Search results for: bone fracture risk

Authors: Sandra Pietri, Helene Dubout, Sabrina Ena, Candice Hoste, Enrico Bastianelli

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Bone Therapeutics is a bone cell therapy company addressing high unmet medical needs in the field of bone fracture repair, more specifically in non-union and delayed-union fractures where the bone repair process is impaired. The company has developed a unique allogeneic osteoblastic cell product (ALLOB®) derived from bone marrow which is currently tested in humans in the indication of delayed-union fractures. The purpose of our study was to directly compare ALLOB® vs. non-differentiated mesenchymal stem cells (MSC) for their in vitro osteogenic characteristics and their in vivo osteogenic potential in order to determine which cellular type would be the most adapted for bone fracture repair. Methods: Healthy volunteers’ bone marrow aspirates (n=6) were expended (i) into BM-MSCs using a complete MSC culture medium or (ii) into ALLOB® cells according to its manufacturing process. Cells were characterized in vitro by morphology, immunophenotype, gene expression and differentiation potential. Additionally, their osteogenic potential was assessed in vivo in the subperiosteal calvaria bone formation model in nude mice. Results: The in vitro side-by-side comparison studies showed that although ALLOB® and BM-MSC shared some common general characteristics such as the 3 minimal MSC criteria, ALLOB® expressed significantly higher levels of chondro/osteoblastic genes such as BMP2 (fold change (FC) > 100), ALPL (FC > 12), CBFA1 (FC > 3) and differentiated significantly earlier than BM-MSC toward the osteogenic lineage. Moreover the bone formation model in nude mice demonstrated that used at the same cellular concentration, ALLOB® was able to induce significantly more (160% vs.107% for control animals) bone formation than BM-MSC (118% vs. 107 % for control animals) two weeks after administration. Conclusion: Our side-by-side comparison studies demonstrated that in vitro and in vivo, ALLOB® displays superior osteogenic capacity to BM-MScs and is therefore a better candidate for the treatment of bone fractures.

Keywords: gene expression, histomorphometry, mesenchymal stem cells, osteogenic differentiation potential, preclinical

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Authors: B. V. Murlimanju, P. J. Jiji, Latha V. Prabhu, Mangala M. Pai

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Background: The scaphoid is the most commonly fractured bone of the wrist. The fracture may disrupt the vessels and end up as the avascular necrosis of the bone. The objective of the present study was to investigate the morphology and number of the nutrient foramina in the cadaveric dried scaphoid bones of the Indian population. Methods: The present study included 46 scaphoid bones (26 right sided and 20 left sided) which were obtained from the gross anatomy laboratory of our institution. The bones were macroscopically observed for the nutrient foramina and the data was collected with respect to their number. The tabulation of the data and analysis were done. Results: All of our specimens (100%) exhibited the nutrient foramina over the non-articular surfaces. The foramina were observed only over the palmar and dorsal surfaces of the scaphoid bones. The foramina were observed both proximal and distal to the mid waist of the scaphoid bone. The foramen ranged between 9 and 54 in each scaphoid bone. The foramina over the palmar surface ranged between, 2-24 in number. The foramina over the dorsal surface ranged between, 7-36 in number. The foramina proximal to the waist ranged between 2 and 24 in number and distal to the waist ranged between 3 and 39. Conclusion: We believe that the present study has provided additional data about the nutrient foramina of the scaphoid bones. The data is enlightening to the orthopedic surgeon and would help in the hand surgeries. The morphological knowledge of the vasculature, their foramina of entry and their number is required to understand the concepts in the avascular necrosis of the proximal scaphoid and non-union of the fracture at the waist of the scaphoid.

Keywords: avascular necrosis, nutrient, scaphoid, vascular

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Authors: Massimiliano Panella, Sara Bortoluzzi, Sophia Russotto, Daniele Nicolini, Carmela Rinaldi

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Osteoporosis affects more than 200 million people worldwide. About 75% of osteoporosis cases are undiagnosed or diagnosed only when a bone fracture occurs. Since osteoporosis related fractures are significant determinants of the burden of disease and health and social costs of aging populations, we believe that this is the early identification and treatment of high-risk patients should be a priority in actual healthcare systems. Screening for osteoporosis by dual energy x-ray absorptiometry (DEXA) is not cost-effective for general population. An alternative is pulse-echo ultrasound (PEUS) because of the minor costs. To this end, we developed an early detection program for osteoporosis with PEUS, and we evaluated is possible impact and sustainability. We conducted a cross-sectional study including 1,050 people in Italy. Subjects with >1 major or >2 minor risk factors for osteoporosis were invited to PEUS bone mass density (BMD) measurement at the proximal tibia. Based on BMD values, subjects were classified as healthy subjects (BMD>0.783 g/cm²) and pathological including subjects with suspected osteopenia (0.783≤BMD>0.719 g/cm²) or osteoporosis (BMD ≤ 0.719 g/cm²). The responder rate was 60.4% (634/1050). According to the risk, PEUS scan was recommended to 436 people, of whom 300 (mean age 45.2, 81% women) accepted to participate. We identified 240 (80%) healthy and 60 (20%) pathological subjects (47 osteopenic and 13 osteoporotic). We observed a significant association between high risk people and reduced bone density (p=0.043) with increased risks for female gender, older ages, and menopause (p<0.01). The yearly cost of the screening program was 8,242 euros. With actual Italian fracture incidence rates in osteoporotic patients, we can reasonably expect in 20 years that at least 6 fractures will occur in our sample. If we consider that the mean costs per fracture in Italy is today 16,785 euros, we can estimate a theoretical cost of 100,710 euros. According to literature, we can assume that the early treatment of osteoporosis could avoid 24,170 euros of such costs. If we add the actual yearly cost of the treatments to the cost of our program and we compare this final amount of 11,682 euros to the avoidable costs of fractures (24,170 euros) we can measure a possible positive benefits/costs ratio of 2.07. As a major outcome, our study let us to early identify 60 people with a significant bone loss that were not aware of their condition. This diagnostic anticipation constitutes an important element of value for the project, both for the patients, for the preventable negative outcomes caused by the fractures, and for the society in general, because of the related avoidable costs. Therefore, based on our finding, we believe that the PEUS based screening performed could be a cost-effective approach to early identify osteoporosis. However, our study has some major limitations. In fact, in our study the economic analysis is based on theoretical scenarios, thus specific studies are needed for a better estimation of the possible benefits and costs of our program.

