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Introduction Department of the Air Force basic military training (BMT) is the 7.5-week initial entry training for all enlisting U.S. Air Force and Space Force recruits. Overuse musculoskeletal injuries (MSKI) during training threaten success in BMT, and trainees with nutritional deficiencies are at higher risk. Several efforts are made at BMT to mitigate these issues to help trainees graduate on time, such as the distribution of multivitamins (MVI) to female recruits. However, trainee compliance with the prescribed MVI has been reported to be low, calling into question the effectiveness of this intervention. This study evaluated the effect of briefing modality offered to these trainees at the time of distribution on educational effectiveness, MVI compliance, and injury rates. Materials and Methods This was a randomized controlled cohort study of BMT female trainees. Subjects included all female trainees of a single iteration of BMT concurrently completing training within the same squadron. At the outset of training, cohorts were randomly educated in one of two ways regarding the provided MVI. The control cohort (n  = 80) was presented with the standard educational video created by BMT-registered dietitians, while the test cohort (n  = 79) was presented the video and then also briefed in-person by a group of subject matter experts. At the end of BMT, the trainees completed a questionnaire regarding their knowledge, confidence, and compliance with the MVI. Additionally, a routinely collected training database was queried and analyzed for differences in injuries and training outcomes using the chi-squared test with significance set to α ≤ 0.05. Results Although both cohorts found their educational presentation useful, the "in-person" cohort reported significantly higher compliance rates and were found to be diagnosed with MSKI and bone stress injuries at significantly lower rates (43% and 66% relative risk reductions, respectively). Conclusions Education to female BMT trainees regarding the MVI, which included a face-to-face discussion with subject matter experts, resulted in greater compliance and reduced incidence of MSKI and bone stress injury, compared to a video prepared by registered dietitians alone. Such educational approaches should continue to be strived for in this and other military population health measures. This study's implication of MVI efficacy for injury risk reduction in female trainees should be further studied, verified, and improved upon in this and other populations. [ABSTRACT FROM AUTHOR]

Background: Lower extremity bone stress injuries (BSIs) are common among athletes who participate in high-impact activities. Conventional imaging is limited in assessing healing of BSIs. Hypothesis: Serial ultrasonography (US) can identify changes in appearance of lower extremity BSIs over time that can be correlated with symptoms and return to exercise/sport. Study Design: Cohort observational study. Level of Evidence: Level 3. Methods: Adults 18 to 50 years old with a recent exercise-associated BSI of distal tibia/fibula or metatarsals diagnosed by magnetic resonance imaging (MRI) were enrolled. US was performed every 2 weeks for 12 weeks. The sonographic appearance (soft tissue edema, periosteal reaction, hyperemia on power Doppler, callus) was correlated with the numerical rating scale (NRS) for pain and ability to return to sport/exercise. Results: A total of 30 patients were enrolled (mean age, 35.3 ± 7.7 years; 21 [70.0%] female). The tibia was most frequently affected (n = 15, 50.0%), followed by metatarsals (n = 14, 46.7%) and fibula (n = 1, 3.3%). At week 4, 25 of 30 (83.3%) had at least 1 US finding associated with the BSI. The degree of hyperemia was correlated with NRS at weeks 4 and 6 (Spearman correlations [ρ] 0.45 [0.09, 0.69] and 0.42 [0.07, 0.67], respectively), as well as return to sport/exercise at week 6 (ρ -0.45 [-0.68, -0.09]). US soft tissue edema was also correlated with NRS at week 6 (ρ 0.38 [0.02, 0.65]). Conclusion: Serial US of lower extremity BSIs can provide objective measures of healing. US findings were correlated with clinical outcomes at multiple timepoints. Clinical Relevance: US may have advantages over conventional imaging for monitoring healing of lower extremity BSIs. Further research is needed to better understand the prognostic value of these sonographic indicators of BSI healing and role in assessing readiness for return to sport/exercise. [ABSTRACT FROM AUTHOR]

Females who engage in high levels of sports have a high prevalence of menstrual cycle disorders and bone stress injuries (BSI). In this study, we determined the prevalence of menstrual disorders and fractures in female athletes and their association with bone mineral density (BMD) parameters. Cross-Sectional Study. Forty-one female athletes from a public High-Performance Regional Centre; 24 high-endurance athletes (HEA) and 17 other athletes, were included. To form the control group, we invited medical students from a public University. Twenty-nine non-athletes (NA) were included. A health surveys and a dual-energy X-ray absorptiometry (DXA) were conducted for all participants. Among the participants (median age, 24 years; body mass index, 21 kg/m2), the percentage of long-term amenorrhoea was 42 % in HEA vs. 0 % in NHEA (OR 25.35; 95 % CI 1.37–470.50, p = 0.008) or 10 % in NA (OR 6.20; 95 % CI 1.46–26.24, p = 0.022), and the percentage of BSI was 29 % in HEA vs. 0 % in NHEA or NA. Both groups of female athletes (HEA and NHEA) showed higher Z-scores than those of NA in the femur; however, only NHEA had a significant increase in the BMD on lumbar spine than that of NA. The prevalence of long-term amenorrhoea and/or BSI was significantly higher in the HEA than in the NHEA or NA females. In contrast, HEA, like NHEA, had higher BMD values in the femur than those of controls. It is unlikely that DXA parameters can be used to estimate cortical BSI risk in this population. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Athletics (track and field) athletes are prone to develop bone stress injuries (BSIs) but epidemiological data on BSIs from top-level sports events are scarce. Objective: To describe the incidence and characteristics of BSIs during 24 international athletics championships held from 2007 to 2023. Methods: BSI-related data were prospectively collected during 24 international athletics championships, including the Olympic Games (n = 3), World Outdoor Championships (n = 4), European Outdoor Championships (n = 6), World Indoor Championships (n = 3) and European Indoor Championships (n = 8). Descriptive and comparative statistics were used to assess the epidemiological characteristics of BSIs. Results: BSIs accounted for 1.5% of all reported injuries (n = 36; 1.2 per 1000 registered athletes (95%CI 0.8 to 1.6)). No significant difference of BSI incidence was detected between female (2.0 per 1000 athletes (95%CI: 0.9 to 2.3)) and male athletes (0.9 per 1000 athletes (95%CI: 0.4 to 1.4)) (relative risk (RR) = 1.73, 95%CI: 0.88 to 3.40). BSI incidence was significantly higher during outdoor championships (1.6 per 1000 registered athletes (95%CI: 1.0 to 2.1)) as compared to indoor championships (0.2 per 1000 registered athletes (95%CI: 0.0 to 0.5)) (RR = 10.4, 95%CI: 1.43 to 76.0). Most BSIs were sustained in the foot (n = 50%) or leg (n = 33%). BSIs were reported in athletes participating in endurance disciplines (52.8%) or in explosive disciplines (47.2%). Conclusions: BSIs represent a small portion of injuries sustained during international athletics championships. Collective results suggest that injury rates are higher in outdoor competitions as compared to indoor competitions. The most common injury locations comprise the foot and leg. Clinical Trial Number: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Excessive fluoride exposure induces skeletal fluorosis, but the specific mechanism responsible is still unclear. Therefore, this study aimed to identify the pathogenesis of fluoride-induced bone injuries. Methods: We systematically searched fluoride-induced bone injury-related genes from five databases. Then, these genes were subjected to enrichment analyses. A TF (transcription factor)–mRNA–miRNA network and protein–protein interaction (PPI) network were constructed using Cytoscape, and the Human Protein Atlas (HPA) database was used to screen the expression of key proteins. The candidate pharmacological targets were predicted using the Drug Signature Database. Results: A total of 85 studies were included in this study, and 112 osteoblast-, 35 osteoclast-, and 41 chondrocyte-related differential expression genes (DEGs) were identified. Functional enrichment analyses showed that the Atf4, Bcl2, Col1a1, Fgf21, Fgfr1 and Il6 genes were significantly enriched in the PI3K-Akt signaling pathway of osteoblasts, Mmp9 and Mmp13 genes were enriched in the IL-17 signaling pathway of osteoclasts, and Bmp2 and Bmp7 genes were enriched in the TGF-beta signaling pathway of chondrocytes. With the use of the TF–mRNA–miRNA network, the Col1a1, Bcl2, Fgfr1, Mmp9, Mmp13, Bmp2, and Bmp7 genes were identified as the key regulatory factors. Selenium methyl cysteine, CGS-27023A, and calcium phosphate were predicted to be the potential drugs for skeletal fluorosis. Conclusions: These results suggested that the PI3K-Akt signaling pathway being involved in the apoptosis of osteoblasts, with the IL-17 and the TGF-beta signaling pathways being involved in the inflammation of osteoclasts and chondrocytes in fluoride-induced bone injuries. [ABSTRACT FROM AUTHOR]

