Interimplant fractures present a significant challenge for orthopedic surgeons. Despite a noticeable rise in these cases in recent years, our understanding of this specific fracture type remains ...limited. This study aims to analyze and identify the primary risk factors associated with interimplant femoral fractures. We conducted a retrospective analysis involving 20 patients with interimplant femoral fracture (case group) and 18 patients who had both proximal and distal femoral implants but did not experience interimplant fractures (control group). Our analysis focused on demographic factors (age, sex, BMI) and radiographic parameters (implant types, gap between implants, cortical thickness, femoral canal area) to identify potential risk factors. In the case group, all patients were females, whereas in the control group, 16 patients were female and 2 were males. The mean age in the case group was 88
±
9 years and in the control group was 87
±
12 years. None of the demographic differences reached statistical significance. The mean cortical thickness in the case group was 6
±
2.25 mm, whereas in the control group, it was 9
±
1.75 mm (
p
-value < 0.001). The median gap between the proximal and distal tips of the implants measured 194
±
126 mm in the case group and 66
±
78 mm in the control group (
p
-value < 0.001). Additionally, the mean femoral canal area was 284
±
102 mm
2
in the case group and 227
±
26 mm
2
in the control group (
p
-value < 0.010). Our data indicate that a small cortical thickness, a wide femoral canal area, and having a hip arthroplasty despite a gap between the implants exceeding 110 mm are factors that elevate the risk of interimplant femoral fracture. Notably, osteoporosis therapy emerges as a protective factor against these fractures.
Intramedullary fixation is considered the most stable treatment for pertrochanteric fractures of the proximal femur and cut-out is one of the most frequent mechanical complications. In order to ...determine the role of clinical variables and radiological parameters in predicting the risk of this complication, we analysed the data pertaining to a group of patients recruited over the course of six years.
A total of 571 patients were included in this study, which analysed the incidence of cut-out in relation to several clinical variables: age; gender; the AO Foundation and Orthopaedic Trauma Association classification system (AO/OTA); type of nail; cervical-diaphyseal angle; surgical wait times; anti-osteoporotic medication; complete post-operative weight bearing; and radiological parameters (namely the lag-screw position with respect to the femoral head, the Cleveland system, the tip-apex distance (TAD), and the calcar-referenced tip-apex distance (CalTAD)).
The incidence of cut-out across the sample was 5.6%, with a higher incidence in female patients. A significantly higher risk of this complication was correlated with lag-screw tip positioning in the upper part of the femoral head in the anteroposterior radiological view, posterior in the latero-lateral radiological view, and in the Cleveland peripheral zones. The tip-apex distance and the calcar-referenced tip-apex distance were found to be highly significant predictors of the risk of cut-out at cut-offs of 30.7 mm and 37.3 mm, respectively, but the former appeared more reliable than the latter in predicting the occurrence of this complication.
The tip-apex distance remains the most accurate predictor of cut-out, which is significantly greater above a cut-off of 30.7 mm.
G. Caruso, M. Bonomo, G. Valpiani, G. Salvatori, A. Gildone, V. Lorusso, L. Massari. A six-year retrospective analysis of cut-out risk predictors in cephalomedullary nailing for pertrochanteric fractures: Can the tip-apex distance (TAD) still be considered the best parameter?.
2017;6:481-488. DOI: 10.1302/2046-3758.68.BJR-2016-0299.R1.
Background and purpose: Adenosine is an endogenous modulator, interacting with four G‐protein coupled receptors (A1, A2A, A2B and A3) and acts as a potent inhibitor of inflammatory processes in ...several tissues. So far, the functional effects modulated by adenosine receptors on human synoviocytes have not been investigated in detail. We evaluated mRNA, the protein levels, the functional role of adenosine receptors and their pharmacological modulation in human synoviocytes.
Experimental approach: mRNA, Western blotting, saturation and competition binding experiments, cyclic AMP, p38 mitogen‐activated protein kinases (MAPKs) and nuclear factor (NF)‐κB activation, tumour necrosis factor α (TNF‐α) and interleukin‐8 (IL‐8) release were assessed in human synoviocytes isolated from patients with osteoarthritis.
Key results: mRNA and protein for A1, A2A, A2B and A3 adenosine receptors are expressed in human synoviocytes. Standard adenosine agonists and antagonists showed affinity values in the nanomolar range and were coupled to stimulation or inhibition of adenylyl cyclase. Activation of A2A and A3 adenosine receptors inhibited p38 MAPK and NF‐κB pathways, an effect abolished by selective adenosine antagonists. A2A and A3 receptor agonists decreased TNF‐α and IL‐8 production. The phosphoinositide 3‐kinase or Gs pathways were involved in the functional responses of A3 or A2A adenosine receptors. Synoviocyte A1 and A2B adenosine receptors were not implicated in the inflammatory process whereas stimulation of A2A and A3 adenosine receptors was closely associated with a down‐regulation of the inflammatory status.