Keywords: osteoporosis, prevention, public health, screening

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Authors: Herng-Sheng Lee, Chi-Yi Chen, Wan-Ting Huang, Li-Jen Chang, Solomon Chih-Cheng Chen, Hsin-Yi Yang

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A variety of gastrointestinal disorders, such as Crohn’s disease, ulcerative colitis, and coeliac disease, are recognized as risk factors for osteoporosis and osteoporotic fractures. One recent study suggests that individuals with irritable bowel syndrome (IBS) might also be at increased risk of osteoporosis and osteoporotic fractures. Up to now, the association between IBS and the risk of fractures at different anatomic sites occurrences is not completely clear. We conducted a population-based cohort analysis to investigate the fracture risk of IBS in comparison with non-IBS group. We identified 29,505 adults aged ≥ 20 years with newly diagnosed IBS using the Taiwan National Health Insurance Research Database in 2000-2012. A comparison group was constructed of patients without IBS who were matched according to gender and age. The occurrence of fracture was monitored until the end of 2013. We analyzed the risk of fracture events to occur in IBS by using Cox proportional hazards regression models. Patients with IBS had a higher incidence of osteoporotic fractures compared with non-IBS group (12.34 versus 9.45 per 1,000 person-years) and an increased risk of osteoporotic fractures (adjusted hazard ratio [aHR] = 1.27, 95 % confidence interval [CI] = 1.20 – 1.35). Site specific analysis showed that the IBS group had a higher risk of fractures for spine, forearm, hip and hand than did the non-IBS group. With further stratification for gender and age, a higher aHR value for osteoporotic fractures in IBS group was seen across all age groups in males, but seen in elderly females. In addition, female, elderly, low income, hypertension, coronary artery disease, cerebrovascular disease, and depressive disorders as independent osteoporotic fracture risk factors in IBS patients. The IBS is considered as a risk factor for osteoporotic fractures, particularly in female individuals and fracture sites located at the spine, forearm, hip and hand.

Keywords: irritable bowel syndrome, fracture, gender difference, longitudinal health insurance database, public health

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Authors: Srikanta Tagore Sarkar, Prasanta Kumar Mandal, Dibakar Roy

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The association of a capitate fracture with a scaphoid fracture has been termed as the naviculocapitate syndrome. The existence of some nondisplaced fractures of scaphoid and capitate with or without the fracture of lunate or radius suggests that there is a spectrum of these injuries, and this confuses the terminology. With our case; we report an unusual variety of this naviculocapitate syndrome with distal radial Colles fracture in addition to the nondisplaced fractures of the scaphoid, capitate and the dorsal lip of radial fracture. When we looked at the literature there is no another Colles fracture reported together with undisplaced scapho-capitate syndrome. The coronal and sagittal images that obtained from the MDCT (Multidetector computed tomography) is useful and effective imaging modality to diagnose complex wrist fractures with more details that are not detected in X-rays.

Keywords: scaphoid, capitate, Colles’ fracture, syndrome, MDCT, unusual

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Authors: L. Roseiro, C. Veiga, V. Maranha, A. Neto, N. Laraqi, A. Baïri, N. Alilat

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In orthopedic surgery there are various situations in which the surgeon needs to implement methods of cutting and drilling the bone. With this type of procedure the generated friction leads to a localized increase in temperature, which may lead to the bone necrosis. Recognizing the importance of studying this phenomenon, an experimental evaluation of the temperatures developed during the procedure of drilling bone has been done. Additionally the influence of the use of the procedure with / without additional lubrication during drilling of bone has also been done. The obtained results are presented and discussed and suggests an advantage in using additional lubrication as a way to minimize the appearance of bone tissue necrosis during bone drilling procedures.