Introduction The rising prevalence of electronic cigarette (e-cigarette) use has prompted concerns regarding its potential health implications. While much attention has focused on respiratory and cardiovascular effects, injuries, oral trauma, and bone fractures linked to e-cigarette use have received less scrutiny. This paper aims to comprehensively review the landscape of injuries, oral trauma, and bone fractures induced by e-cigarettes, shedding light on this underexplored facet of e-cigarette-related harm. Material and Methods This literature review has analyzed 16 papers. Inclusion criteria: researches and case reports published after 2015. PubMed and Google Scholar has been searched to identify the papers. Analysis of the Literature Existing literature suggests a growing incidence of injuries, oral trauma, and bone fractures associated with e-cigarette use, albeit with limited systematic investigation. Mechanisms underlying these injuries range from device malfunctions to inadvertent impacts during use. Case reports highlight a spectrum of injuries, including oral burns, dental trauma, and skeletal fractures, often involving the face and mouth regions. Conclusions Despite the lack of comprehensive epidemiological data emerging evidence underscores the need for heightened awareness and preventive measures to mitigate e-cigarette-related injuries. Enhanced education, regulation of e-cigarette devices, and promotion of safer usage practices are crucial steps towards reducing the burden of e-cigarette-related harm on oral and skeletal health. [ABSTRACT FROM AUTHOR]

Purpose: To explore the consistency of FRACTURE (Fast-field-echo Resembling A CT Using Restricted Echo-spacing) MRI and X-Ray/computerized tomography (CT) in the evaluation of bone injuries in knee and ankle joints. Methods: From Nov. 2020 to Jul. 2023, 42 patients with knee joint or ankle joint injuries who underwent FRACTURE MRI examinations were retrospectively collected. 11 patients were examined by both X-Ray and FRACTURE examinations. 31 patients were examined by both CT and FRACTURE examinations. The fracture, osteophyte, and bone destruction of the joints were evaluated by two radiologists using X-Ray/CT and FRACTURE images, respectively. Kappa test was used for consistency analysis. Results: The evaluation consistency of fracture, osteophyte and bone destruction via X-Ray and FRACTURE images by radiologist 1 were 0.879, 0.867 and 0.847 respectively, and for radiologist 2 were 0.899, 0.930, and 0.879, respectively. The evaluation consistency of fracture, osteophyte and bone destruction via CT and FRACTURE images by radiologist 1 were 0.938, 0.937 and 0.868 respectively, and for radiologist 2 were 0.961, 0.930, and 0.818, respectively. Conclusion: For fracture, osteophyte, and bone destruction of knee and ankle joints. FRACTURE MRI showed a high consistency with X-Ray/CT examinations. [ABSTRACT FROM AUTHOR]

Background: Early soft tissue management is crucial in lower extremity defects, particularly those involving vital tissue exposure, bone integrity impairment or underlying instrumentation material. In the recent literature, free flaps and perforator flaps are considered as suitable options for this region. However early microsurgery planning may not be possible in every center due to the surgical experience, equipment or hospital and patient related factors. In such cases, transposition fasciocutaneous flaps emerge as a more accessible and efficient choice. Methods: All patients who underwent reconstruction with a random pattern transposition flap due to tissue defect in the lower extremity between 2019 and 2023 were retrospectively analyzed. Demographic characteristics, comorbidities, and defect mechanisms were recorded. Additionally, information regarding bone injuries, interventions performed, duration between injury and reconstruction, pre- and post-reconstruction cultures, and antibiotic treatments were documented. Post-reconstruction complications, ambulation period, and discharge time were also assessed. The limitations of microsurgery and reasons for flap planning were noted. Results: Twelve patients were included in this study. The mean age of the patients was 44 (20–67). The mechanism of defects were gunshot (6), fall (3), traffic accident (1), pressure ulcer (1), and tumor excision (1). In three patients (25%) who have previously undergone an operation for soft tissue defect, but there was exposed titanium implant or bone due to skin necrosis, a transposition flap was performed as a salvage procedure. In addition, 8 patients (73%) had multiple or comminuted bone fractures and 1 patient (8.3%) had a single bone fracture. While fixation was performed with titanium implants in 41.7% (5 patients) of the patients in the defect area, the fracture was stabilized with an external fixator in 2 patients and with a Kishner wire in 1 patient. Wound healing was observed good in 10 patients without other complex surgical intervention. Partial necrosis was observed in one patient due to infection. Partial dehiscence was observed in another patient with a pressure ulcer in the calcaneal region which was left to heal secondarily. Conclusions: Transposition fasciocutaneous flaps offers rapid planning process, easy disection and functionally and aesthetically benefits with proper planning. They should be considered as a simple option as salvage of complex soft tissue reconstruction. Level of evidence: Level IV, Therapeutic [ABSTRACT FROM AUTHOR]

Bone, a rigid yet regenerative tissue, has garnered extensive attention for its impressive healing abilities. Despite advancements in understanding bone repair and creating treatments for bone injuries, handling nonunions and large defects remains a major challenge in orthopedics. The rise of bone regenerative materials is transforming the approach to bone repair, offering innovative solutions for nonunions and significant defects, and thus reshaping orthopedic care. Evaluating these materials effectively is key to advancing bone tissue regeneration, especially in difficult healing scenarios, making it a critical research area. Traditional evaluation methods, including two-dimensional cell models and animal models, have limitations in predicting accurately. This has led to exploring alternative methods, like 3D cell models, which provide fresh perspectives for assessing bone materials' regenerative potential. This paper discusses various techniques for constructing 3D cell models, their pros and cons, and crucial factors to consider when using these models to evaluate bone regenerative materials. We also highlight the significance of 3D cell models in the in vitro assessments of these materials, discuss their current drawbacks and limitations, and suggest future research directions. This work addresses the challenge of evaluating bone regenerative materials (BRMs) crucial for bone tissue engineering. It explores the emerging role of 3D cell models as superior alternatives to traditional methods for assessing these materials. By dissecting the construction, key factors of evaluating, advantages, limitations, and practical considerations of 3D cell models, the paper elucidates their significance in overcoming current evaluation method shortcomings. It highlights how these models offer a more physiologically relevant and ethically preferable platform for the precise assessment of BRMs. This contribution is particularly significant for "Acta Biomaterialia" readership, as it not only synthesizes current knowledge but also propels the discourse forward in the search for advanced solutions in bone tissue engineering and regeneration. [Display omitted] [ABSTRACT FROM AUTHOR]

Objectives To determine (1) the incidence rate of lower extremity (LE) bone stress injuries (BSIs) in United States Air Force Special Warfare (AFSPECWAR) trainees during the first 120 days of training, and (2) factors associated with sustaining a LE BSI. Design Retrospective cohort study. Methods AFSPECWAR Airmen (n  = 2,290, mean age = 23.7 ± 3.6 years) entering an intensive 8-week preparatory course "SW-Prep" between October 2017 and May 2021. We compared anthropometric measurements, previous musculoskeletal injury (MSKI), fitness measures, and prior high-impact sports participation in those that did and did not suffer a BSI during the 120-day observation period using independent t -tests and chi-square tests. A multivariable binary logistic regression was used to determine factors associated with suffering a BSI. Results A total of 124 AFSPECWAR trainees suffered a BSI during the surveillance period, yielding an incidence proportion of 5.41% and an incidence rate of 1.4 BSIs per 100 person-months. The multivariate logistic regression revealed that lower 2-minute sit-up scores, no prior history of participation in a high-impact high-school sport, and a history of prior LE MSKI were associated with suffering a BSI. A receiver operator characteristic curve analysis yielded an area under the curve (AUC) of 0.727. Conclusion BSI incidence proportion for our sample was similar to those seen in other military settings. Military trainees without a history of high-impact sports participation who achieve lower scores on sit-ups tests and have a history of LE MSKI have a higher risk for developing a LE BSI during the first 120 days of AFSPECWAR training. [ABSTRACT FROM AUTHOR]

