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Objectives To evaluate osteogenic markers and alveolar ridge profile changes in guided bone regeneration (GBR) of chronic non-contained bone defects using a non-resorbable TiO2 block. Material and methods Three buccal bone defects were created in each hemimandible of eight beagle dogs and allowed to heal for 8 weeks before GBR. Treatment was assigned by block randomisation: TiO2 block: TiO2-scaffold and a collagen membrane, DBBM particulates: Deproteinised bovine bone mineral (DBBM) and a collagen membrane, Empty control: Only collagen membrane. Bone regeneration was assessed on two different healing timepoints: early (4 weeks) and late healing (12 weeks) using several immunohistochemistry markers including alpha smooth muscle actin (α-SMA), osteopontin, osteocalcin, tartrate-resistant acid phosphatase and collagen type I. Histomorphometry was performed on Movat Pentachrome and Von Kossa/Van Gieson stained sections. Stereolithographic models were used to compare alveolar profile changes. Results The percentage of α-SMA and osteopontin increased in TiO2 group after 12 weeks of healing at the bone-scaffold interface, while collagen type I increased in the empty control group. In the defect area, α-SMA decreased in the empty control group, while collagen type I increased in the DBBM group. All groups maintained alveolar profile from 4 to 12 weeks, but TiO2 group demonstrated the widest soft tissue contour profile. Conclusions The present findings suggested contact osteogenesis when GBR is performed with a TiO2 block or DBBM particulates. The increase in osteopontin indicated a potential for bone formation beyond 12 weeks. The alveolar profile data indicated a sustained lateral increase in lateral bone augmentation using a TiO2 block and a collagen membrane, as compared to DBBM and a collagen membrane or a collagen membrane alone.

Background and Objectives: he treatment of large bone defects in geriatric patients often presents a major surgical challenge because of age-related bone loss. In such patients, the scarcity of healthy makes autologous grafting techniques hard to perform. On the one hand, clinicians’ fear of possible infections limits using bone substitute materials (BSM). On the other hand, BSM is limitless and spares patients another surgery to harvest autologous material. Materials and Methods: To address the aptness of BSM in geriatric patients, we performed a retrospective analysis of all patients over the age of 64 years who visited our clinic between the years 2011–2018. The study assessed postoperative complications clinically and healing results radiologically. The study included 83 patients with bone defects at the distal radius, proximal humerus, and proximal tibia. The defect zones were filled with BSM based on either nanocrystalline hydroxyapatite (NHA) or calcium phosphate (CP). For comparison, a reference group (empty defect, ED) without the void filling with a BSM was also included. Results: 106 patients sustained traumatic fractures of the distal radius (71.7%), proximal humerus (5.7%), and proximal tibia (22.6%). No difference was found between the BSM groups in infection occurrence (p = 1.0). Although not statistically significant, the BSM groups showed a lower rate of pseudarthrosis (p = 0.09) compared with the ED group. Relative risk (RR) of complications was 32.64% less in the BSM groups compared with the ED group. The additional beneficial outcome of BSM was demonstrated by calculating the number needed to treat (NNT). The calculation showed that with every six patients treated, at least one complication could be avoided. Radiological assessment of bone healing showed significant improvement in the bridging of the defect zone (p < 0.001) when BSM was used. Conclusions: In contrast to previous studies, the study showed that BSM could support bone healing and does not present an infection risk in geriatric patients. The NNT calculation indicates a wider potential benefit of BSM.

Objectives: Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a major socio-economic impact. Higher incidence of bone fractures in children and adults with ASD, urge the investigation of alterations in the bone metabolism. Methods: To assess the effect of autism on bone metabolism, [for full text, please go to the a.m. URL]

Fragestellung: Untersuchungen an infertilen Männern haben gezeigt, dass diese häufig sowohl einen Hypogonadismus als auch eine verminderte Knochendichte bis hin zu einer Osteoporose aufweisen. Das Nagermodell der experimentellen Autoimmun-Orchitis (EAO) dient als Tiermodell für die Untersuchung [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Biofeedback was reported as an effective concept for bruxism treatment, through increasing patient’s awareness of the habit. During bruxing both ear canals become tighter, therefore, an in-ear device can provide biofeedback. The in-ear device is fitted to the ear canal in physiological status, during bruxing the ear-canal tightens resulting in stress on the canal walls and unpleasant feeling. Subsequently, patients stop their bruxing habit. The aim of this study is to provide first clinical evidence that in-ear devices have a positive impact on relieving bruxism in patients. Despite the low number of patients, this early study was designed as a controlled prospective study. The trial included seven female patients with a median age of 47.3 years (23–64 years). Only two patients implemented their devices for eight and seven months, respectively. One patient reported a relief in her symptoms, like headaches and pain intensity during the night, by 50% after three month and 80% after six months. Despite the limited number of participants, the study reflects a potential of Intra-aural devices as effective biofeedback devices in treating bruxism.

Purpose: Pre-clinical studies indicate that concomitant thoracic trauma impairs fracture healing of long bones and reduces callus formation. The aim of this study was to investigate whether patients with accompanying chest trauma suffer from delayed fracture healing of long bones in comparison with patients with fractures of two long bones or isolated fractures. Patients and Methods: This is a clinical retrospective study from a level I trauma center. The patients were divided into three groups: (1) thoracic trauma and fracture of a long bone, (2) fractures of two long bones, (3) isolated fracture of a long bone. The fracture consolidation was defined using the radiographic union scale in tibial fractures (RUST). A RUST value of ≥10 six-to-eight months after definitive operative intervention represented complete fracture healing. Results: In the first group 19 (43.2%) fractures did not show full consolidation, in the second group 14 (45.2%) and 13 (41.9%) and in the third group 14 (36.8%). The analysis revealed no statistically significant differences between the groups regarding consolidation of the fractures six-to-eight months after definitive operative intervention (p = 0.84). Conclusions: Unlike previously reported pre-clinical data, this study did not demonstrate a negative effect on fracture consolidation in long bones when accompanied by thoracic trauma. Furthermore, the results demonstrated that concomitant fractures of two long bones does not have a negative effect on fracture consolidation.