Keywords: bone necrosis, bone drilling, thermography, surgery

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Authors: Madushani Rodrigo, Banuka Athuraliya

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In today's world of medical diagnosis and prediction, machine learning stands out as a strong tool, transforming old ways of caring for health. This study analyzes the use of machine learning in the specialized domain of sports medicine, with a focus on the timely and accurate detection of bone fractures in cricket athletes. Failure to identify bone fractures in real time can result in malunion or non-union conditions. To ensure proper treatment and enhance the bone healing process, accurately identifying fracture locations and types is necessary. When interpreting X-ray images, it relies on the expertise and experience of medical professionals in the identification process. Sometimes, radiographic images are of low quality, leading to potential issues. Therefore, it is necessary to have a proper approach to accurately localize and classify fractures in real time. The research has revealed that the optimal approach needs to address the stated problem and employ appropriate radiographic image processing techniques and object detection algorithms. These algorithms should effectively localize and accurately classify all types of fractures with high precision and in a timely manner. In order to overcome the challenges of misidentifying fractures, a distinct model for fracture localization and classification has been implemented. The research also incorporates radiographic image enhancement and preprocessing techniques to overcome the limitations posed by low-quality images. A classification ensemble model has been implemented using ResNet18 and VGG16. In parallel, a fracture segmentation model has been implemented using the enhanced U-Net architecture. Combining the results of these two implemented models, the FracXpert system can accurately localize exact fracture locations along with fracture types from the available 12 different types of fracture patterns, which include avulsion, comminuted, compressed, dislocation, greenstick, hairline, impacted, intraarticular, longitudinal, oblique, pathological, and spiral. This system will generate a confidence score level indicating the degree of confidence in the predicted result. Using ResNet18 and VGG16 architectures, the implemented fracture segmentation model, based on the U-Net architecture, achieved a high accuracy level of 99.94%, demonstrating its precision in identifying fracture locations. Simultaneously, the classification ensemble model achieved an accuracy of 81.0%, showcasing its ability to categorize various fracture patterns, which is instrumental in the fracture treatment process. In conclusion, FracXpert has become a promising ML application in sports medicine, demonstrating its potential to revolutionize fracture detection processes. By leveraging the power of ML algorithms, this study contributes to the advancement of diagnostic capabilities in cricket athlete healthcare, ensuring timely and accurate identification of bone fractures for the best treatment outcomes.

Keywords: multiclass classification, object detection, ResNet18, U-Net, VGG16

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Authors: Vladyslav Povoroznyuk, Larysa Martynyuk, Iryna Syzonenko, Liliya Martynyuk

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Osteoporosis is one of the important problems in postmenopausal women due to an increased risk of sudden and unexpected fractures. This study is aimed to determine the connection between bone mineral density (BMD) and trabecular bone score (TBS) in Ukrainian women suffering from metabolic syndrome. Participating in the study, 566 menopausal women aged 50-79 year-old were examined and divided into two groups: Group A included 336 women with no obesity (BMI ≤ 29.9 kg/m²), and Group B – 230 women with metabolic syndrome (diagnosis according to IDF criteria, 2005). Dual-energy X-ray absorptiometry was used for measuring of lumbar spine (L1-L4), femoral neck, total body and forearm BMD and bone quality indexes (last according to Med-Imaps installation). Data were analyzed using Statistical Package 6.0. A significant increase of lumbar spine (L1-L4), femoral neck, total body and ultradistal radius BMD was found in women with metabolic syndrome compared to those without obesity (p < 0.001) both in their totality and in groups of 50-59 years, 60-69 years, and 70-79 years. TBS was significantly higher in non-obese women compared to metabolic syndrome patients of 50-59 years and in the general sample (p < 0.05). Analysis showed significant positive correlation between body mass index (BMI) and BMD at all levels. Significant negative correlation between BMI and TBS (L1-L4) was established. Despite the fact that BMD indexes were significantly higher in women with metabolic syndrome, the frequency of vertebral and non-vertebral fractures did not differ significantly in the groups of patients.

Keywords: bone mineral density, trabecular bone score, metabolic syndrome, fracture

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Authors: Ahmad N. Shuid, Azri Jalil, Sabarul A. Mokhtar, Mohd F. Khamis, Norliza Muhammad

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Micro-CT provides a 3-D image of fracture callus, which can be used to calculate quantitative parameters. In this study, micro-CT was used to assess the fracture healing of orchidectomised rats, an androgen-deficient osteoporosis model. The effect of testosterone (hormone replacement) on fracture healing was also assessed with micro-CT. The rats were grouped into orchidectomised-control (ORX), sham-operated (SHAM), and orchidectomised; and injected with testosterone intramuscularly once weekly (TEN). Treatment duration was six weeks. The fracture was induced and fixed with plates and screws in the right tibia of all the rats. An in vitro micro-CT was used to scan the fracture callus area which consisted of 100 axial slices above and below fracture line. The analysis has shown that micro-CT was able to detect a significant difference in the fracture healing rate of ORX and TEN groups. In conclusion, micro-CT can be used to assess fracture healing in androgen-deficient osteoporosis. This imaging tool can be used to test agents that influence fracture healing in the androgen-deficient model.