Tissue repair and regeneration, such as bone and nerve restoration, face significant challenges due to strict regulations within the immune microenvironment, stem cell differentiation, and key cell behaviors. The development of 3D scaffolds is identified as a promising approach to address these issues via the efficiently structural regulations on cell fates and behaviors. In particular, 3D‐printed polymer scaffolds with diverse micro‐/nanostructures offer a great potential for mimicking the structures of tissue. Consequently, they are foreseen as promissing pathways for regulating cell fates, including cell phenotype, differentiation of stem cells, as well as the migration and the proliferation of key cells, thereby facilitating tissue repairs and regenerations. Herein, the roles of structural functions of 3D‐printed polymer scaffolds in regulating the fates and behaviors of numerous cells related to tissue repair and regeneration, along with their specific influences are highlighted. Additionally, the challenges and outlooks associated with 3D‐printed polymer scaffolds with various structures for modulating cell fates are also discussed. [ABSTRACT FROM AUTHOR]

Objective: Hamatometacarpal fracture-dislocations (HMFD) are rare hand injuries resulting from axial loading. This study aimed to present the clinical presentation and outcomes of HMFD, which is rare and likely to be missed in the emergency department. Methods: A retrospective analysis of 15 patients who underwent surgical intervention for HMFD between 2015 and 2023 was conducted. At the last follow-up, the presence of union, malunion, residual subluxation, and Kellgren-Lawrence grading scale were evaluated. Time to diagnosis, time to return to work (RTW), level of difficulty in working, grip strength, and disabilities of the arm, shoulder, and hand (DASH) scores were evaluated. Results: The mean patient age was 30.6 years. Most injuries (93.3%) were due to punching. Open reduction was performed in 73.3% of cases. No complications were reported during the mean of 52.3-month follow-up. Open reduction was associated with a lower DASH scores. Hand-intensive work was correlated with a longer time to RTW and higher difficulty to RTW. Delayed diagnosis was correlated with worse grip strength, but not with significantly different DASH scores. Conclusion: HMFD is a rare hand injury that presents as a diagnostic challenge. Achieving anatomical reduction is crucial for restoring hand function. Therefore, comprehensive treatment strategies should be planned individually, taking into account patients's injury patterns. [ABSTRACT FROM AUTHOR]

Bone tissue engineering (BTE) is the most promising strategy to repair bones injuries and defects. It relies on the utilization of a temporary support to host the cells and promote nutrient exchange (i.e., the scaffold). Supercritical CO2 assisted drying can preserve scaffold nanostructure, crucial for cell attachment and proliferation. In this work, agarose aerogels, loaded with hydroxyapatite were produced in view of BTE applications. Different combinations of agarose concentration and hydroxyapatite loadings were tested. FESEM and EDX analyses showed that scaffold structure suffered from partial closure when increasing filler concentration; hydroxyapatite distribution was homogenous, and Young's modulus improved. Looking at BTE applications, the optimal combination of agarose and hydroxyapatite resulted to be 1% w/w and 10% w/v, respectively. Mechanical properties showed that the produced composites could be eligible as starting scaffold for BTE, with a Young's Modulus larger than 100 kPa for every blend. [ABSTRACT FROM AUTHOR]

Bone-stress injury (BSI) is common in collegiate athletes. Injury rates and health care use in running athletes are not well documented. To describe the rate and classification of injury and associated health care use in collegiate cross-country runners with BSI. Descriptive epidemiology study. Sports medicine facilities participating in the Pac-12 Health Analytics Program. Pac-12 Conference collegiate cross-country athletes. Counts of injury and health care resources used for each injury. Injury rates were calculated based on athlete-seasons. A total of 168 BSIs were reported over 4 seasons from 80 team-seasons (34 men's and 46 women's team-seasons) and 1220 athlete-seasons, resulting in 1764 athletic training services and 117 physician encounters. Bone-stress injuries represented 20% of all injuries reported by cross-country athletes. The average BSI rate was 0.14 per athlete-season. Injury rates were higher in female (0.16) than male (0.10) athletes and higher in the 2019–2020 season (0.20) than the 2020–2021 (0.14), 2018–2019 (0.12), and 2021–2022 (0.10) seasons. Most BSIs occurred in the lower leg (23.8%) and the foot (23.8%). The majority of injuries were classified as overuse and time loss (72.6%) and accounted for most of the athletic training services (75.3%) and physician encounters (72.6%). We found a mean of 10.89 athletic training services per overuse and time-loss injury and 12.20 athletic training services per overuse and non–time-loss injury. Mean occurrence was lower for physician encounters (0.70), prescription medications (0.04), tests (0.75), procedures (0.01), and surgery (0.02) than for athletic training services (10.50). Bone-stress injuries are common in collegiate cross-country runners and require considerable athletic training resources. Athletic trainers should be appropriately staffed for this population, and suspected BSIs should be confirmed with a medical diagnosis. Future investigators should track treatment codes associated with BSI to determine best-practice patterns. [ABSTRACT FROM AUTHOR]

Purpose: To achieve accurate socket shield preparation with newly proposed guides that are based on guiding rails and to investigate the effect of rail format (unilateral or bilateral) and rail height on the accuracy and efficiency of the guides. Materials and methods: Two surgical guides based on grooved rails to guide the rotary instruments were produced. The first guide was used to cut the root into a labial shield with a pre‐designed form and a lingual one, while the second guide was used to reduce the socket shield to the alveolar bone crest. The CBCT and intraoral scan data were first obtained and superimposed using the software. After isolating the root which would be used as a socket shield, grooved rails were designed on two separate guide templates according to the chosen rotary instruments to obtain a labial shield with a pre‐designed form. An in vitro study was then conducted based on four cases in each group to determine the accuracy, efficiency, and optimal parameters of the guides, which was then verified with a clinical report. Comparisons between groups were performed with a one‐way analysis of variance (ANOVA, for comparison between multiple groups) and the Student‐Newman‐Keuls test (for comparison between two groups). Results: With these two guides, the root can be divided into two pieces, including a palatal one and a labial one with a pre‐designed form within a short time. Guide templates with bilateral rails more than 7 mm in height and those with unilateral rails 9 mm in height significantly increased the surgery accuracy, showing accurate shield preparation and decreased bone injury. Moreover, the guides with bilateral rails of more than 5 mm significantly decreased the surgery time for shield preparation. The presented case further verified the accuracy and efficiency of the guides. Conclusions: The newly proposed guides can help to accurately prepare the socket shield, resulting in long‐term stability of peri‐implant tissues. Moreover, bilateral guiding rails with a height of 7–9 mm are recommended in such a guided socket shield surgery. [ABSTRACT FROM AUTHOR]

The periosteum plays a critical role in bone repair and is significantly influenced by the surrounding immune microenvironment. In this study, we employed 10× single-cell RNA sequencing to create a detailed cellular atlas of the swine cranial periosteum, highlighting the cellular dynamics and interactions essential for cranial bone injury repair. We noted that such injuries lead to an increase in M2 macrophages, which are key in modulating the periosteum's immune response and driving the bone regeneration process. These macrophages actively recruit periosteal stromal cells (PSCs) by secreting Neuregulin 1 (NRG1), a crucial factor in initiating bone regeneration. This recruitment process emphasizes the critical role of PSCs in effective bone repair, positioning them as primary targets for therapeutic interventions. Our results indicate that enhancing the interaction between M2 macrophages and PSCs could significantly improve the outcomes of treatments aimed at cranial bone repair and regeneration. [ABSTRACT FROM AUTHOR]

Bioactive degradable scaffolds that facilitate bone healing while fighting off initial bacterial infection have the potential to change established strategies of dealing with traumatic bone injuries. To achieve this a composite material made from calcium phosphate graphene (CaPG), and MXene was synthesized. CaPG was created by functionalizing graphene oxide with phosphate groups in the presence of CaBr with a Lewis acid catalyst. Through this transformation, Ca2+ and PO43− inducerons are released as the material degrades thereby aiding in the process of osteogenesis. The 2D MXene sheets, which have shown to have antibacterial properties, were made by etching the Al from a layered Ti3AlC2 (MAX phase) using HF. The hot‐pressed scaffolds made of these materials were designed to combat the possibility of infection during initial surgery and failure of osteogenesis to occur. These two failure modes account for a large percentage of issues that can arise during the treatment of traumatic bone injuries. These scaffolds were able to retain induceron‐eluting properties in various weight percentages and bring about osteogenesis with CaPG alone and 2 wt% MXene scaffolds demonstrating increased osteogenic activity as compared to no treatment. Additionally, added MXene provided antibacterial properties that could be seen at as little as 2 wt%. This CaPG and MXene composite provides a possible avenue for developing osteogenic, antibacterial materials for treating bone injuries. [ABSTRACT FROM AUTHOR]

