The main graphene‐family materials used in biomedicine include graphene, graphene oxide, and reduced graphene oxide. They have been well documented for their distinctive microstructure and excellent physicochemical properties. Although they also have some shortcomings, such as slow biodegradation and dose‐dependent biotoxicity, these problems can be solved by using them in conjunction with other biomaterials. Silk fibroin (SF), a natural polymer material with many advantageous properties, has been used widely in biomedicine. However, SF requires modification by other biomaterials to improve its mechanical properties and control its degradation rate for further use. In recent years, the combined application of graphene‐family materials and SF has increased gradually, and the effects of it on cell behavior have been preliminary investigated, such as promoting cell adhesion, proliferation, and differentiation. Further studies of the combined use have been conducted in biomedicine, including tissue engineering, biosensor, and other biomedical usage. In this paper, this combined application has been outlined and summarized, and some envisioned challenges and future perspectives have been mentioned. We hope that this review will provide some reference and inspiration for the combined application of graphene‐family materials and SF in biomedicine in the future.
Purpose Hook plate fixation is one of the most frequently used methods for unstable distal clavicular fractures, but it is still unknown if there is a need for coracoclavicular (CC) reconstruction. This study aimed to compare the efficacy of hook plate fixation with versus without CC reconstruction for distal clavicular fractures. Methods Eighty-one patients who underwent hook plate fixation (HP group, n = 45) or hook plate fixation plus suture anchor reconstruction (HPA group, n = 36) for Neer type II or V clavicular fractures were enrolled. Demographics, fracture characteristics, and surgical data were recorded. Union time, coracoclavicular distance (CCD), post-operative complications, Constant score, and Disabilities of the Arm, Shoulder, and Hand (DASH) score were compared between HPA and HP groups. Results Constant score in the HPA group was higher than that in the HP group (91.8 ± 3.6 vs 88.8 ± 6.0, P = 0.007). However, there were no significant differences in union time, DASH score, CCD, and post-operative complications between the two groups (P > 0.05). Hook plate fixation combined with CC reconstruction costed more (3023.7 ± 202.6 vs 2416.2 ± 167.6 EUR, P < 0.001) and prolonged operative duration (78.2 ± 9.2 vs 73.7 ± 8.3 min, P = 0.023) compared with hook plate fixation alone. Conclusion Hook plate fixation with or without suture anchor reconstruction achieved satisfactory outcomes for Neer type II or V clavicular fractures. However, hook plate fixation plus CC reconstruction showed better functional outcomes compared with hook plate fixation alone.
Background Femoral head fractures are rare injuries that are often associated with poor functional outcomes and complications. The purpose of this study was to evaluate the incidence, treatment methods and approaches, complications, and functional outcomes of femoral head fractures. Methods We conducted a retrospective review of fifty patients who sustained femoral head fractures from January 2011- December 2018. There were thirty-seven (74%) males and thirteen (26%) females with a median age of 40 years. According to Pipkin’s classification, there were eighteen (36%) Pipkin I, ten (20%) Pipkin II, eight (16%) Pipkin III, and fourteen (28%) Pipkin IV patients. Treatment methods were categorized into non-operative, operative by open reduction and internal fixation (ORIF), and immediate total hip replacement (THR). The recorded surgical approach consists of an anterior(S-P) approach, posterior(K-L) approach, lateral stab, and combined anterior + lateral stab approach for fixation. The patients were also stratified by the Injury Severity Score (ISS), associated injuries, and, mechanism of injuries. The modified harris hip score (MHHS) was used to evaluate the ongoing complications with the clinical outcome of patients with two years or greater follow-up. Results Eight (16%) patients were managed successfully with closed reduction without surgery and thirty-seven (74%) patients required operative reduction and internal fixation (ORIF) of the femoral head and acetabulum, and 5 (10%) patients required immediate THR. Six (12%) developed AVN, and four (8%) required a secondary THR. Sixteen patients (33%) developed post-traumatic osteoarthritis (PTOA), eight (16%) developed heterotopic ossification (HO) and six patients (12%) had sciatic nerve injury, none requiring operative treatment. Overall functional results according to MHHS were, excellent in two (4%) patients, good in sixteen (32%) patients, fair in twenty-two (44%) patients, and poor in ten (20%) patients. A statistically significant difference in outcome was observed among four pipkin subtypes. Conclusion Femoral head fractures are a rare injury that is often associated with poor outcomes. In this study, we report the functional outcomes and complications of all treatment approaches for femoral head fracture based on the Pipkin classification. The treatment aim should always be the anatomical reduction of the fragments. This study, adds to the growing literature on femoral head fracture and provides a reference for the clinical treatment to guide patient management. Trial registration: Our study was approved by the Clinical Research and Biomedical Ethical Committee of West China Hospital, Sichuan University performed following the Declaration of Helsinki. All the participants provided written informed consent to attend the study.