Keywords: androgen, fracture, orchidectomy, osteoporosis

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Authors: Philippe Dillien, Patrice Forget, Harald Engel, Olivier Cornu, Marc De Kock, Jean Cyr Yombi

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Introduction: Hip fracture precedes commonly death in elderly people. Identification of high-risk patients may contribute to target patients in whom optimal management, resource allocation and trials efficiency is needed. The aim of this study is to construct a predictive score of mortality after hip fracture on the basis of the objective prognostic factors available: Neutrophil-to-lymphocyte ratio (NLR), age, and sex. C-Reactive Protein (CRP), is also considered as an alternative to the NLR. Patients and methods: After the IRB approval, we analyzed our prospective database including 286 consecutive patients with hip fracture. A score was constructed combining age (1 point per decade above 74 years), sex (1 point for males), and NLR at postoperative day+5 (1 point if >5). A receiver-operating curve (ROC) curve analysis was performed. Results: From the 286 patients included, 235 were analyzed (72 males and 163 females, 30.6%/69.4%), with a median age of 84 (range: 65 to 102) years, mean NLR values of 6.47+/-6.07. At one year, 82/280 patients died (29.3%). Graphical analysis and log-rank test confirm a highly statistically significant difference (P<0.001). Performance analysis shows an AUC of 0.72 [95%CI 0.65-0.79]. CRP shows no advantage on NLR. Conclusion: We have developed a score based on age, sex and the NLR to predict the risk of mortality at one year in elderly patients after surgery for a hip fracture. After external validation, it may be included in clinical practice as in clinical research to stratify the risk of postoperative mortality.

Keywords: neutrophil-to-lymphocyte ratio, hip fracture, postoperative mortality, medical and health sciences

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Authors: Omid Gholipoor Bashiri, Ghafur Mosavi, Aliasghar Behnamghader, Seyed Mahmood Rabiee

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Objective: To determine the effect of selected bone graft on the compression properties of radial bone in rabbit. Design-Experimental in vivo study. Animals: A total of 45 adult male New Zealand white rabbits. Procedures: The rabbits were anesthetized and a one-cm-full thickness piece of radial bone was removed using oscillating saw in the all rabbit. The rabbits were divided into 5 groups on the basis of the material used to fill the bone defect: group 1: the paste of bone cement calcium phosphate; group II: the paste of calcium phosphate mixture with type I collagen; group III: tricalcium phosphate mixed with hydroxyapatite (TCP & HP) with 5% porosity; group IV: the same scaffold as group III with 10% porosity; and group V: the same scaffold as group III and IV with 20% porosity, with 9 rabbits in each group. Subsequently subdivided into 3 subgroups of 3 rabbits each. Results: There was a significant increase in compression properties of radial bone in the group II and V in 2nd and 3rd months as compared with groups I, III and IV. The mean endurable crack-strength in group II and V were slightly higher than that of normal radius (P<0.05). Conclusion and clinical relevance: Application of calcium phosphate paste with type I collagen and scaffold of tricalcium phosphate with hydroxyapatite having 20% porosity indicated to have positive effect in integral formation of qualitative callus at the site of fracture and early re-organization of callus to regain mechanical strength too.

Keywords: calcium phosphate, tricalcium phosphate, hydroxyapatite, radial bone, compressive properties, porosity, type i collagen, rabbit

Procedia PDF Downloads 452

Authors: Hong Je Kang, Young Chae Choi, Jin Sung Park, Isac Kim

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Purpose: Osteoporotic fractures are an important among postmenopausal women. When osteoporotic distal radial fractures occur, osteoporosis must be treated to prevent the hip and spine fractures. Intravenous injection of Zoledronic acid is expected to improve preventing osteoporotic fractures. Many articles reported the effect of intravenous Zoledronic acid to BMD of the hip and spine fracture or non-fracture patients with low BMD. However, that with distal radial fractures has rarely been reported. Therefore, the authors decided to study the effect of Zoledronic acid in BMD score, bone union, and bone turnover markers in the patients who underwent volar plating due to osteoporotic distal radial fractures. Materials: From April 2018 to May 2022, postmenopausal women aged 55 years or older who had osteoporotic distal radial fractures and who underwent surgical treatment using volar plate fixation were included. Zoledronic acid (5mg) was injected intravenously between 3 and 5 days after surgery. BMD scores after 1 year of operation were compared with the initial scores. Bone turnover markers were measured before surgery, after 3 months, and after 1 year. Radiological follow-up was performed every 2 weeks until the bone union and at 1 year postoperatively. Clinical outcome indicators were measured one year after surgery, and the occurrence of side effects was observed. Result: Total of 23 patients were included, with a lumbar BMD T score of -2.89±0.2 before surgery to -2.27±0.3 one year after surgery (p=0.012) and a femoral neck BMD T score of -2.45±0.3 before surgery to -2.36±0.3 (p=0.041) after one year, and all were statistically significant. Measured as bone resorption markers, serum CTX-1 was 337.43±10.4 pg/mL before surgery, 160.86±8.7 pg/mL (p=0.022) after three months, and 250.12±12.7 pg/mL (p=0.031) after one year. Urinary NTX-1 was 39.24±2.2 ng/mL before surgery, 24.46±1.2 ng/mL (p=0.014) after three months and 30.35±1.6 ng/mL (p=0.042) after one year. Measured as bone formation markers, serum osteocalcin was 13.04±1.1 ng/mL before surgery, 8.84±0.7 ng/mL (p=0.037) after 3 months and 11.1±0.4 ng/mL (p=0.026) after one year. Serum bone-specific ALP was 11.24±0.9 IU/L before surgery, 8.25±0.9 IU/L (p=0.036) after three months, and 10.2±0.9 IU/L (p=0.027) after one year. All were statistically significant. All cases showed bone union within an average of 6.91±0.3 weeks without any signs of failure. Complications were found in 5 out of 23 cases (21.7%), such as headache, nausea, muscle pain, and fever. Conclusion: When Zoledronic acid was used, BMD was improved in both the spine and femoral neck. This may reduce the likelihood and subsequent morbidity of additional osteoporotic fractures. This study is meaningful in that there was no difference in the duration of bone union and radiological characteristics in patients with distal radial fractures administrated with intravenous BP early after the fractures, and improvement in BMD and bone turnover indicators was measured.