Tap dance generates forces and joint motions that can lead to injury; however, little is known about the magnitude of load across different tap steps. The purpose of this study was to calculate peak vertical forces, average vertical foot velocities, and maximum/minimum ankle angles produced by tap dancers with different levels of experience performing the toe cannon, heel cannon, flap, and cramp roll. This prospective cross-sectional study included 14 female tap dancers aged ≥18 years with varying tap experience. Participants were recorded by three cameras while performing a choreographed tap combination containing four steps of interest on a force platform. Adjusting for experience and dancer-level clustering, we identified the steps—cramp roll and toe cannon—that had the highest peak vertical ground reaction force, angles, and velocities compared to flap and heel cannon. There was no effect of experience. The results supported our hypothesis and provide new insights into step production. Over time, the larger forces associated with these steps could pose an increased risk of injury to bones and joints when compared to smaller forces, which may suggest the importance of adjusting routines to reduce or avoid injury. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal injuries are a common occurrence in sport. The goal of sport injury epidemiology is to study these injuries at a population level to inform their prevention and treatment. Main body: This review provides an overview of musculoskeletal sport injuries and the musculoskeletal system from a biological and epidemiologic perspective, including injury mechanism, categorizations and types of sport injuries, healing, and subsequent injuries. It is meant to provide a concise introductory substantive background of musculoskeletal sport injuries for epidemiologists who may not have formal training in the underlying anatomy and pathophysiology. Conclusion: An understanding of sport injuries is important for researchers in sport injury epidemiology when determining how to best define and assess their research questions and measures. [ABSTRACT FROM AUTHOR]

Stem cell-based therapy plays a significant role in the repair of bone defects. However, traditional stem cell transplantation strategies in bone tissue engineering are characterized by low survival rates and unstable treatment outcomes. In this study, we propose a timely delivery strategy for inflammatory changes in the setting of bone injury to improve the survival rate of transplanted cells and bone repair. The results of cell tracing in vivo showed that this strategy could effectively improve the survival rate of low-dose exogenous transplanted cells in bone defect areas, and CD31 immunofluorescence and histological sections suggested that this strategy effectively promoted vascularization and new bone formation in the calvarial defect area. Subsequently, we analyzed the mechanism of action of the "Two-step" strategy from the perspective of inflammatory microenvironment regulation, and the results suggested that the first batch transplanted stem cells caused localized and transient increases in tissue apoptosis levels and inflammatory factors, and recruited macrophage chemotaxis, and the second batch of cells may promote pro-inflammatory - anti-inflammatory transformation of the tissue. Finally, mRNA sequencing results suggest that the first batch cells in the "Two-step" strategy are important initiators in bone repair, which not only actively regulate the immune microenvironment at the bone defect, but also guide richer cellular activity and more positive biochemical responses. Therefore, the "Two-step" strategy leads to efficient inflammatory environment regulation and superior bone repair effects, which may provide an alternative option for the treatment of bone defects in the future. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI), recognized as the world's most serious public health problem, currently lacks effective treatment options. The development of the patch has great clinical significance whether it is used as a skull implant material or TBI repair. In response to this critical health challenge, a novel 3D‐printed bi‐layer cranial‐brain patch (SMB6) with dual functionality, addressing both TBI repair and skull regeneration, is developed. In the first layer, the incorporation of high concentrations of mesoporous bioactive glass nanoparticles establishes a microenvironment for bone regeneration. Meanwhile, the second layer, comprised of methacrylated silk fibroin hydrogel, provides essential mechanical support for nanocell membrane vesicles loaded with macrophage colony‐stimulating factor and interleukin‐6. This innovative design aims to interrupt the cascade of secondary brain injury. In experimental models of TBI, SMB6 demonstrates remarkable efficacy in inhibiting brain edema, exerting therapeutic effects on blood vessels, nerves, and inflammation. Additionally, promising outcomes are observed in promoting bone regeneration in skull defect models. This work not only introduces a potential therapeutic patch for TBI‐related diseases but also provides novel insights for the clinical translation of cranial patches. [ABSTRACT FROM AUTHOR]

(1) Background: Bone bruises in acute anterior cruciate ligament (ACL) injuries are closely linked to the occurrence of simultaneous meniscal and cartilage damage. Despite the frequent occurrence of associated injuries including bone bruises, meniscus, and cartilage damage in patients with ACL injuries, a systematic review of the relationships between the presence of bone bruises and the extent of meniscus and cartilage injuries has yet to be conducted. (2) Methods: Multiple comprehensive databases, including MEDLINE, EMBASE, and the Cochrane Library, were searched for studies that evaluated the relationship between bone bruises and meniscus or cartilage injuries following ACL injuries. Study selection, data extraction, and meta-analysis were performed. The Methodological Index for Non-Randomized Studies (MINORS) was used for quality assessments, and Review Manager 5.3 was used for data analysis. (3) Results: Data were extracted from 22 studies encompassing a total of 2891 patients with ACL injuries. Among the included studies, six studies investigated the relationships between bone bruises and medial meniscus (MM) or lateral meniscus (LM) injuries, while three studies investigated the relationships between bone bruises and cartilage injuries. There were no significant correlations between the presence of bone bruises and MM injuries (relative risk (RR) = 1.32; p = 0.61). A quantitative analysis indicated that individuals with bone bruises had a 2.71-fold higher likelihood of sustaining LM injuries than those without bone bruises (RR = 2.71; p = 0.0003). The analysis confirmed a significant relationship between bone bruises and cartilage injuries (RR = 6.18; p = 0.003). (4) Conclusions: Bone bruises occur most frequently in the lateral compartment. Bone bruises resulting from ACL injuries are related to accompanying LM injuries and cartilage injuries. Knowing these associations and the frequency of injuries may allow orthopedic surgeons to promptly address ACL-related meniscus and cartilage injuries on MRI results and in future clinical practice. [ABSTRACT FROM AUTHOR]

Bone stress injuries are prevalent among athletes and military recruits and can significantly compromise training schedules. The development of an ankle–foot orthosis to reduce tibial load and enable a faster return to activity will require new device testing methodologies capable of capturing the contribution of muscular force on tibial strain. Thus, an actuated robotic surrogate leg was developed to explore how tibial strain changes with different ankle–foot orthosis conditions. The purpose of this work was to assess the reliability, scalability, and behavior of the surrogate. A dual actuation system consisting of a Bowden cable and a vertical load applied to the femur via a material testing system, replicated the action-reaction of the Achilles-soleus complex. Maximum and minimum principal strain, maximum shear strain, and axial strain were measured by instrumented strain gauges at five locations on the tibia. Strains were highly repeatable across tests but did not consistently match in vivo data when scaled. However, the stiffness of the ankle–foot orthosis strut did not systematically affect tibial load, which is consistent with in vivo findings. Future work will involve improving the scalability of the results to match in vivo data and using the surrogate to inform exoskeletal designs for bone stress injuries. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to comprehensively evaluate traumatic ankle injuries using Magnetic Resonance Imaging (MRI) and provide detailed insights into demographics, injury patterns, and prevalence. Methods: A total of 55 patients with suspected ankle injuries following trauma were included in this descriptive study. MRI was employed for evaluation, and data were collected over an 18-month period. Demographic details, injury types, and prevalence were systematically analyzed. Results: The study revealed a higher incidence of traumatic ankle injuries in the 21-30 age group, with a male predominance. Acute onset of symptoms, commonly associated with twisting, was observed. Ligament injuries were predominant (83.6%), with lateral ligaments, especially the Anterior Talofibular Ligament, most frequently affected. Tendon injuries, bone injuries (including contusions, fractures, osteochondral lesions, and osteonecrosis), and joint effusion were also identified. Conclusion: MRI emerged as a valuable tool for characterizing traumatic ankle injuries. Ligament injuries, particularly grade 1 sprains, predominated, emphasizing the role of lateral ligaments. Notable variations in injury patterns, tendon involvement, and bone injuries were elucidated. The study contributes to clinical understanding and highlights the importance of tailored treatment strategies based on imaging findings. [ABSTRACT FROM AUTHOR]