Background Merino land sheep are a popular pre-clinical large animal model in research on systemic skeletal diseases such as osteoporosis. Interpretation of studies is difficult because many reference parameters are missing or not established. This study aims to determine the reference parameters of the skeletal system (peak bone mass = PBM, T-Score). A defined standard allows an easier comparison of the study data of the animal model with human studies (T-Score). Materials and methods A total of 116 Dual Energy X-ray Absorptiometry DXA measurements were performed on 74 untreated sheep. The average age of the animals was 57 months. The BMD, BMC, and fat content of the sheep were determined by the relevant human region of interest (ROI). From this, the PBM and from this the T-score for each of the animals were calculated. Results Using 682 DXA measurements BMD and BMC were determined to provide an indication to PBM. For BMD a significant correlation to the age of the animals was observed (p = 0.043). A significant correlation was also seen for BMC (B) (p ≤ 0.001). In the age-dependent analysis, a widespread of values above the linear regression line was measured for both BMD and BMC between the 50th and 90th months of life. From an age of about 90 months, a wider spread of values below the linear regression line was found, although the average values continued to rise. Discussion The evaluation of the 116 DXA measurements allowed the determination of the PBM for merino land sheep. With the help of the PBM, a T-score was calculated for each animal. The statistical analysis shows significant differences in BMD values between the different animal groups in each of the four ROIs investigated. Individual control or sham groups per study are therefore not sufficient. To improve comparability, an independent reference group should be established. Conclusion An independent reference group for PBM and a T-score was established from four to six-year-old animals. The bone density increases with the age of the animals. Around the fourth year of life, a first peak could be observed. Also, after the seventh year of life, a further peak with the beginning plateau phase was observed. When compiling a group of animals for an osteoporosis model, animals from the age of seven years should, therefore, be used.

Fragestellung: Osteoporose und osteoporotische Frakturen sind eine enorme Belastung für Patienten und das Gesundheitssystem. Ein Aspekt der besonderen Herausforderung besteht darin, eine suffiziente Frakturversorgung zu erreichen. Hier gilt es, neue Osteosynthesematerialien für geschwächte[zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019)

Objectives: Interference fit fixation of soft-tissue grafts is in clinical focus to allow anatomic graft fixation, which increases stability and graft isometry. Although many screws are commercially available, enhanced biodegradability, handling and stability in early healing phases remain under demand.[for full text, please go to the a.m. URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019)

Objectives: Autism spectrum disorder (ASD) is a developmental disorder with a major impact on health care and finance systems. A possible co-regulation of the disease through bone cells can have potential therapeutic impact. Therefore, this study aims to characterize bone tissue in mouse models of ASD.[for full text, please go to the a.m. URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019)

Introduction: Nonunions are a challenge for orthopedic surgeons. In hypertrophic nonunions, improvement of mechanical stability usually is the satisfactory treatment, whereas in atrophic nonunions improvement of the biological environment is most important. However, scientific evidence revealed that "avital" nonunions are not avascular and fibrous tissue contains cells with osteogenic potential. To find out if systemic factors suppress this intrinsic potential in atrophic nonunions, this study compares characteristics of hypertrophic with atrophic nonunion patients. Methods: We analyzed medical records of 162 surgically treated patients suffering from aseptic long bone nonunions. Atrophic and hypertrophic nonunions were distinguished by absence or presence of callus and calcification in the fracture gap. Mechanical implant loosening and patient characteristics such as age, gender, and body mass index were assessed. Fracture classification according to AO/OTA, open and closed fractures, and osteosynthesis were recorded. In addition, comorbidities and allergies between both groups were compared. Results: A higher number of hypertrophic nonunion patients were male with often allergies. Hypertrophic nonunion occurred more often after intramedullary nailing compared to atrophic nonunions. Atrophic nonunion patients being nonallergic were significantly older than nonallergic patients suffering from hypertrophic nonunions. In both atrophic and hypertrophic nonunion patients, age was lower in patients with accompanying injuries compared with age of patients with isolated fractures. Conclusion: Systemic factors influence development of nonunion types. In nonallergic patients, atrophic nonunions occur more often in the elderly. This manuscript is a first step to identify different factors which might influence the nature of nonunion. To enable nonunion treatment which is tailored to individual patient characteristics, further prospective studies with more sophisticated research methods are necessary.

The overarching goal of the gathering was to define a concept for technology design research in Giessen to improve patient outcomes through the design of assistive technology that assists both patients and surgeons. The emerging field of regenerative rehabilitation where trauma patients are treated by methods of regenerative medicine promises great improvements for our field, but clinical success is yet to be realised. The symposium was specifically organised to acknowledge and address these issues.

Objectives: Bone regeneration after a fracture is an important subject amongst clinicians, researchers and scientists. In large defects, mineralized fibrocartiliganous callus leads to pseudarthrosis, a type of a non-union. Non-unions may occur in approximately 10% of all fractures and in up to [for full text, please go to the a.m. URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018)

Objectives: Osteoporosis is characterized by lower bone mass and deteriorated bone microarchitecture resulting in higher fracture risks among elderly patients. This study used a senile rat animal model to characterize and establish clinically relevant osteoporotic model. Our study aimed to deepen understanding[for full text, please go to the a.m. URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018)