Keywords: zeoldreonic acid, BMD, osteoporosis, distal radius

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Authors: Kwi Young Kang

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Objective: To determine the association between inflammatory and structural lesions on sacroiliac joint (SIJ) MRI and BMD and to identify risk factors for low BMD in patients with axial spondyloarthritis (axSpA). Methods: Seventy-six patients who fulfilled the ASAS axSpA criteria were enrolled. All underwent SIJ MRI and BMD measurement at the lumbar spine, femoral neck, and total hip. Inflammatory and structural lesions on SIJ MRI were scored. Laboratory tests and assessment of radiographic and disease activity were performed at the time of MRI. The association between SIJ MRI findings and BMD was evaluated. Results: Among the 76 patients, 14 (18%) had low BMD. Patients with low BMD showed significantly higher bone marrow edema (BME) and deep BME scores on MRI than those with normal BMD (p<0.047 and 0.007, respectively). Inflammatory lesions on SIJ MRI correlated with BMD at the femoral neck and total hip. Multivariate analysis identified the presence of deep BME on SIJ MRI, increased CRP, and sacroiliitis on X-ray as risk factors for low BMD (OR: 5.6, 14.6, and 2.5, respectively). Conclusion: The presence of deep BME on SIJ MRI, increased CRP levels, and severity of sacroiliitis on X-ray were independent risk factors for low BMD.

Keywords: axial spondyloarthritis, sacroiliac joint MRI, bone mineral density, sacroiliitis

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Authors: Yu-Shan Wu, Po-Liang Lai, I-Ming Chu

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Poly(methylmethacrylate)(PMMA) is the most frequently used bone void filler for vertebral augmentation in osteoporotic fracture. PMMA bone cement not only exhibits strong mechanical properties but also can fabricate according to the shape of bone defect. However, the adhesion between the PMMA-based cement and the adjacent bone is usually weak and as PMMA bone cement is inherently bioinert. The combination of bioceramics and polymers as composites may increase cell adhesion and improve biocompatibility. The nano-hydroxyapatite(HAP) not only plays a significant role in maintaining the properties of the natural bone but also offers a favorable environment for osteoconduction, protein adhesion, and osteoblast proliferation. However, defects and cracks can form at the polymer/ceramics interface, resulting in uneven distribution of stress and subsequent inferior mechanical strength. Surface-modified HAP nano-crystals were prepared by chemically grafting poly(ε-caprolactone)(PCL) on surface-modified nano-HAP surface to increase the affinity of polymer/ceramic phases .Thus, incorporation of surface-modified nano-hydroxyapatite (EC-HAP) may not only improve the interfacial adhesion between cement and bone and between nanoparticles and cement, but also increase biocompatibility. In this research, PMMA mixing with 0, 5, 10, 15, 20, 25 and 30 wt% EC-HAP were examined. MC3T3-E1 cells were used for the biological evaluation of the response to the cements in vitro. Morphology was observed using scanning electron microscopy (SEM). Mechanical properties of HAP/PMMA and EC-HAP/PMMA cement were investigated by compression test. Surface wettability of the cements was measured by contact angles.

Keywords: bone cement, biocompatibility, nano-hydroxyapatite, polycaprolactone, PMMA, surface grafting

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Authors: Jai Hyung Park, Eugene Kim, Jin Hun Park, Min Joon Oh

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Introduction: Subchondral insufficiency fracture of the femoral head (SIF) is a rare complication; however, it has been recognized to cause femoral head collapse. Subchondral insufficiency fracture (SIF) is caused by normal or physiological stress without any trauma. It has been reported in osteoporotic patients after the fixation of the proximal femur with an Intramedullary nail. Case presentation: We reported 5 cases with SIF of the femoral head after proximal femur fracture fixation with Intra-medullary nail. All patients had osteoporosis as an underlying disease. Good reduction was achieved in all 5 patients. SIF was found from about 3 months to 4 years after the initial operation, and all the fractures were solidly united at the final diagnosis. We investigated retrospectively the feature of those cases and several factors that affected the occurrence of SIF. Discussion: There are a few discussions regarding the SIF of the femoral head. These discussions may include the predisposing risk factors, how to diagnose the SIF in osteoporotic patients, and the peri-operative factors to prevent SIF. Conclusion: Subchondral insufficiency fracture of the femoral head is a considerable complication after the internal fixation of the proximal femur. There are several factors that can be modified. If they could be controlled in the peri-operative period, SIF could be prevented or handled in advance. Other options related to arthroplasty can be considered in old osteoporotic patients.