BACKGROUND: Peripheral nerves play an important role in bone metabolism. In clinical practice, the specific impact of nerve injury on bone transport technology needs further study. OBJECTIVE: To investigate the effect of tibial nerve injury on the treatment of tibial slip by single-plane osteotomy. METHODS: Thirty-two patients with tibial bone defects admitted to Tangshan Second Hospital from May 2011 to June 2022 were selected. According to the presence or absence of tibial nerve injury, patients were divided into the tibial nerve injury group (n=16) and the non-tibial nerve injury group (n=16). Both groups were treated with single-plane osteotomy and bone slip. After treatment, the patients were followed up to collect the mineralization zone healing index, external fixation index, docking point healing and needle infection. After the removal of external fixation, the bone healing and functional evaluation were evaluated by a classification of the Association for the Study and Application of the Method of Ilizarov (ASAMI). RESULTS AND CONCLUSION: (1) All 32 patients were followed up for (25.28±4.79) months. There were no significant differences in bone healing time, external fixation time, healing index and external fixation index between the two groups (P > 0.05). Needle infection occurred in two cases of the tibial nerve injury group and one case of the non-tibial nerve injury group, all of which were PALEY I, and there was no significant difference between the two groups (P > 0.05). The non-union rate of the occlusal end of the tibial nerve injury group was 31%, and that of the non-tibial nerve injury group was 13%; there was no statistical difference between the two groups (P > 0.05). The excellent and good rate of ASAMI bone healing score in the two groups was 100%; the excellent and good rate of limb score was 81% in the tibial nerve injury group and 94% in the non-tibial nerve injury group; there was no statistical difference between the two groups (P > 0.05). (2) Our research shows that tibial nerve injury has no significant effect on the mineralization speed, external fixation time, union of the occlusal end, infection of the needle tract, and the quality of bone formation in the mineralized area of the single-plane osteotomy. [ABSTRACT FROM AUTHOR]

Simple Summary: Wildlife rescue centers frequently admit animals with injuries and bone fractures. Open fractures are common in birds due to their anatomy, and this can lead to complications like osteomyelitis, which implies a serious bone infection and often necrosis, or death of the affected bone tissue. Antibiotic therapy is crucial, but the rise in antimicrobial-resistant isolates in wildlife raises concerns about treatment efficacy. A study focused on isolating, identifying, and assessing antimicrobial resistance in bacteria from wounds and fractures in wild birds. Among 36 isolates, Staphylococcus spp. dominated (63.8%), with 82.6% exhibiting antimicrobial resistance, particularly to clindamycin, an antimicrobial key in the treatment of infected bone fractures. This escalating resistance poses a dual threat to wildlife—therapeutic failure and the spread of resistant bacteria in ecosystems. Injuries and bone fractures are the most frequent causes of admission at wildlife rescue centers. Wild birds are more susceptible to open fractures due to their anatomical structure, which can lead to osteomyelitis and necrosis. Antibiotic therapy in these cases is indispensable, but the increase of antimicrobial-resistant isolates in wildlife has become a significant concern in recent years. In this context, the likelihood of antibiotic failure and death of animals with infectious issues is high. This study aimed to isolate, identify, and assess the antimicrobial resistance pattern of bacteria in wounds and open fractures in wild birds. To this end, injured birds admitted to a wildlife rescue center were sampled, and bacterial isolation and identification were performed. Then, antimicrobial susceptibility testing was assessed according to the disk diffusion method. In total, 36 isolates were obtained from 26 different birds. The genera detected were Staphylococcus spp. (63.8%), Escherichia (13.9%), Bacillus (11.1%), Streptococcus (8.3%), and Micrococcus (2.8%). Among Staphylococcus isolates, S. lentus and S. aureus were the most frequent species. Antimicrobial resistance was detected in 82.6% of the isolates, among which clindamycin resistance stood out, and 31.6% of resistant isolates were considered multidrug-resistant. Results from this study highlight the escalating scope of antimicrobial resistance in wildlife. This level of resistance poses a dual concern for wildlife: firstly, the risk of therapeutic failure in species of significant environmental value, and, secondly, the circulation of resistant bacteria in ecosystems. [ABSTRACT FROM AUTHOR]

We review the spectrum of acute osseous injuries in athletes, ranging from osseous contusion (bone bruise) injuries to nondisplaced cortical fractures. The basic biomechanical concepts, underlying histopathologic changes, and characteristic magnetic resonance imaging (MRI) features of acute osseous injuries are presented. Bone bruise injuries of varying severity are highlighted to showcase the breadth of imaging findings on MRI and methods for characterizing such lesions. We emphasize the importance of accurately assessing patterns of injury on MRI to communicate more effectively with team medical staff and recognize the implications on return to play. This article offers the foundational tools for approaching bone bruise injuries in elite athletes to add value to the diagnosis and treatment of this unique patient population. [ABSTRACT FROM AUTHOR]

Presently, millions worldwide suffer from degenerative and inflammatory bone and joint issues, comprising roughly half of chronic ailments in those over 50, leading to prolonged discomfort and physical limitations. These conditions become more prevalent with age and lifestyle factors, escalating due to the growing elderly populace. Addressing these challenges often entails surgical interventions utilizing implants or bone grafts, though these treatments may entail complications such as pain and tissue death at donor sites for grafts, along with immune rejection. To surmount these challenges, tissue engineering has emerged as a promising avenue for bone injury repair and reconstruction. It involves the use of different biomaterials and the development of three-dimensional porous matrices and scaffolds, alongside osteoprogenitor cells and growth factors to stimulate natural tissue regeneration. This review compiles methodologies that can be used to develop biomaterials that are important in bone tissue replacement and regeneration. Biomaterials for orthopedic implants, several scaffold types and production methods, as well as techniques to assess biomaterials' suitability for human use—both in laboratory settings and within living organisms—are discussed. Even though researchers have had some success, there is still room for improvements in their processing techniques, especially the ones that make scaffolds mechanically stronger without weakening their biological characteristics. Bone tissue engineering is therefore a promising area due to the rise in bone-related injuries. [ABSTRACT FROM AUTHOR]

Masters runners are often defined as those ages 35 years and older who train and compete in running events. These runners represent a growing population of the overall running community and experience running‐related injuries including bone stress injuries (BSIs). Similar to younger runners, health considerations in masters runners include the goal to optimize bone health with focus on mitigating age‐associated loss of bone strength and preventing BSIs through a combination of ensuring appropriate physical activity, optimizing nutrition, and correcting faulty biomechanics. Importantly, BSIs in masters runners may include characteristics of both overuse injury from insufficient recovery and failure of bone weakened by age‐related loss of bone (insufficiency fractures). This narrative review covers the limited available research on strategies to optimize bone health in masters runners. Applying knowledge on masters athletes and extrapolating from other populations, we propose strategies on treatment and prevention of BSIs. Finally, the review highlights gaps in knowledge that require further age‐specific discoveries to advance treatment and prevention. [ABSTRACT FROM AUTHOR]

The jawbone, a unique structure in the human body, undergoes faster remodeling than other bones due to the presence of stem cells and its distinct immune microenvironment. Long-term exposure of jawbones to an oral environment rich in microbes results in a complex immune balance, as shown by the higher proportion of activated macrophage in the jaw. Stem cells derived from the jawbone have a higher propensity to differentiate into osteoblasts than those derived from other bones. The unique immune microenvironment of the jaw also promotes osteogenic differentiation of jaw stem cells. Here, we summarize the various types of stem cells and immune cells involved in jawbone reconstruction. We describe the mechanism relationship between immune cells and stem cells, including through the production of inflammatory bodies, secretion of cytokines, activation of signaling pathways, etc. In addition, we also comb out cellular interaction of immune cells and stem cells within the jaw under jaw development, homeostasis maintenance and pathological conditions. This review aims to eclucidate the uniqueness of jawbone in the context of stem cell within immune microenvironment, hopefully advancing clinical regeneration of the jawbone. [ABSTRACT FROM AUTHOR]

