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The accuracy of screw placement is a key factor for the stability of the cannulated screws used in the fixation of femoral neck fractures. In this study we designed a navigation device for ensuring the screw reaches the ideal position for optimal fixation. From March 2019 to September 2020, 66 patients with femoral neck fracture were enrolled and divided into 2 groups, one group was treated using the traditional free-hand cannulated screw fixation and the other using the new navigation device with assisted fixation. The effectiveness of the 2 methods was compared based on surgery duration, intraoperative bleeding, number of fluoroscopic examination and guidewire insertion attempts, screw parallelism, and effective fixation area. Fracture healing, complications and hip joint function were assessed after operation. The new navigation device reduced the duration of surgery without causing additional intraoperative bleeding, and significantly reduced number of fluoroscopy examination and guidewire insertion attempts (4.00±1.58 vs. 6.09±1.94 with traditional surgery). The accuracy of screw implantation was improved, as demonstrated by increased screw parallelism (0.71±0.57° vs. 1.66 ±1.01° with traditional surgery) and higher effective fixed area (64.88±10.52 vs. 58.61±9.19 mm2 with traditional surgery). In the postoperative follow-up, except for one case of femoral head necrosis and one case of bone nonunion in the traditional surgical group, the other patients showed fracture healing. There was no significant difference in hip joint function between the 2 groups. The new navigation device enables rapid and accurate guidewire positioning for cannulated screw fixation through simple operation procedures, resulting in good prospect for clinical transformation.

The contamination of bone defects is a serious therapeutic problem. The treatment of infected bone defects involves rigorous infection control followed by bone reconstruction. Considering these two processes, the development of biomaterials possessing antibacterial and osteogenic properties offers a promising approach for the treatment of infected bone defects. In this study, a dual-functional, thermosensitive, and injectable hydrogel composed of chitosan (CS), quaternized CS (QCS), and nano-hydroxyapatite (nHA) was designed, and the ratio of CS to QCS in the hydrogel was optimized to enhance the antibacterial efficacy of CS while reducing the cytotoxicity of QCS. In vitro studies demonstrated that the hydrogel with an 85 %:15 % ratio of CS to QCS exhibited excellent biocompatibility and antibacterial properties while also possessing suitable mechanical characteristics and degradability. The incorporation of nHA into the hydrogel enhanced MC3T3-E1 proliferation and osteogenic differentiation. Moreover, this hydrogel demonstrated superior in vivo therapeutic effectiveness in a rabbit model of infected bone defect. In summary, this study provides a promising material design and a comprehensive one-step treatment strategy for infected bone defects.

Abstract Objective Floating knee type IIC, according to Fraser’s classification, is an uncommon severe injury that typically occurs in polytrauma. In such cases, intra-articular fracture and the high degree of comminution and deformity of the mid-distal femur make fixation challenging. The purpose of this study was to demonstrate that minimally invasive plate osteosynthesis (MIPO) technology can simplify these complex problems and improve patient prognosis. Case presentation A 38-year-old man injured his left leg in a car accident, causing pain, swelling, deformity, and limited mobility on his left knee and thigh, and two small open wounds were noted mainly of the anterior aspect of the mid-distal thigh. Physical examination and computed tomography angiography of the lower limb confirmed that there was no damage to the neurovascular system. The clinical diagnosis was closed intra-articular fracture of the proximal tibia, open intra-articular fracture of the distal femur with extension to the diaphysis, and a patellar fracture on the ipsilateral knee. The treatment strategy involved a locking plate system applying MIPO technology. Postoperative evaluation of the patient was satisfactory, with immediate functional exercise, full weight-bearing after three months, and return to daily activity without pain. Final follow-up taken 3 years after surgery showed good lower limb alignment and complete plasticity of the bone structure, by which time the patient showed good limb function. Conclusions Minimally invasive techniques can provide a simple and effective treatment for some complex fractures.

Peptide-based hydrogels are widely studied and applied in bone repair because of their good biocompatibility, biodegradability and designability. Peptide-based hydrogels can be endowed with different properties by introducing biologically functional groups into the peptide chain and adjusting the composition of the peptide-based hydrogels. In addition, in combination with growth factors, cells, and other scaffold materials, the peptide-based hydrogels can meet the needs of bone repair under different conditions. Therefore, we first analyzed the expected properties of peptide-based hydrogels in bone repair and methods to obtain these properties. Then, we focused on the applications in bone repair, especially the repair scheme based on peptide-based hydrogels for different types of bone defects. Peptide-based hydrogels can be used alone to fill bone defects, playing a role in bone conduction. The peptide-based hydrogels can also be used as a sustained-release carrier for cells, drugs, and the like, to improve the microenvironment of local bone regeneration and enhance the bone regeneration capacity. In addition, peptide-based hydrogels can provide solutions for repairing large segmental and weight-bearing bone defects by incorporating other scaffold materials. This review will provide the theoretical basis and cutting-edge design strategies for peptide-based hydrogels to promote the repair of bone defects.