Keywords: insufficiency fracture of femoral head, intra-medullary nail, osteoporosis, proximal femur fracture

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Authors: Rajesh Bansal, Amit Raj Sharma, Vakil Singh

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The success and predictability of titanium implants for long durations are well established and there has been a tremendous increase in the popularity of implants among patients as well as clinicians over the last four decades. However, sometimes complications arise, which lead to the loss of the implant as well as the prosthesis. Fracture of dental implants is rare; however, at times, implants or abutment screws fracture and lead to many problems for the clinician and the patient. Possible causes of implant fracture include improper design, overload, fatigue and corrosion. Six retrieved fractured dental implants, with varying diameters and designs, were collected from time to time to examine by scanning electron microscope (SEM) to characterize fracture behavior and assess the mechanism of fracture. In this investigation, it was observed that fracture of the five dental implants occurred due to fatigue crack initiation and propagation from the thread roots.

Keywords: titanium, dental, implant, fracture, failure

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Authors: Guoyang Fu, Wei Yang, Chun-Qing Li

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The most common type of cracks that appear on metal pipes is longitudinal cracks. For ductile metal pipes, the existence of plasticity eases the stress intensity at the crack front and consequently increases the fracture resistance. It should be noted that linear elastic fracture mechanics (LEFM) has been widely accepted by engineers. In order to make the LEFM applicable to ductile metal materials, the increase of fracture toughness due to plasticity should be excluded from the total fracture toughness of the ductile metal. This paper aims to develop a model of elastic fracture toughness for ductile metal pipes with external longitudinal cracks. The derived elastic fracture toughness is a function of crack geometry and material properties of the cracked pipe. The significance of the derived model is that the well-established LEFM can be used for ductile metal material in predicting the fracture failure.

Keywords: Ductile metal pipes, elastic fracture toughness, longitudinal crack, plasticity

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Authors: Hasanzade Nazenin, Hasanova Naila

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According to the WHO, osteoporosis is one of the most important health problems in the world and occupies the 4th place in its importance after cardiovascular pathology, oncological diseases and diabetes mellitus. The significance of osteoporosis is determined by its prevalence among the population, the severity of the course, the cause of death, disability, reduced quality of life, high economic costs for prevention and treatment. Osteoporosis is a systemic skeletal disease characterized by a decrease in bone mass and a violation of the structure of bone tissue, leading to an increase in bone fragility and the risk of fractures. Osteoporosis is manifested by low-traumatic fractures. Due to the complexity of the recovery process, the treatment of osteoporotic fractures is one of the important problems of modern traumatology. Diagnostic markers are needed to monitor the recovery period. Human cartilage glycoprotein -39, which has been studied so far in inflammatory processes in the bones, may allow the development of the correct treatment regimen, reflecting the level of metabolic processes in the bone tissue. The study was performed to examine the dynamics of human cartilage glycoprotein-39 (HCgp39) in the blood serum during osteoporosis and fracture healing. The material of the study is formed by the examination results of 68 people aged 38-83. Group I - control group consisted of 14 practically healthy people, group II - 14 patients with osteoporosis, group III - 15 patients with non-osteoporotic fractures, group IV - 25 patients with osteoporotic fractures. In groups, they were analyzed by enzyme-linked immunosorbent assay 3 times during the first month. As a result, in the first month of the recovery period, no significant difference was observed in the HCgp39 dynamics for groups II and IV (p> 0.05). However, there was a significant reduction in group III (p <0.05). As no osteoporotic changes were observed in this patient group, bone healing was rapid and it was possible to monitor the dynamics of HCgp39 changes within 1 month. Patients with osteoporosis and other bone fractures in the process of complete recovery need to study HCgp39 more as a diagnostic indicator.

Keywords: osteoporosis, osteoporotic fractures, human cartilage glycoprotein, HCgp39

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Authors: Rajendra Kumar Kanojia

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Treatment of fracture both bones of leg following trauma is done intially at nearby primary health care center.primary management for shock,pain,control of bleeding,plaster application. These are treated for primay fixation of fracture, debridment of wound. Then, they were refered to tertiary care where they were again and planned for further treatment. This leads to loss of lot of time, money, job, etc.

Keywords: fracture both bones leg, non-union, ilizarov, cost

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Authors: Masoumeh Haghbin Nazarpak, Hamidreza Tolabi, Aryan Ekhlasi

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Bone defects are mentioned as one of the most challenging clinical conditions, affecting millions of people each year. A fracture, osteoporosis, tumor, or infection usually causes these defects. At present, autologous and allogeneic grafts are used to correct bone defects, but these grafts have some difficulties, such as limited access, infection, disease transmission, and immune rejection. Bone tissue engineering is considered a new strategy for repairing bone defects. However, problems with scaffolds’ design with unique structures limit their clinical applications. In addition, numerous in-vitro studies have been performed on the behavior of bone cells in two-dimensional environments. Still, cells grow in physiological situations in the human body in a three-dimensional environment. As a result, the controlled design of porous structures with high structural complexity and providing the necessary flexibility to meet specific needs in bone tissue repair is beneficial. For this purpose, a three-dimensional composite scaffold based on gelatin and sodium alginate hydrogels is used in this research. In addition, the antibacterial drug-loaded halloysite nanotubes were introduced into the hydrogel scaffold structure to provide a suitable substrate for controlled drug release. The presence of halloysite nanotubes improved hydrogel’s properties, while the drug eliminated infection and disease transmission. Finally, it can be acknowledged that the composite scaffold prepared in this study for bone tissue engineering seems promising.