Although previous studies have demonstrated the advantages of early surgery for traumatic spinal cord injury (SCI), the appropriate surgical timing for cervical SCIs (CSCIs) without bone injury remains controversial. Here, we investigated the influence of relatively early surgery within 48 h of injury on the neurological recovery of elderly patients with CSCI and no bone injury. In this retrospective multicenter study, we reviewed data from 159 consecutive patients aged ≥65 years with CSCI without bone injury who underwent surgery in participating centers between 2010 and 2020. Patients were followed up for at least 6 months following CSCI. We divided patients into relatively early (≤48 h after CSCI, n = 24) and late surgery (>48 h after CSCI, n = 135) groups, and baseline characteristics and neurological outcomes were compared between them. Multivariate analysis was performed to identify factors associated with neurological recovery. The relatively early surgery group demonstrated a lower prevalence of cardiac disease, poorer baseline American Spinal Injury Association (ASIA) impairment scale grade, and lower baseline ASIA motor score (AMS) than those of the late surgery group (P < 0.030, P < 0.001, and P < 0.001, respectively). Although the AMS was lower in the relatively early surgery group at 6 months following injury (P = 0.001), greater improvement in this score from baseline to 6-months post injury was observed (P = 0.010). Multiple linear regression analysis revealed that relatively early surgery did not affect postoperative improvement in AMS, rather, lower baseline AMS was associated with better AMS improvement (P < 0.001). Delirium (P = 0.006), pneumonia (P = 0.030), and diabetes mellitus (P = 0.039) negatively influenced postoperative improvement. Although further validation by future studies is required, relatively early surgery did not show a positive influence on neurological recovery after CSCI without bone injury in the elderly. [ABSTRACT FROM AUTHOR]

Ionizing radiation (IR) induces severe hematopoietic injury by causing DNA and RNA damage as well as activating the immune responses, necessitating the development of effective therapeutic strategies. Ribonuclease L (RNase L) as an innate immune response pathway is triggered by exogenous and endogenous abnormal dsRNA under viral infection and dyshomeostasis, thereby activating the immune responses. Thus, we investigated the effect of RNase L on irradiation-induced bone marrow damage using RNase L knockout (RNase L−/−) mice. Phenotypic analysis revealed that RNase L knockout mitigates irradiation-induced injury in the bone marrow. Further investigation into the mechanism of RNase L by RNA-seq, qRT-PCR, and CBA analysis demonstrated that RNase L deficiency counteracts the upregulation of genes related to immune responses induced by irradiation, including cytokines and interferon-stimulated genes. Moreover, RNase L deficiency inhibits the increased levels of immunoglobulins in serum induced by irradiation. These findings indicate that RNase L plays a role in the immune response induced by irradiation in the bone marrow. This study further enhances our understanding of the biological functions of RNase L in the immune response induced by irradiation and offers a novel approach for managing irradiation-induced bone marrow injury through the regulation of RNase L activation. [ABSTRACT FROM AUTHOR]

Patients with bone diseases often experience increased bone fragility. When bone injuries exceed the body's natural healing capacity, they become significant obstacles. The global rise in the aging population and the escalating obesity pandemic are anticipated to lead to a notable increase in acute bone injuries in the coming years. Our research developed a novel DLP resin for 3D printing, utilizing poly(ethylene glycol diacrylate) (PEGDA) and various monomers through the PET-RAFT polymerization method. To enhance the performance of bone scaffolds, triply periodic minimal surfaces (TPMS) were incorporated into the printed structure, promoting porosity and pore interconnectivity without reducing the mechanical resistance of the printed piece. The gyroid TPMS structure was the one that showed the highest mechanical resistance (0.94 ± 0.117 and 1.66 ± 0.240 MPa) for both variants of resin composition. Additionally, bioactive particles were introduced to enhance the material's biocompatibility, showcasing the potential for incorporating active compounds for specific applications. The inclusion of bioceramic particles produces an increase of 13% in bioactivity signal for osteogenic differentiation (alkaline phosphatase essay) compared to that of control resins. Our findings highlight the substantial improvement in printing precision and resolution achieved by including the photoabsorber, Rose Bengal, in the synthesized resin. This enhancement allows for creating intricately detailed and accurately defined 3D-printed parts. Furthermore, the TPMS gyroid structure significantly enhances the material's mechanical resistance, while including bioactive compounds significantly boosts the polymeric resin's biocompatibility and bioactivity (osteogenic differentiation). [ABSTRACT FROM AUTHOR]

Objective: Stretching is performed with numerous purposes in multiple settings such as prevention, rehabilitation, fitness training and sports. Its patterns of use substantially depend on the education and beliefs of health care and exercise professionals as they represent the multiplicators recommending and prescribing interventions to clients, patients and athletes. This study investigated movement experts' knowledge about the scientific evidence on stretching effects. Design: Survey study. Participants: A total of 117 exercise and health professionals (physiotherapists, sports scientists, coaches) attending a training convention in Austria (male: n = 44, female: n = 73, 36±11 years) completed a digital survey. With its 22 items, the questionnaire addressed the movement experts' awareness of the evidence on stretching effects regarding a variety of related topics selected based on the findings of topical systematic reviews. Results: The majority of the individuals (57–88%) assumed positive effects of stretching on recovery, prevention of muscle injury, range of motion, muscular imbalance and artery elasticity. No or adverse effects were mostly claimed on bone injury prevention, maximal/explosive strength, and delayed-onset muscle soreness. In only 10 of 22 items, participants' classifications were in accord with the scientific evidence. Conclusions: The awareness of research findings on stretching effects among exercise and health professionals is alarmingly low. Future studies may hence be geared to improve implementation and science communication. [ABSTRACT FROM AUTHOR]

Nowadays, due to the increasing number of diseases and injuries related to bone tissue, there is an acute problem of creating a material that could be incorporated into the bone tissue structure and contribute to accelerated bone regeneration. Such materials can be represented by a polymeric matrix that holds the material in the bone and an inorganic component that can be incorporated into the bone structure and promote accelerated bone regeneration. Therefore, in this work we investigated polyvinyl alcohol-based composite cryogels containing an in situ deposited inorganic filler, hydroxyapatite. The freezing temperature was varied during the synthesis process. The composition of the components was determined by infrared spectroscopy and the phase composition by X-ray phase analysis, from which it was found that the main phase of the composite is hydroxyapatite and that the particle size decreases with increasing freezing temperature. The elemental composition of the surface is dominated by carbon, oxygen, phosphorus and calcium; no impurities of other elements not typical for polyvinyl alcohol/ hydroxyapatite cryogels were found. Higher mechanical properties and melting points were observed at −15 °C. Cryogenic treatment parameters did not affect cell viability; however, cell viability was above 80% in all samples. [ABSTRACT FROM AUTHOR]

Objective • To investigate the effect of a nursing health education model based on the Rosenthal effect on the posttraumatic growth of patients with a first accidental fracture. Methods • We recruited 212 patients with a first accidental fracture from February 2021 to February 2022; the patients were divided into a control group (n = 106) and an Rosenthal Group (n = 106). The control group received daily care during hospitalization, and the Rosenthal Group received treatment based on a Rosenthal effect health education model. We compared the 2 groups before and after treatment using the Chinese Posttraumatic Growth Inventory (C-PTGI), the Connor-Davidson Resilience Scale (CD-RISC), the Pittsburgh Sleep Quality Index (PSQI), a Visual Analog Scale (VAS) to assess pain, the 36-item Short Form Health Survey (SF-36) to assess quality of life, the Hamilton Anxiety Scale (HAMA), and the Hamilton Depression Scale (HAMD). Results • The psychological resilience of both groups of patients improved after treatment, as assessed by C-PTGI and CD-RISC (all P < .05), and the Rosenthal Group improved more than the control group after treatment (all P < .05). The sleep quality and pain scores, as measured by PSQI and VAS, improved for both groups of patients after treatment, and the Rosenthal group improved more than the control group after treatment (all P < .05). The quality of life, as assessed by SF-36, of both groups of patients was similar before treatment (all P > .05) and improved significantly after treatment (all P < .05). The patients’ depression and anxiety, as assessed by HAMA and HAMD, improved in both groups after treatment (all P < .05), and the Rosenthal group improved more than the control group after treatment (all P < .05). Conclusion • The Rosenthal effect nursing health education model promotes the posttraumatic psychological growth of patients with a first accidental fracture and enhances their psychological resilience, showing that the Rosenthal effect has important health benefits and can be promoted for clinical application to adjust a patient’s psychological state. [ABSTRACT FROM AUTHOR]

