactory radiologic and functional outcome. [ABSTRACT FROM AUTHOR]

The article discusses the importance of rehabilitation for ankle fractures in adults, highlighting the challenges in fully recovering ankle mobility and physical activity post-fracture. A Cochrane systematic review found that early weightbearing and removable ankle supports may have a small impact on ankle function, but the differences may not be clinically significant. The review emphasizes the need for future studies to measure patient-important outcomes like pain and satisfaction, and suggests the development of a core outcome set for ankle fractures to standardize outcome measurement in trials. [Extracted from the article]

Background: We have applied an anterior locking compression mini plate in addition to a conventional superior locking compression plate for the treatment of wedge or multifragmentary clavicular fractures. Methods: Medical and radiologic data were retrospectively reviewed for patients who underwent surgical fixation with an anterior locking compression mini plate and conventional anatomical locking compression plate in a clavicle fracture of AO/OTA 15.2 B and 15.2 C. The primary outcome was bone union, and the secondary outcome was postoperative complications associated with the procedure. The functional outcomes included the Visual Analog Scale (VAS), University of California at Los Angeles Shoulder Scale (UCLASS), and Constant Shoulder Scale (CSS). Results: Nineteen patients with AO/OTA 15.2 B and 2 C clavicular fractures were followed for an average of 16 months (range: 12–30). The average patient age was 41 (range: 21–76) years, and 17 male and 2 female patients were included. The most common cause of clavicle fractures was sports activity (36.8%). A total of 10 patients had AO/OTA classification 15.2 C, and 9 patients had AO/OTA classification 15.2 B clavicular fractures. Primary fracture union healing was observed in all 19 (100%) patients, and the average time to bone union was 11 weeks (range: 7~21). There was no fixation failure or postoperative infection. The mean VAS, UCLASS, and CSS scores at the final follow-up were 0.6, 33.4, and 65 on a 75-point scale (87 on a 100-point scale), respectively. Conclusions: Dual plating using an anterior mini plate with a superior LCP could be considered as an option to minimize soft-tissue injury in comminuted mid-shaft clavicle fractures. [ABSTRACT FROM AUTHOR]

Simple Summary: Fracture healing in dogs can be challenging, especially in complex fractures. Comminuted fractures, where bones break into multiple fragments, are particularly prone to complications like delayed or failed healing. Despite their complexity, there is little veterinary-specific data on how often these fractures occur, their common complications, and the most effective treatments. This study reviewed 542 cases of long bone fractures in dogs treated at a veterinary clinic in Berlin, focusing on 99 cases of complex comminuted fractures. The femur (thigh bone) was most often affected, followed by the tibia/fibula (shin bones), radius/ulna (forearm bones), and humerus (upper arm bone). Plates, pins, or external fixators were used to stabilize the bones. Most fractures (72%) healed successfully, but 28% had complications like delayed healing or implant failure. Severe trauma, open fractures, and multiple bone fragments were linked to higher risks. Fractures treated with plates healed slower, and the femur required the longest recovery time, while the humerus healed the fastest. This study emphasizes the challenges of treating complex fractures in dogs and highlights the need for improved surgical techniques and standardized guidelines. The findings aim to support veterinarians in providing better care and improving outcomes for injured dogs. Fracture healing in dogs is a complex process influenced by factors such as age, weight, fracture type, and underlying conditions. Among fractures, complex diaphyseal comminuted fractures stand out due to their susceptibility to complications like delayed union or nonunion. Despite the recognized complexities, veterinary-specific data on their incidence, complications, and effective treatment strategies remain surprisingly scarce. This retrospective study analyzed 99 comminuted fractures among 542 long bone fractures treated at the Small Animal Clinic of the Freie Universität Berlin (2007–2014). The femur (n = 42) was most affected, followed by the tibia/fibula (n = 29), radius/ulna (n = 24), and humerus (n = 4). Plates (n = 81) and intramedullary pins or external fixators (n = 16) were used for osteosynthesis. Healing occurred without complications in 72%, while 28% experienced issues such as implant failure or delayed union. Open fractures, high-energy trauma, and >3 fragments were associated with higher complication rates (p < 0.05). Fractures treated with plates healed slower (p = 0.016), and implants were removed later compared to other methods (p = 0.049). This study highlights the challenges of managing complex fractures and emphasizes the need for tailored surgical approaches. It provides new insights into their treatment and outcomes, paving the way for future research to establish standardized veterinary protocols. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of vitamin D on the speed and quality of pediatric fracture healing. Methods: A 4-year prospective study of healthy children with shaft fractures of the forearm bones (treated with minimally invasive osteosynthesis) or femur (treated by traction or by minimally invasive osteosynthesis). All children had their vitamin D levels examined four times—at the time of the injury, 1, 3, and 5 months after the injury. Also, all children underwent radiograph follow-ups (same time as blood tests) to evaluate fracture healing. Children were, in the beginning, blindly divided into two similarly sized groups—one group was orally administered cholecalciferol throughout the follow-up, the second group was not, and we compared those groups. Results: Altogether, 63 children were included in the study—36 supplemented and 27 non-supplemented. In supplemented children, the vitamin D levels increased statistically significantly during the follow-up period, in contrast to the non-supplemented group. The fracture healing on radiographs was also statistically significantly faster and better in the supplemented group. When we divided children according to fracture type, we observed statistically significantly better fracture healing in children with forearm fractures in the supplemented group for the whole study period. In children with femoral fractures, the healing in the supplemented group was statistically significantly better after 3 months; however, after 1 and 5 months, the difference was not statistically significant. Conclusions: Based on our results, we recommend vitamin D testing and administration for children treated for forearm and femoral fractures. Level of evidence: Level I. [ABSTRACT FROM AUTHOR]

Introduction: The use of two monocortical malleable 04‐hole miniplates, placed above and below the mental foramen, has been indicated to prevent the adverse effects of tension and torsion forces on fracture healing. To obtain good fixation in the mandible's outer cortex screws, 5–8 mm long have been recommended. However, studies have shown thicknesses in the mental foramen region of up to 3 mm, meaning the length of the screw could be a risk to nerve or tooth root damage. The purpose of this study is to identify the influence of screw length on osteosynthesis quality in the region of the mental foramen. Materials and Methods: 10 synthetic polyurethane human lower jaw replicas were subjected to a linear loading test to evaluate fixation techniques with 5 and 10 mm of displacement. In the photoelastic analysis, 02 lower jaw models were made of photoelastic resin and subjected to linear loading in the fixation technique with 10 mm of displacement. Two 04‐hole miniplates in the region of the mental foramen either fixed completely with 4 mm screws (group 1) or with 5 mm screws in the tension zone and 8 mm screws in the compression zone (group 2). The variables were registered for peak load and peak displacement, and final load and final displacement. One‐way analysis of variance (ANOVA) was applied, followed by the Tukey test, with a significance of 5% (p = 0.05) for the comparisons between the means. Results: Considering 95% confidence intervals, the mechanical test showed no statistical differences in peak load between the fixations groups. In the photoelastic analysis, the fringes were concentrated on the distal segment of the fracture in both groups. Conclusion: Due to the lack of statistical difference in the biomechanical and photoelastic tests, considering the methodologic limitation, our study indicates a tendency of advantage toward the treatment of fractures with two 04‐hole plates, fixed with 4 mm screws, to minimize complications like tooth or nerve damage. In vivo studies are needed to verify the convergence of the results of in vitro studies to evaluate the resistance and stability in real masticatory forces. [ABSTRACT FROM AUTHOR]

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