Keywords: halloysite nanotubes, bone tissue engineering, composite scaffold, controlled drug release

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Authors: Hye Kyung Kim, Myung-Gyou Kim, Kang-Hyun Leem

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Postmenopausal osteoporosis is characterized by low bone density which leads to increased bone fragility and greater susceptibility to fracture. Current treatments for osteoporosis are dominated by drugs that inhibit bone resorption although they also suppress bone formation that may contribute to pathogenesis of osteonecrosis. To restore the extensive bone loss, there is a great need for anabolic treatments that induce osteoblasts to build new bone. Pre-osteoblastic cells produce proteins of the extra-cellular matrix, including type I collagen at first, and then to successively produce alkaline phosphatase (ALP) and osteocalcin during differentiation to osteoblasts. Finally, osteoblasts deposit calcium. Present study investigated the effects of egg yolk peptide (EYP) on osteogenic activities and bone matrix gene expressions in human osteoblastic MG-63 cells. The effects of EYP on cell proliferation, alkaline phosphatase (ALP) activity, collagen synthesis, and mineralization were measured. The expression of osteogenic genes including COL1A1 (collagen, type I, alpha 1), ALP, BGLAP (osteocalcin), and SPP1 (secreted phosphoprotein 1, osteopontin) were measured by quantitative realtime PCR. EYP dose-dependently increased MG-63 cell proliferation, ALP activity, collagen synthesis, and calcium deposition. Furthermore, COL1A1, ALP, and SPP1 gene expressions were increased by EYP treatment. Present study suggested that EYP treatment enhanced osteogenic activities and increased bone matrix osteogenicgenes. These results could provide a mechanistic explanation for the bone-strengthening effects of EYP.

Keywords: egg yolk peptide, osteoblastic MG-63 cells, alkaline phosphatase, collagen synthesis, osteogenic genes, COL1A1, osteocalcin, osteopontin

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Authors: Reda Abdel Azim, Tariq Shehab

Abstract:

The main objective of this study is to develop a subsurface fracture map of naturally fractured reservoirs by overcoming the limitations associated with different data sources in characterising fracture properties. Some of these limitations are overcome by employing a nested neuro-stochastic technique to establish inter-relationship between different data, as conventional well logs, borehole images (FMI), core description, seismic attributes, and etc. and then characterise fracture properties in terms of fracture density and fractal dimension for each data source. Fracture density is an important property of a system of fracture network as it is a measure of the cumulative area of all the fractures in a unit volume of a fracture network system and Fractal dimension is also used to characterize self-similar objects such as fractures. At the wellbore locations, fracture density and fractal dimension can only be estimated for limited sections where FMI data are available. Therefore, artificial intelligence technique is applied to approximate the quantities at locations along the wellbore, where the hard data is not available. It should be noted that Artificial intelligence techniques have proven their effectiveness in this domain of applications.

Keywords: naturally fractured reservoirs, artificial intelligence, fracture intensity, fractal dimension

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Authors: Sergei Kosarev

Abstract:

Wrong treatment tactics for hand and wrist sport-related injuries can lead to the inability to play sports in the future. It is especially important for professional athletes. The members of the Russian Olympic Team are treated in our hospital -Federal Clinical Research Center (Moscow). For their treatment, we use minimally invasive methods such as wrist arthroscopy and also orthobiologics procedures. In 2022 we had cases with scaphoid fracture and TFCC injuries. In all the cases, we were using the arthroscopy technic for treatment. The scaphoid fracture was fixed by K-wires with free bone grafting. For TFCC injures we used transossal sutures. Rehabilitation started the next day after surgery. Rehabilitation included hand therapy and physiotherapy. All athletes returned to the sport after 8-12 weeks after surgery. One of them had pain in the wrist after 12 weeks after surgery, not more than 4 point VAS. Pain syndrome was blocked after 2 PRP injections in the ulnar side of the wrist.

Keywords: sport trauma, wrist arthroscopy, wrist pain, scaphoid fracture

Procedia PDF Downloads 99

Authors: Solehuddin Shuib, Koay Boon Aik, Zainul Ahmad Rajion

Abstract:

There are many types of mechanical failure on the dental implant. In this project, the failure that needs to take into consideration is the bone resorption on the dental implant. Human bone has its ability to remodel after the implantation. As the dental implant is installed into the bone, the bone will detect and change the bone structure to achieve new biomechanical environment. This phenomenon is known as bone remodeling. The objective of the project is to improve the performance of dental implant by using different types of design. These designs are used to analyze and predict the failure of the dental implant by using finite element analysis (FEA) namely ANSYS. The bone is assumed to be fully attached to the implant or cement. Hence, results are then compared with other researchers. The results were presented in the form of Von Mises stress, normal stress, shear stress analysis, and displacement. The selected design will be analyzed further based on a theoretical calculation of bone remodeling on the dental implant. The results have shown that the design constructed passed the failure analysis. Therefore, the selected design is proven to have a stable performance at the recovery stage.