Background: The healing of a bone injury is a highly complex process involving a multitude of different tissue and cell types, including immune cells, which play a major role in the initiation and progression of bone regeneration. Methods: We histologically analyzed the spatio-temporal occurrence of cells of the innate immune system (macrophages), the adaptive immune system (B and T lymphocytes), and bone cells (osteoblasts and osteoclasts) in the fracture area of a femoral osteotomy over the healing time. This study was performed in a bone osteotomy gap mouse model. We also investigated two key challenges of successful bone regeneration: hypoxia and revascularization. Results: Macrophages were present in and around the fracture gap throughout the entire healing period. The switch from initially pro-inflammatory M1 macrophages to the anti-inflammatory M2 phenotype coincided with the revascularization as well as the appearance of osteoblasts in the fracture area. This indicates that M2 macrophages are necessary for the restoration of vessels and that they also play an orchestrating role in osteoblastogenesis during bone healing. The presence of adaptive immune cells throughout the healing process emphasizes their essential role for regenerative processes that exceeds a mere pathogen defense. B and T cells co-localize consistently with bone cells throughout the healing process, consolidating their crucial role in guiding bone formation. These histological data provide, for the first time, comprehensive information about the complex interrelationships of the cellular network during the entire bone healing process in one standardized set up. With this, an overall picture of the spatio-temporal interplay of cellular key players in a bone healing scenario has been created. Conclusions: A spatio-temporal distribution of immune cells, bone cells, and factors driving bone healing at time points that are decisive for this process—especially during the initial steps of inflammation and revascularization, as well as the soft and hard callus phases—has been visualized. The results show that the bone healing cascade does not consist of five distinct, consecutive phases but is a rather complex interrelated and continuous process of events, especially at the onset of healing. [ABSTRACT FROM AUTHOR]

Background and Objectives: In this review, we have explored the relationship between overtraining syndrome (OTS) and bone stress injuries among paralympic athletes. OTS is a complex condition that arises from an imbalance between training volume, nutrition, and recovery time, leading to significant negative effects on paralympic athlete's performance and overall well-being. On the other hand, bone stress injuries occur when abnormal and repetitive loading is applied to normal bone, resulting in microdamage accumulation and potential. The prevalence of overtraining syndrome and bone stress injuries among athletes highlights the need for a better understanding of their relationship and implications for prevention and management strategies. Methods: A literature review from the PubMed, Web of Science, and Google Scholar databases including the MeSH keywords "overtraining syndrome", "bone", and "paralympic athletes". Results: Studies have consistently shown that athletes engaged in endurance sports are particularly susceptible to overtraining syndrome. The multifactorial nature of this condition involves not only physical factors, but also psychological and environmental determinants. In addition, the diagnosis and management of OTS and bone stress injuries present challenges in clinical practice. Conclusions: Currently, there are no definitive biochemical markers for overtraining syndrome. The diagnosis is based on a combination of subjective measures such as questionnaires, symptoms checklists, and objective biomarkers, including hormone levels, inflammatory markers, and imaging studies. However, these diagnostic approaches have limitations regarding their specificity and sensitivity. [ABSTRACT FROM AUTHOR]

This study investigates the pattern of hand injuries presenting to a UK regional tertiary centre. All referrals to our Hand Surgery Unit in 2019 were reviewed. Subgroup analyses of sex, deprivation, occupational injuries and assault cases were carried out. Over the study period, 4216 cases were referred. Most were male (70%), with a median age of 36 years and from a deprived area (75.2%). Soft tissue injury was documented in 53.6% and bone injury (fracture/dislocation) in 52.4%. Surgical management was required in 2214 (52.5%) cases. Work-related injuries accounted for 16.7% of cases and were more likely to require surgery. Assault-related injuries accounted for 8% of cases, with a male preponderance. Our findings can help facilitate service provision and guide regional and national prevention policies. Level of evidence: III [ABSTRACT FROM AUTHOR]

Background: Osteochondral injuries (OCIs) are common in patients with acute lateral patellar dislocation, which can produce both short- and long-;term adverse effects. However, the pattern of these injuries warrants further analysis, especially in relation to patient age. Purpose: To determine the overall prevalence of concomitant OCIs as well as the prevalence differences based on location and age after acute lateral patellar dislocations. Study design: Systematic review; Level of evidence, 4. Methods: A comprehensive search of PubMed, Embase, Web of Science, and Cochrane Library was completed from inception to July 20, 2022. All articles reporting the prevalence of OCI were included. The sample characteristics such as age, study design, magnetic resonance imaging diagnostic data, and the number of patients with OCI were extracted. The Methodological Index for Non-Randomized Studies (MINORS) was used for quality assessment. The overall and per-;site injury rates were calculated, and the prevalence was stratified by age-;group (≤16 and >16 years) and compared. Results: The systematic review included 39 studies involving 3354 patients. MINORS scores were 11.94 ± 1.98 and 16 ± 3.46 in the noncomparative and comparative studies, respectively. The overall prevalence of bone bruises and OCI was 89.6% (95% CI, 77.4%-97.7%) and 48.8% (95% CI, 39.0%-58.7%), respectively. In both overall and >16-year-old patients, the lateral femoral condyle (LFC) was the most common site of bone bruise (90.5% [95% CI, 84.0%-95.6%] and 91.5% [95% CI, 84.3%-96.9%], respectively); however, the medial patellar bruise was more common in patients ≤16 years (89.2% [95% CI, 82.9%-94.4%]). Among the pooled sites of OCI, the medial patella accounted for the largest proportion (36.9% [95% CI, 28.0%-46.3%]). OCIs were more common in patients >16 years (52.6% [95% CI, 39.4%-65.6%]) than in patients ≤16 years (46.6% [95% CI, 33.2%-60.3%]). Conclusion: Bone bruises on the LFC were most prevalent overall and in patients >16 years, whereas bone bruises on the medial patella were more prevalent in patients ≤16 years. OCIs were frequently seen in patients >16 years, with the most common site being the medial patella. [ABSTRACT FROM AUTHOR]

Background: Excessive fluoride exposure induces skeletal fluorosis, but the specific mechanism responsible is still unclear. Therefore, this study aimed to identify the pathogenesis of fluoride-induced bone injuries. Methods: We systematically searched fluoride-induced bone injury-related genes from five databases. Then, these genes were subjected to enrichment analyses. A TF (transcription factor)–mRNA–miRNA network and protein–protein interaction (PPI) network were constructed using Cytoscape, and the Human Protein Atlas (HPA) database was used to screen the expression of key proteins. The candidate pharmacological targets were predicted using the Drug Signature Database. Results: A total of 85 studies were included in this study, and 112 osteoblast-, 35 osteoclast-, and 41 chondrocyte-related differential expression genes (DEGs) were identified. Functional enrichment analyses showed that the Atf4, Bcl2, Col1a1, Fgf21, Fgfr1 and Il6 genes were significantly enriched in the PI3K-Akt signaling pathway of osteoblasts, Mmp9 and Mmp13 genes were enriched in the IL-17 signaling pathway of osteoclasts, and Bmp2 and Bmp7 genes were enriched in the TGF-beta signaling pathway of chondrocytes. With the use of the TF–mRNA–miRNA network, the Col1a1, Bcl2, Fgfr1, Mmp9, Mmp13, Bmp2, and Bmp7 genes were identified as the key regulatory factors. Selenium methyl cysteine, CGS-27023A, and calcium phosphate were predicted to be the potential drugs for skeletal fluorosis. Conclusions: These results suggested that the PI3K-Akt signaling pathway being involved in the apoptosis of osteoblasts, with the IL-17 and the TGF-beta signaling pathways being involved in the inflammation of osteoclasts and chondrocytes in fluoride-induced bone injuries.

