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Femoral head necrosis is a rare but devastating complication following femoral neck fracture. The reported incidence of avascular necrosis after femoral neck fracture fixation varies widely, and there is no consensus regarding its risk factors. The aim of this study was to analyze the risk factors for femoral head necrosis after internal fixation in femoral neck fracture. This retrospective study included 166 patients with femoral neck fractures treated with surgical reduction and internal fixation at the authors' institution from January 2004 to December 2008. Eight patients died for reasons unrelated to the surgery, and 12 patients were lost to follow-up. The remaining 146 patients (146 fractures) were followed until union or until conversion to total hip arthroplasty. The patients included 61 males and 85 females with an average age of 47.5 years (range, 18-68 years). The authors analyzed the following factors: age, sex, Garden classification, reduction quality, surgical methods, injury-to-surgery interval, preoperative traction, weight-bearing time, and implant removal. All patients were followed for a mean of 52 months (range, 6-90 months). The incidence of femoral head necrosis was 14.4% (21/146). Garden classification (P=.012), reduction quality (P=.008), implant removal (P=.020), and preoperative traction (P=.003) were significantly associated with femoral head necrosis. Patient age (P=.990), sex (P=.287), injury-to-surgery interval (P=.360), weight-bearing time (P=.868), and surgical methods (P=.987) were not significantly associated with femoral head necrosis. In multivariate logistic regression analysis, implant removal was not a significant risk factor for femoral head necrosis development (P=.498). Garden classification, reduction quality, and preoperative traction had a significant effect on femoral head necrosis development.

Diabetes mellitus is a chronic metabolic disease with a proinflammatory microenvironment, causing poor vascularization and bone regeneration. Due to the lack of effective therapy and one-sided focus on the direct angiogenic properties of biomaterials and osteogenesis stimulation, the treatment of diabetic bone defect remains challenging and complex. In this study, using gelatin methacryloyl (GelMA) as a template, a lithium (Li) -modified bioglass-hydrogel for diabetic bone regeneration is developed. It exhibits a sustained ion release for better bone regeneration under diabetic microenvironment. The hydrogel is shown to be mechanically adaptable to the complex shape of the defect. In vitro, Li-modified bioglass-hydrogel promoted cell proliferation, direct osteogenesis, and regulated macrophages in high glucose (HG) microenvironment, with the secretion of bone morphogenetic protein-2 and vascular endothelial growth factor to stimulate osteogenesis and neovascularization indirectly. In vivo, composite hydrogels containing GelMA and Li-MBG (GM/M-Li) release Li ions to relieve inflammation, providing an anti-inflammatory microenvironment for osteogenesis and angiogenesis. Applying Li-modified bioglass-hydrogel, significantly enhances bone regeneration in a diabetic rat bone defect. Together, both remarkable in vitro and in vivo outcomes in this study present an opportunity for diabetic bone regeneration on the basis of HG microenvironment.

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ABSTRACT:Outcomes following the open reduction and internal fixation (ORIF) of displaced acetabular fractures in the elderly have been inconsistent. Several factors associated with significant poor clinical outcomes have been reported; however, the factor that contributes independently to the outcomes remains unknown. This study aims to identify independent prognostic factors for the outcomes of surgically treated displaced acetabular fractures in the elderly. A total of 86 elderly patients with displaced acetabular fractures were treated by ORIF between May 1990 and June 2010. Matta's criteria and modified Merle d'Aubigne-Postel score were used as reduction grades and clinical outcome measures, respectively. Reduction grades and six radiographic features were identified as prognostic factors. The six radiographic features include quadrilateral plate fracture, Gull sign, posterior dislocation of hip, femoral head injury (FHI), comminuted posterior wall fracture (CPWF), and posterior wall marginal impaction. The average clinical score of the patients associated with the six radiographic features was 14.4 AE 3.1, whereas the average clinical score for those without was 17.2 AE 1.6 points. The average clinical score of the patients with anatomical, imperfect, and poor reduction were 16.8 AE 2.4, 14.5 AE 2.3, and 11.3 AE 1.4 points, respectively. Multivariate analysis identified three independent predictors of clinical outcomes: reduction grades (t ¼ À10.45, p ¼ 0.000), CPWF (t ¼ À2.74, p ¼ 0.008), and FHI (t ¼ À3.51, p ¼ 0.000). Both CPWF and FHI are important risk factors for clinical outcome. The postoperative quality of reduction independently predicted patient prognosis, and anatomical reduction is predictive of a good prognosis. ß

Background To compare the efficacy and safety of simultaneous vs staged unicompartmental knee arthroplasty (UKA) for bilateral unicompartmental osteoarthritis of the knee. Methods We performed a retrospective analysis of prospectively collected data on 93 patients with bilateral knee medial compartment arthritis underwent simultaneous UKA (Group A, 39) or staged UKA (Group B, 54 cases) from January 2008 to December 2015. Group A: 6 males and 33 females aged 64.9 ± 7.7 years; Group B: 5 males and 49 females aged 64.2 ± 6.4 years. There were no statistically significant differences in pre-operative age, sex ratio, or body weight index between the groups ( P > 0.05). Groups were compared in terms of total anesthesia time, volume of drainage, blood transfusion rate, hemoglobin level on post-operative day 3, total post-operative inpatient days, treatment expenses, post-operative therapeutic effect (KSS scores), and complications. Results All patients had follow-up visits post-operatively. The follow-up visit interval was 32–133 months and 41.9 months on average. Total anesthesia time, postoperative length of hospital stay, and hospitalization expenses in Group A were significantly less than those of Group B ( P < 0.05). Hemoglobin levels in Group A were significantly lower than those of Group B at post-op day 3 ( P < 0.05). However, no significant differences in volume of drainage, the rate of transfusion, complications, and KSS scores were detected between Groups A and B ( P > 0.05). Conclusions Both simultaneous and staged UKA achieved the desired therapeutic effect in treatment of bilateral knee medial compartment arthritis. However, simultaneous UKA reduced the cost and the postoperative length of hospital stay without increasing post-operative complications.

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This study aims to assess the biomechanical properties of a novel fixation system (named AFRIF) and to compare it with other five different fixation techniques for quadrilateral plate fractures. This in vitro biomechanical experiment has shown that the multidirectional titanium fixation (MTF) and pelvic brim long screws fixation (PBSF) provided the strongest fixation for quadrilateral plate fracture; the better biomechanical performance of the AFRIF compared with the T-shaped plate fixation (TPF), L-shaped plate fixation (LPF), and H-shaped plate fixation (HPF); AFRIF gives reasonable stability of treatment for quadrilateral plate fracture and may offer a better solution for comminuted quadrilateral plate fractures or free floating medial wall fracture and be reliable in preventing protrusion of femoral head.