Objective To analyze necrotic femoral head after long‐term internal fixation for femoral neck fractures using micro‐computed tomography (CT) for bone histomorphometry. Methods The experimental group included six patients (two men and four women; mean age 62.00 ± 9.36 years) who underwent hip arthroplasty at 47.67 ± 14.22 months after internal fixation. Surgery was performed because of femoral head necrosis after femoral neck fracture between October 2018 and October 2020. The control group included three patients (two men and one woman; mean age 69.33 ± 4.62 years) who underwent hip arthroplasty for femoral neck fracture. In the experimental group, micro‐CT quantitative analysis of the whole femur, sclerotic region around screws, screw paths, sclerotic region and screw paths, and relatively normal region was performed. The bone volume fraction (BV/TV), number of bone trabeculae (Tb.N), connection density (Conn.D), thickness of bone trabeculae (Tb.Th), separation of bone trabeculae (Tb.SP), structural model index (SMI), and bone mineral density (BMD) of each part were quantitatively analyzed. Results The BV/TV (0.3180 ± 0.0617), Conn.D (6.9261 ± 2.4715/mm3), Tb.Th (0.3262 ± 0.0136 μm), and BMD (298.9241 ± 54.2029 g/cm3) of the sclerotic region around the screws were significantly higher in the experimental group than the BV/TV (0.1248 ± 0.0390), Conn.D (2.5708 ± 0.5187/mm3), Tb.Th (0.1713 ± 0.0333 μm), and BMD (66.5181 ± 43.0380 g/cm3) in the control group (P < 0.05). The BV/TV (0.2222 ± 0.0684), Tb.Th (0.2775 ± 0.0326 μm), and BMD (195.0153 ± 71.8509 g/cm3) in the collapsed region were significantly higher in the experimental group than in the control group (P < 0.05). In the experimental group, the volume ratio of the sclerotic region around screws and screw paths to the entire femoral head was 0.4964 ± 0.0950. Conclusion After internal fixation for femoral neck fracture, a large number of sclerotic plate‐like trabeculae were observed around the long‐term retained implant. The screw paths and surrounding sclerotic comprise approximately 50% of the femoral head volume.
Background Femoral neck fractures are a common traumatic injury. The removal of the internal fixation remains controversial, especially in terms of mechanical stability. Moreover, collapsed necrosis of the femoral head continues to occur after fracture healing. We believe that sclerotic cancellous bone (SCB) formation around the screw is associated with femoral head necrosis. We aimed to compare mechanical features before and after implant removal and determine the effect of SCB formation on stress distribution. Methods Cylindrical cancellous bone sections were collected from a relatively normal region and an SCB region of a necrotic femoral head, and their elastic moduli were measured. Four femoral finite element models were developed: a) femoral neck fracture healing with implants, b) fracture healing without implants, c) sclerosis around the screw with implants, and d) sclerosis around the screw without implants. Results The maximum von Mises peak stresses of models a and b were 66.643 MPa and 63.76 MPa, respectively, and were concentrated in the upper lateral femur. The main stress was scattered at the lowest screw tail, femoral calcar region, and lateral femur shaft. Moreover, coronal plane strain throughout the screw paths near the femoral head in models a and b was mostly in the range of 1000–3000 με. The maximum stress concentrations in models c and d were located at the lower femoral head and reached 91.199 MPa and 78.019 MPa, respectively. Conclusions The stresses in the sclerotic model around the cannulated screws are more concentrated on the femoral head than in the healing model without sclerotic bone. The overall stresses in the healing femoral neck fracture model were essentially unchanged before and after removal of the internal fixation.
BackgroundEarly and accurate diagnosis of infection-induced osteomyelitis, which often involves increased PD-L1 expression, is crucial for better treatment outcomes. Radiolabeled anti-PD-L1 nuclear imaging allows for sensitive and non-invasive whole-body assessments of PD-L1 expression. This study aimed to compare the efficacy of 18F-FDG and an 18F-labeled PD-L1-binding peptide probe (18F-PD-L1P) in PET imaging of implant-associated Staphylococcus aureus osteomyelitis (IAOM).MethodsIn this study, we synthesized an anti-PD-L1 probe and compared its efficacy with 18F-FDG and 18F-PD-L1P in PET imaging of implant-associated Staphylococcus aureus osteomyelitis (IAOM). The %ID/g ratios (i.e., radioactivity ratios between the infected and non-infected sides) of both probes were evaluated for sensitivity and accuracy in post-infected 7-day tibias and post-infected 21 days, and the intensity of 18F-PD-L1P uptake was compared with pathological changes measured by PD-L1 immunohistochemistry (IHC).ResultsCompared with 18F-FDG, 18F-PDL1P demonstrated higher %ID/g ratios for both post-infected 7-day tibias (P=0.001) and post-infected 21 days (P=0.028). The intensity of 18F-PD-L1P uptake reflected the pathological changes of osteomyelitic bones. In comparison to 18F-FDG, 18F-PDL1P provides earlier and more sensitive detection of osteomyelitis caused by S. aureus.ConclusionOur findings suggest that the 18F-PDL1P probe is a promising tool for the early and accurate detection of osteomyelitis caused by S. aureus.
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