In Silico of Different Gait Cycle in Customised Leg Orthosis: A Finite Element Approach

Leg orthosis is one of medical device for fracture bone treatment. Several complications have been reported when patients are wearing the conventional Plaster of Paris or fibreglass leg orthosis. Its including numbness due to tight application, swelling, venous congestion and skin irritation. Therefore, the aim of this study is to develop and biomechanical analyse a customized leg cast that could tackle those complications. First, the leg was scanned using a 3D scanner. The leg cast was constructed from a 3D scanned leg model and designed using 3-Matic software which later simulated in finite element analysis using Marc software. The study focuses on three gait cycles; midstance, heel strike and toe off where stress and deformation were predicted. From the results, the cast only supported the ankle in midstance phase with only 7.297MPa stress and not capable to support the ankle in heel strike and toe off phases with maximum stress of 106.99 MPa and 213.12 MPa, respectively, which are beyond its yield strength of ABS, 23MPa. The average of overall displacement occurred for both skin and cast were less than 1.5mm. In short, the cast could only support the ankle in midstance phase and cannot be used for heel strike.

Monocyte/Macrophage Lineage Cells From Fetal Erythromyeloid Progenitors Orchestrate Bone Remodeling and Repair

A third of the population sustains a bone fracture, and the pace of fracture healing slows with age. The slower pace of repair is responsible for the increased morbidity in older individuals who sustain a fracture. Bone healing progresses through overlapping phases, initiated by cells of the monocyte/macrophage lineage. The repair process ends with remodeling. This last phase is controlled by osteoclasts, which are bone-specific multinucleated cells also of the monocyte/macrophage lineage. The slower rate of healing in aging can be rejuvenated by macrophages from young animals, and secreted proteins from macrophage regulate undifferentiated mesenchymal cells to become bone-forming osteoblasts. Macrophages can derive from fetal erythromyeloid progenitors or from adult hematopoietic progenitors. Recent studies show that fetal erythromyeloid progenitors are responsible for the osteoclasts that form the space in bone for hematopoiesis and the fetal osteoclast precursors reside in the spleen postnatally, traveling through the blood to participate in fracture repair. Differences in secreted proteins between macrophages from old and young animals regulate the efficiency of osteoblast differentiation from undifferentiated mesenchymal precursor cells. Interestingly, during the remodeling phase osteoclasts can form from the fusion between monocyte/macrophage lineage cells from the fetal and postnatal precursor populations. Data from single cell RNA sequencing identifies specific markers for populations derived from the different precursor populations, a finding that can be used in future studies. Here, we review the diversity of macrophages and osteoclasts, and discuss recent finding about their developmental origin and functions, which provides novel insights into their roles in bone homeostasis and repair.

Sox11 Modified Tendon-Derived Stem Cells Promote the Repair of Osteonecrosis of Femoral Head

Osteonecrosis of the femoral head (ONFH) is a leading cause of mobility impairment which may lead to a total hip replacement. Recent studies have found tendon derived stem cells (TDSCs) might be an ideal cell source for musculoskeletal tissue regeneration. And our previous study has shown Sox11 could promote osteogenesis of bone marrow-derived MSCs. However, the effect of TDSCs or Sox11 over-expressing TDSCs (TDSCs-Sox11) on bone regeneration in ONFH has not been investigated. In the present study, TDSCs were infected with AAV carrying Sox11 or empty vector. We showed that Sox11 could promote the proliferation and osteogenic differentiation of TDSCs, as well as angiogenesis in vitro. The western blot analysis showed that Sox11 could activate the PI3K/Akt signaling pathway to promote osteogenesis of TDSCs. Finally, using a rabbit model of hormone-induced ONFH, our result demonstrated that local administration of TDSCs or TDSCs overexpressing Sox11 could accelerate bone regeneration in necrotic femoral heads, and TDSCs overexpressing Sox11 showed better effects. TDSCs over-expressing Sox11 might be a promising cell source for stem cell therapy to promote bone regeneration, such as ONFH, fracture, bone defect, and so on.

USE OF THE DEVELOPED BONE HOLDER FOR OPEN REPOSITION OF SMALL TUBULAR BONES

The disadvantages and traumatic injury of using traditional traumatological instrumentation for open reduction of metacarpal fractures prompted the development of a modified bone holder. The clinical experience of using the developed instrument is presented, the advantages of its use are displayed. Keywords: metacarpal bone fracture, bone holder, osteosynthesis.