Background Femoral head fractures are rare injuries often associated with poor functional outcomes and complications. The purpose of this study was to evaluate the incidence, treatment methods and approaches, complications, and functional outcomes of femoral head fractures. Methods We retrospectively reviewed 50 patients who sustained femoral head fractures between January 2011 and December 2018. There were thirty-seven (74%) males and thirteen (26%) females with a median age of 40 years. According to Pipkin’s classification, there were eighteen (36%) Pipkin I, ten (20%) Pipkin II, eight (16%) Pipkin III, and fourteen (28%) Pipkin IV patients. Treatment methods were categorized into non-operative, operative by open reduction and internal fixation (ORIF), and immediate total hip replacement (THR). The recorded surgical approach consists of an anterior(S-P) approach, posterior(K-L) approach, lateral stab, and combined anterior + lateral stab approach for fixation. The patients were also stratified by the Injury Severity Score (ISS), associated injuries, and, mechanism of injuries. The modified harris hip score (MHHS) was used to evaluate the ongoing complications with the clinical outcome of patients with two years or greater follow-up. Results Eight (16%) patients were managed successfully with closed reduction without surgery and thirty-seven (74%) patients required operative reduction and internal fixation (ORIF) of the femoral head and acetabulum, and 5 (10%) patients required immediate THR. Six (12%) patients developed AVN, and four (8%) required a secondary THR. Sixteen patients (33%) developed post-traumatic osteoarthritis (PTOA), eight (16%) developed heterotopic ossification (HO) and six patients (12%) had sciatic nerve injury, none requiring operative treatment. Overall functional results according to MHHS were, excellent in two (4%) patients, good in sixteen (32%) patients, fair in twenty-two (44%) patients, and poor in ten (20%) patients. A statistically significant difference in outcome was observed among four pipkin subtypes. Conclusion Femoral head fractures are rare injuries often associated with poor outcomes. In this study, we report the functional outcomes and complications of all treatment approaches for femoral head fracture based on the Pipkin classification. The treatment aim should always be the anatomical reduction of the fragments. This study, adds to the growing literature on femoral head fracture and provides a reference for the clinical treatment to guide patient management. Trial registration Our study was approved by the Clinical Research and Biomedical Ethical Committee of West China Hospital, Sichuan University, and was performed in accordance with the Declaration of Helsinki. All participants provided written informed consent to participate in this study.
Background The objective of this study was to evaluate the effectiveness of our strategy for managing floating hip injuries. Methods From January 2014 and December 2019, all patients with a floating hip underwent surgical treatment in our hospital were included in the retrospective study, with a minimum follow-up of 1 year. All patients were managed according to a standardised strategy. Data on epidemiology, radiography, clinical outcomes and complications were collected and analysed. Results Twenty-eight patients were enrolled, with an average age of 45 years. The mean follow-up was 36.9 months. According to the Liebergall classification, Type A floating hip injuries predominated (n = 15, 53.6%). Head and chest injuries were the most common associated injuries. When multiple operative settings were required, we prioritized the fixation of the femur fracture at the first operation. The mean time from injury to definitive femoral surgery was 6.1 days, with most (75%) femoral fractures treated with intramedullary fixation. More than half (54%) of acetabular fractures were treated with a single surgical approach. Pelvic ring fixation included isolated anterior fixation, isolated posterior fixation, combined anterior and posterior fixation, of which isolated anterior fixation was the most common. Postoperative radiographs suggested that the anatomic reduction rates of acetabulum and pelvic ring fractures were 54% and 70%, respectively. According to grading system of Merle d’Aubigne and Postel, 62% of patients achieved satisfactory hip function. Complications included delayed incision healing (7.1%), deep vein thrombosis (10.7%), heterotopic ossification (10.7%), femoral head avascular necrosis (7.1%), post-traumatic osteoarthritis (14.3%), fracture malunion (n = 2, 7.1%) and nonunion (n = 2, 7.1%). In the patients with complications described above, only two patients underwent resurgery. Conclusions Although there is no difference in clinical outcomes and complications among different types of floating hip injuries, special attention should be paid to anatomical reduction of the acetabular surface and restoration of the pelvic ring. In addition, the severity of such compound injuries often exceeds that of an isolated injury and often requires specialised multidisciplinary management. Because of no standard guidelines for treatment of such injuries, our experience in the management of such a complex case is to fully assess the complexity of the injury and formulate an appropriate surgical plan based on the principles of damage control orthopaedics.
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