Bone injuries such as fractures are one major cause of morbidities worldwide. A considerable number of fractures suffer from delayed healing, and the unresolved acute pain may transition to chronic and maladaptive pain. Current management of pain involves treatment with NSAIDs and opioids with substantial adverse effects. Herein, we tested the hypothesis that the purine molecule, adenosine, can simultaneously alleviate pain and promote healing in a mouse model of tibial fracture by targeting distinctive adenosine receptor subtypes in different cell populations. To achieve this, a biomaterial‐assisted delivery of adenosine is utilized to localize and prolong its therapeutic effect at the injury site. The results demonstrate that local delivery of adenosine inhibited the nociceptive activity of peripheral neurons through activation of adenosine A1 receptor (ADORA1) and mitigated pain as demonstrated by weight bearing and open field movement tests. Concurrently, local delivery of adenosine at the fracture site promoted osteogenic differentiation of mesenchymal stromal cells through adenosine A2B receptor (ADORA2B) resulting in improved bone healing as shown by histological analyses and microCT imaging. This study demonstrates the dual role of adenosine and its material‐assisted local delivery as a feasible therapeutic approach to treat bone trauma and associated pain. [ABSTRACT FROM AUTHOR]

Purpose: Radiocarpal dislocation fractures (RCDF) are rare injuries that usually occur in a violent trauma setting. Our work aimed to analyze our patients' functional and radiological results after surgery and identify potential medium- and long-term complications while reviewing other series previously reported in the literature. Methods: We have performed a retrospective study over five years at our university hospital, eleven patients were selected, and the mean follow-up was about 33 months. We used Dumontier's and Moneim's classifications for classifying the injuries. All the patients underwent surgery followed by cast immobilization. The QuickDash score and Green O'Brien score modified by Cooney were used to assess the functional result, while the radiological result was judged on standard wrist radiographs. Results: Out of the eleven patients, only one described a Dumontier type I radiocarpal dislocation; all the others were type II. Following the Moneim classification, two patients were type II. Most cases showed posterior displacement. In 80% of cases, the radiocarpal fracture-dislocation was combined with other bone or ligament injuries. All patients received surgical treatment followed by cast immobilization for 45 days. The mean loss of range of motion at the last follow-up was about 39%, keeping the arch intact in most cases. Quick dash score was 29.54, and Green O'Brien's score was 71.1. Three of the patients showed osteoarthritic remodeling. Conclusion: A careful clinical and radiological evaluation, followed by an anatomic surgical reduction of the articulating surface of the distal radius, as well as the handling of the associated lesions, are major conditions for a satisfactory clinical result. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to determine the contribution of 3-dimensional computer tomography (3D-CT) in the diagnosis of the articular fractures compared with X-rays and computer tomography (CT), and to establish if 3D-CT can confirm or modify the preoperative plans. Methods: We have conducted a retrospective study between 2020 - 2022, 46 patients with articular fractures. We have asked 5 independent surgeons to make comparative analyses of the information required for a correct diagnosis and preoperative planning, obtained from X-ray, CT and 3D-CT. Each time, the surgeon was requested to categorize the fracture using specific classification systems and articulate their recommended treatment approach. Results: The study showed us the importance of 3D-CT to achieve a correct diagnosis for the articular fractures by ana-lyzing the discrepancies between X-ray, CT and 3D-CT, with direct influence upon the presurgical plan. In 37% of the cases, fracture lines were not apparent on X-rays but were visible on CT scans. However, in more than 27% of these instances, specific bone injuries, like central articular depression or unique split-comminution patterns, were not evident on standard CT scans but could be identified using 3D-CT scans. Conclusions: To establish the correct diagnosis and the proper therapeutical plan for the articular fractures, it is necessary to make a complete ra-diological evaluation, which consists of X-ray, CT and 3D-CT. [ABSTRACT FROM AUTHOR]

Bone is a hard connective tissue which helps to maintain the body structure and functions. Several factors like aging, drugs, hormonal changes, and physical activities may lead to bone injuries and fractures. Fracture without bone loss will heal if proper immobilisation techniques are used. But if there is an extensive bone loss fracture fails to heal and get filled with fibrous tissue. To address these problems bone graft materials are used. Autologous bone graft is considered as the ideal graft material. However, complications related to its harvesting process including donor site morbidity and pain, limit its use in bone regeneration. Allograft and xenografts can also be used, but there are some problems like immune reaction and chance of rejection. Biosynthetic bone grafts are developed as an alternative to conventional bone grafting materials. These grafts generally contain one or more of three critical components: (1) osteoinductive factors that induce the various stages of bone regeneration, (2) osteoconductive matrix to provide physical support and direction to the repair process, and (3) osteogenic stem cells that are capable of differentiating and facilitating the bone formation process. This article will cover common biosynthetic substitutes for augmenting bone healing. [ABSTRACT FROM AUTHOR]

If the wound has healed and the radiographs show that the splint bone is stable and the fracture is healing, no further treatment is necessary (Figure 5). Fractures of the vestigial metacarpal and metatarsal bones, which are commonly referred to as splint bones, can occur anywhere along the length of the bone and are very common in horses of all ages (Jackson et al., [3]). (a) wound over the lateral splint bone; (b) oblique radiograph showing a comminuted fracture of the splint bone. gl TREATMENT OF PROXIMAL SPLINT BONE FRACTURES Proximal splint bone fractures are the most difficult to treat and a variety of management techniques including surgical intervention have been described. [Extracted from the article]

Critical bone defects resulting in delayed and non-union are a major concern in the field of orthopedics. Over the past decade, mesenchymal stem cells (MSCs) have become a promising frontier for bone repair and regeneration owing to their high expansion rate and osteogenic differentiation potential ex vivo. MSCs have also long been associated with their ability to modulate immune response in the recipients. These can even skew the immune response towards pro-inflammatory or anti-inflammatory type by sensing their local microenvironment. MSCs adopt anti-inflammatory phenotype at bone injury site and secrete various immunomodulatory factors such as IDO, NO, TGFβ1 and PGE-2 which have redundant role in osteoblast differentiation and bone formation. As such, several studies have also sought to decipher the immunomodulatory effects of osteogenically differentiated MSCs. The present review discusses the immunomodulatory status of MSCs during their osteogenic differentiation and summarizes few mechanisms that cause immunosuppression by osteogenically differentiated MSCs and its implication during bone healing. • Immunomodulation by MSCs plays critical role during bone regeneration. • Osteogenically differentiated MSCs retain immunomodulatory role. • Immune-regulation by MSCs during osteogenic differentiation can have clinical implications during bone repair. [ABSTRACT FROM AUTHOR]

Currently, the use of additive technologies for the production of bone substitutes determines the effectiveness of the latest methods of treatment and prosthetics in traumatic surgery, oncology, crania-maxillofacial surgery, dentistry, etc. The introduction of additive technologies is the result of the integration of medical visualization, in particular, based on the technologies of computer imaging, and engineering CAD/CAM/CAE systems. In connection with the increase in the number and severity of various types of bone tissue injuries received as a result of wounds during military operations in Ukraine, an important issue in orthopaedics and traumatology is making informed decisions about the possibility of restoring the integrity and functions of bone tissue when using different types of composition, the strength of biopolymer composites. The scientific aim of research is the development of principles and methods for making scientifically based decisions in the design and additive manufacturing of bone substitutes based on biopolymer composites with functional properties depending on the nature of the localization of the cavity bone defect and its size. The new knowledge will become the necessary basis for making optimal decisions in practice for the introduction of the latest methods of treatment and prosthetics in trauma surgery, oncology, crania-maxillofacial surgery, dentistry, taking into account the risks of biocompatibility of biopolymer composites. The results of the research will be used to design bone substitutes with controlled composition, structure, porosity, and mechanical strength for the further selection of additive technology for its production from apatite-polymer composites, which will contribute to increasing the efficiency of treatment and prosthetics in orthopaedics and traumatology. [ABSTRACT FROM AUTHOR]

Relative Energy Deficiency in Sport (RED-S) is a complex syndrome that occurs as a result of prolonged Low Energy Availability (LEA) leading to health and performance impairments. However, whilst the coach plays an important role when working with athletes with RED-S, no research exists specifically exploring their role. Therefore, this study investigates the role of the coach from the athletes' perspective within an ultrarunning context. Ultrarunners are at risk of LEA due to large training volumes and record high incidences of psychological and physiological conditions linked to RED-S, such as disordered eating and bone stress injuries. Two female ultrarunners who had experience with RED-S each participated in three semi-structured interviews. The findings highlight the multifaceted role of the coach which changes depending on the stage of the athletes' RED-S Journey. Of primary importance was that the coach should be educated on RED-S in order to provide value throughout. Secondly, for effective recovery, the coach should embrace working with a multidisciplinary support team of experts. Thirdly, the coach should actively work on establishing strong relationships with the athlete and their support network. This will propagate trust and honest conversations, a key requirement for recovery from, and ongoing training post, RED-S. [ABSTRACT FROM AUTHOR]