Gentamicin-Coated Tibia Nail in Fractures and Nonunion to Reduce Fracture-Related Infections: A Systematic Review

The incidence of a fracture-related infection (FRI) can reach 30% of open tibia fractures (OTF). The use of antibiotic-coated implants is one of the newest strategies to reduce the risk of infection in orthopedic surgery. The aim of this study was to investigate the efficacy and safety of a gentamicin-coated tibia nail in primary fracture fixation (FF) and revision surgery (RS) of nonunion cases in terms of FRI incidence. We conducted a systematic review according to the PRISMA checklist on Pub-Med, Cochrane, and EMBASE. Of the 32 studies, 8 were included, for a total of 203 patients treated: 114 were FF cases (63% open fractures) and 89 were RS cases, of which 43% were infected nonunion. In the FF group, four FRI were found (3.8%): three OTF (Gustilo-Anderson III) and one closed fracture; bone healing was achieved in 94% of these cases. There were four relapses of infection and one new onset in the RS group; bone healing occurred in 88% of these cases. No side effects were found. There were no significant differences in terms of FRI, nonunion, and healing between the two groups. Gentamicin-coated tibia nail is an effective therapeutic option in the prophylaxis of high-risk fracture infections and in complex nonunion cases.

Complete Abolition of Opioid Prescribing in an Upper Extremity Surgical Practice

Background Prescription opioids threaten potential addiction, diversion, and death. Nonopioid regimens have demonstrated similar efficacy for select upper extremity postoperative patients. Methods After adopting a practice policy completely abolishing opioid prescriptions, data were collected on all consecutive surgical cases for the next 6 months, without exclusion. There were 800 cases, 61% male and 39% female, with a mean age of 45. Seventy patients (9%) reported already using prescription medications employed in multimodality regimens; no instruction was given to alter consumption. Patients were divided into 5 groups based on the type of surgery: elective soft tissue (24%), trauma wound management (19%), soft tissue structural repairs (9%), hand fracture/bone procedures (34%), and wrist to elbow fracture/bone procedures (14%). Each group was compared directly to each other group with a 2-tailed t-test, P < .05. Results Patients reported achieving pain control without the need for further medication assistance by a mean of postoperative day 2.7. Times to pain control by group were as follows: 1.5, 3.1, 2.7, 2.9, and 3.6 days respectively. Mean postoperative daily pain scores (using a 10-point visual analog scale) for days 1 to 5 were as follows: 2.8, 2.1, 1.5, 1.0, and 0.6, respectively, with a sum of 8.0. During the 6-month tracking period, the practice only received 4 calls from patients with questions about pain control (0.5% of cases). Conclusions Patients achieved good immediate pain control without opioids and reported rapidly declining pain levels over the next several days to the point of no longer requiring medication. Type of Study/Level of Evidence Prospective cohort case series, therapeutic; Level IV.

Effect of Cold Plasma on Histological Compositions of the Rabbits Fracture Bone Tissue

In this research, the rabbits' bones have been fractured, the rabbits were exposed to the cold plasma for five minute times two weeks. The microwave plasma voltage which was used in the search was "175v" and the gas flow was" 2 L" at the room temperature. A Biologic parameters such as alkaline phosphates (ALP), osteocalcin, vitamin D (Vit. D) and calcium (Ca), Triglycerides (TG), Cholesterol (T.chol.), Estradiol and Glucose have studied in its serum. Physiological parameters were measured to prove the effects of plasma on the fracture bone tissue and show the amount of damage and the effect of plasma therapy before and after exposure to plasma.

279 Quality Improvement Audit on Bone Health Assessment and Secondary Prevention of Patients Discharged from an In-patient Rehabilitation Unit Post Fracture

Background Osteoporosis accounts for more disability-adjusted life years than many non-communicable diseases. Identification and treatment is important to reduce morbidity and mortality associated with further fracture.(1) National Osteoporosis Guideline Group recommends all patients with a fragility fracture should undergo a bone health assessment and commence pharmacological therapy if indicated.(2) Methods Electronic discharge summaries of all patients with a diagnosis of fracture discharged from an off-site rehabilitation unit from 1st January 2018 to 31st December 2018 were reviewed. Patient details, location and mechanism of fracture, bone health assessment and discharge prescription were assessed. Following data collection, an education session directed at NCHDs was performed and a discharge checklist prompting bone health review and consideration of pharmacological therapy was introduced. A re-audit was performed at 4 months to assess change following this intervention. Results 74 patients had a diagnosis of fracture. 4 were excluded as fracture resulted from high impact trauma. 100% had corrected calcium measured. 93%(n=65) had Vitamin D(OH) measured. 91%(n=64) had PTH measured. 55%(n=39) were discharged on calcium/vitamin D(OH) supplementation. 33%(n=23) were discharged on Vitamin D(OH) alone. 66%(n=46) were discharged on antiresorptive therapy: 28%(n=13) bisphosphonate, 67% (n=31) denosumab, 4% others. 33%(n=23) were not prescribed any bone protection on discharge. 4 had advanced chronic kidney disease. 6%(n=4) were discharged without calcium/Vitamin D or antiresorptive therapy. A re-audit from January to April 2019 of 15 patients post NCHD education has shown an increase in antiresorptive therapy prescription 86%(n=13) Conclusion Bone health assessment and prescribing practices of antiresorptive therapy in patients undergoing rehabilitation post fracture is sub-optimal. Education of non-consultant hospital doctors can substantially improve rates of antiresorptive therapy prescription.