Conclusions and implications: These results indicate that A2A and A3 adenosine receptors may represent a potential target in therapeutic modulation of joint inflammation.
Abstract Objectives Zirconium is widely used as material for prosthetic devices because of its good mechanical and chemical properties. When exposed to oxygen, zirconium becomes zirconium oxide (ZO, ...chemically ZrO2 ) which is biocompatible. ZO can be also prepared as a colloidal suspension and then used to coat surfaces. Zirconium oxide coating (ZOC) can potentially have specific biologic effects. Methods The effect of ZOC on bone throughout an in vivo study using dental implants covered with ZOC and then inserted in rabbit tibia was tested in this study. Results The histologic analysis demonstrated that (1) bone growth is more evident around ZOC fixtures than in controls and (2) a more mature bone is present in the peri-implant ZOC surface than in controls. Significance ZOC can enhance implant osseointegration.
Purpose
This narrative review intends to summarize the most important and relevant data on diagnosis and treatment of pediatric forearm fractures and to describe the characteristics and advantage of ...each therapeutic option.
Methods
We conducted a literature research considering peer-reviewed papers (mainly clinical trials or scientific reviews) using the string “forearm fracture AND epidemiology” or “forearm fracture AND diagnosis or “ forearm fracture AND treatment” or “forearm fracture AND casting” or “forearm fracture AND surgery”. Studies were identified by searching electronic databases (MEDLINE and PubMed) till April 2020 and reference lists of retrieved articles. Only English-language articles were included in the review.
Results
Conservative management with cast immobilization is a safe and successful treatment option in pediatric forearm fractures. Surgical indication is recommended when an acceptable reduction cannot be obtained with closed reduction and casting. Surgical treatment options are intramedullary nail, plating and hybrid fixation.
Conclusions
There is not a unique consensus about fracture management and treatment. Further studies are necessary to create univocal guidelines about optimal treatment, considering new techniques and available technologies.
Purpose
The exact nature of sex and gender differences in knee osteoarthritis (OA) among patient candidates for total knee arthroplasty (TKA) remains unclear and requires better elucidation to guide ...clinical practice. The purpose of this investigation was to survey physician practices and perceptions about the influence of sex and gender on knee OA presentation, care, and outcomes after TKA.
Methods
The survey questions were elaborated by a multidisciplinary scientific board composed of 1 pain specialist, 4 orthopedic specialists, 2 physiatrists, and 1 expert in gender medicine. The survey included 5 demographic questions and 20 topic questions. Eligible physician respondents were those who treat patients during all phases of care (pain specialists, orthopedic specialists, and physiatrists). All survey responses were anonymized and handled via remote dispersed geographic participation.
Results
Fifty-six physicians (71% male) accepted the invitation to complete the survey. In general, healthcare professionals expressed that women presented worse symptomology, higher pain intensity, and lower pain tolerance and necessitated a different pharmacological approach compared to men. Pain and orthopedic specialists were more likely to indicate sex and gender differences in knee OA than physiatrists. Physicians expressed that the absence of sex and gender-specific instruments and indications is an important limitation on available studies.
Conclusions
Healthcare professionals perceive multiple sex and gender-related differences in patients with knee OA, especially in the pre- and perioperative phases of TKA. Sex and gender bias sensitivity training for physicians can potentially improve the objectivity of care for knee OA among TKA candidates.
Background. As continuous wound instillation with local anaesthetic has not been evaluated after hip/knee arthroplasties, our study was designed to determine whether this technique could enhance ...analgesia and improve patient outcome after joint replacement surgery. Methods. Thirty‐seven patients undergoing elective hip/knee arthroplasties under spinal block were randomly assigned to two analgesia groups. Group M received continuous i.v. infusion of morphine plus ketorolac for 24 h. Then, a multi‐hole 16 G catheter was placed subcutaneously and infusion of saline was maintained for 55 h. Group R received i.v. saline. Thereafter the wound was infiltrated with a solution of ropivacaine 0.5% 40 ml, then a multi‐hole 16 G catheter was placed subcutaneously and an infusion of ropivacaine 0.2% 5 ml h–1 was maintained for 55 h. Visual analogue scale scores were assessed at rest and on passive mobilization by nurses blinded to analgesic treatment. Total plasma ropivacaine concentration was measured. Results. Group R showed a significant reduction in postoperative pain at rest and on mobilization, while rescue medication requirements were greater in Group M. Total ropivacaine plasma concentration remained below toxic concentrations and no adverse effects occurred. Length of hospital stay was shorter in Group R. Conclusion. Infiltration and wound instillation with ropivacaine 0.2% is more effective in controlling postoperative pain than systemic analgesia after major joint replacement surgery. Br J Anaesth 2003; 91: 830–5
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