Background: Osteoporosis attacks approximately 10% of the population worldwide. Sika Deer (Cervus nippon), one of China’s precious traditional medicinal animals, has been widely recorded in ancient Chinese medical books and claimed for centuries to have numerous medical benefits including bone strengthening. This study aimed to find the use of Sika Deer bone in treating osteoporosis according to traditional records and to investigate the protective effect of Sika Deer bone polypeptide extract on glucocorticoid-induced osteoporosis (GIOP) in rats. Results: Sika Deer bone polypeptide extract could increase serum Ca2+ and BGP, decrease serum P3+, ALP, PTH, and CT, but had no effect on serum NO in rats with GIOP. The immunohistochemical iNOS results of the rats’ distal femur were negative in each group. Besides the model group, the eNOS color reaction in osteoblasts was strongly positive in the other three groups. Conclusions: Sika Deer bone polypeptide extract can improve pathological changes in the microstructure and stimulate the expression of eNOS in osteoblasts. The protective effect on bone might be mediated by eNOS-dependent NO generation.How to cite: An L, Shi L, Ye Y, et al. Protective effect of Sika Deer bone polypeptide extract on dexamethasone-induced osteoporosis in rats. Electron J Biotechnol 2021;51. https://doi.org/10.1016/j.ejbt.2021.04.002

Abstract Backgrounds Poor prognosis was reported for complex Pilon fractures involving severe soft tissue damage. It is therefore useful to explore the evolution of different treatment strategies in an effort to reconstruct the axial alignment and articular surface, while minimizing additional damage to the surrounding soft tissues. Methods Seventeen patients with Pilon fractures were enrolled in this retrospective study from December 2009 to October 2014. The injuries were graded according to AO Classification and the Gustilo-Anderson system. Patients were treated with minimally invasive plate osteosynthesis (MIPO) combined with curved incision on the anterior area of ankle. The ankle function and radiological outcome were assessed by the modified Mazur ankle score and Burwell-Charnley criteria, respectively. Visual analogue score (VAS) score was used to assess the degree of patient’s ankle pain, and related complications were also recorded. Results The mean time for fracture healing was 3.6 months (range: 3–6 months). According to Mazur’s criteria, surgical treatment achieved good or excellent outcome in 15 (88.2%) cases, and the average VAS score was 1.19 ± 0.52. On the basis of Burwell-Charnley score, 12 (70.5%) patients achieved anatomic recovery, 4 (23.5%) obtained good reduction, and only 1 (5.9%) patient was diagnosed with valgus deformity. Additionally, 1 (5.9%) patient developed a superficial infection around incision, and 2 (11.8%) experienced superficial peroneal nerve damage. In addition, 2 (11.8%) patients showed radiographic evidence of existing ankle osteoarthritis at the final follow-up. Conclusions This retrospective study is the first to assess the application of a curved incision on the anterior area of ankle with MIPO for the treatment of Pilon fractures, which achieves high functional recovery with a low complication rate. However, large randomized controlled trials comparing different approaches and fixation methods are still needed to conclusively identify the optimal treatment protocol.

The treatment of infected bone defects includes infection control and repair of the bone defect. The development of biomaterials with anti-infection and osteogenic ability provides a promising strategy for the repair of infected bone defects. Owing to its antibacterial properties, chitosan (an emerging natural polymer) has been widely studied in bone tissue engineering. Moreover, it has been shown that chitosan promotes the adhesion and proliferation of osteoblast-related cells, and can serve as an ideal carrier for bone-promoting substances. In this review, the specific molecular mechanisms underlying the antibacterial effects of chitosan and its ability to promote bone repair are discussed. Furthermore, the properties of several kinds of functionalized chitosan are analyzed and compared with those of pure chitosan. The latest research on the combination of chitosan with different types of functionalized materials and biomolecules for the treatment of infected bone defects is also summarized. Finally, the current shortcomings of chitosan-based biomaterials for the treatment of infected bone defects and future research directions are discussed. This review provides a theoretical basis and advanced design strategies for the use of chitosan-based biomaterials in the treatment of infected bone defects.

Bone nonunion has become one of the most severe sequelae of fractures, infections, bone tumors, or revision arthroplasty owing to its high morbidity and disability rate. Recently, bone nonunion has received considerable attention from plastic surgeons. There are different treatment methods for nonunion depending on its classification according to the etiology and pathological types. Bone tissue engineering provides advanced platforms for the treatment of bone nonunion via the use of material scaffolds with sufficient mechanical strength. Meanwhile, it promotes bone regeneration and osseointegration by the addition of various growth factors or drugs. This review describes in detail the classification and leading causes of nonunion, as well as the clinical treatment methods and basic research progress, including the design of metal and bioactive material scaffolds. Future challenges in engineering, material science, and three-dimensional printing are also summarized. This article may provide new perspectives of the clinical translation for the treatment of bone nonunion by understanding the pathogenic mechanism and the rational application of bioactive scaffolds. Keywords: Material, Bone nonunion, Classification, Pathological feature, Treatment progress

Background Trochanteric fractures (TF) have become a major source of morbidity and mortality in elderly. We conducted this study to compare the outcomes of unstable trochanteric fractures treated with the InterTan nail and Gamma3 nail. Methods Between January 2008 and May 2013, patients aged 60 years or older with a diagnosis of unstable TF treated with InterTan nail or Gamma3 nail were included. Patients treated with InterTan nail were pair-matched to patients treated with Gamma3 nail in a 1:2 ratio. Radiographs were obtained at 1, 3, 6, and 12 months follow-up, and all implant position changes, complications, fixation failures and functional scores were recorded. Results Eighty-seven patients were included in the InterTan nail group, and 174 pair-matched patients were included in the Gamma3 nail group. Preoperative scores were similar between the 2 groups. There are significant improvements postoperatively in both groups. The incidence of cut-out and femoral shaft fracture were significantly higher in the Gamma3 nail group than the InterTan nail group (P = 0.024 and P = 0.044, respectively). Patients treated with the InterTan nail experienced longer fluoroscopy and operative times. Conclusions The InterTan nail may have a tendency in better outcomes for patients with unstable TF. However, the limited period of follow-up and inherent defects of nonrandomized trials indicate that better-designed randomized controlled trials will be required. [ABSTRACT FROM AUTHOR]