Keywords: dental implant, FEA, bone remodeling, design

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Authors: Maryam Tajadod

Abstract:

The treatment of cancer is one of the main challenges of nuclear medicine; while cancer begins in an organ, such as the breast or prostate, it spreads to the bone, resulting in metastatic bone. In the treatment of cancer with radiotherapy, the determination of the involved tissues’ dose is one of the important steps in the treatment protocol. Comparing absorbed doses for Lu-177 and Ra-223 and Ac-225 in the bone marrow and soft tissue of bone phantom with evaluating energetic emitted particles of these radionuclides is the important aim of this research. By the use of MCNPX computer code, a model for bone phantom was designed and the values of absorbed dose for Ra-223 and Ac-225, which are Alpha emitters & Lu-177, which is a beta emitter, were calculated. As a result of research, in comparing gamma radiation for three radionuclides, Lu-177 released the highest dose in the bone marrow and Ra-223 achieved the lowest level. On the other hand, the result showed that although the figures of absorbed dose for Ra and Ac in the bone marrow are near to each other, Ra spread more energy in cortical bone. Moreover, The alpha component of the Ra-223 and Ac-225 have very little effect on bone marrow and soft tissue than a beta component of the lu-177 and it leaves the highest absorbed dose in the bone where the source is located.

Keywords: bone metastases, lutetium-177, radium-223, actinium-225, absorbed dose

Procedia PDF Downloads 112

Authors: Abraham Finkelman

Abstract:

Computerized Surgical Guides have been proven to be a predictable way to perform dental implants, with a relatively high accuracy in comparison to a treatment plan. When using the CSG Bone supported, it allows us to make the necessary changes of the hard tissue prior to the implant placement and after the implant placement. The CSG gives us an accurate position for the drilling, and during the implant placement it allows us to alter the vertical position of the implant altering the final position of the abutment and avoiding any risk of any damage to the adjacent anatomical structures. Any Changes required to the bone level can be done prior to the fixation of the CSG using a reduction guide, which incur extra surgical fees and the need of a second surgical guide. Any changes of the bone level after the implant placement are at the risk of damaging the implant neck surface. The technique consists of a universal system that allows us to remove the excess bone around the implant sockets prior to the implant placement which then enables us to place the implant in the vertical position with accuracy as planned with the CSG. The systems consist of a hollow pin of different sizes and diameters. Depending on the implant system that we are using. Length sizes are from 6mm-16mm and a diameter of 2.6mm-4.8mm. Upon the completion of the drilling, the pin is then inserted into the implant socket-using the insertion tool. Once the insertion tool has unscrewed the pin, we can continue with the bone reduction. The bone reduction can be done using conventional methods upon the removal of all the excess bone around the pin. The insertion tool is then screwed into the pin and the pin is then removed. We now, have the new bone level at the crest of the implant socket which is our mark for the vertical position of the implant. In some cases, when we are locating the implant very close to anatomical structures, any form of deviation to the vertical position of the implant during the surgery, can cause damage to such anatomical structures, creating irreversible damages such as paresthesia or dysesthesia of the mandibular nerve. If we are planning for immediate loading and we have done our temporary restauration in base of our computerized plan, deviation in the vertical position of the implant will affect the position of the abutment, affecting the accuracy of the temporary prosthesis, extending the working time till we adapt the prosthesis to the new position.

Keywords: bone reduction, computer aided navigation, dental implant placement, surgical guides

Procedia PDF Downloads 331

Authors: Abdulsalam A. Al-Tamimi, Chris Peach, Paulo Rui Fernandes, Paulo J. Bartolo

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Bone fixation implants currently used to treat traumatic fractured bones and to promote fracture healing are built with biocompatible metallic materials such as stainless steel, cobalt chromium and titanium and its alloys (e.g., CoCrMo and Ti6Al4V). The noticeable stiffness mismatch between current metallic implants and host bone associates with negative outcomes such as stress shielding which causes bone loss and implant loosening leading to deficient fracture treatment. This paper, part of a major research program to design the next generation of bone fixation implants, describes the combined use of three-dimensional (3D) topology optimization (TO) and additive manufacturing powder bed technology (Electron Beam Melting) to redesign and fabricate the plates based on the current standard one (i.e., locking compression plate). Topology optimization is applied with an objective function to maximize the stiffness and constraint by volume reductions (i.e., 25-75%) in order to obtain optimized implant designs with reduced stress shielding phenomenon, under different boundary conditions (i.e., tension, bending, torsion and combined loads). The stiffness of the original and optimised plates are assessed through a finite-element study. The TO results showed actual reduction in the stiffness for most of the plates due to the critical values of volume reduction. Additionally, the optimized plates fabricated using powder bed techniques proved that the integration between the TO and additive manufacturing presents the capability of producing stiff reduced plates with acceptable tolerances.

Keywords: additive manufacturing, locking compression plate, finite element, topology optimization

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Authors: Ennouri Triki, Toan Vu-Khanh

Abstract:

Resistance to combined puncture/cutting by pointed blades is an important property of gloves materials. The purpose of this study is to propose an approach derived from the fracture mechanics theory to calculate the fracture energy associated to the puncture/cutting of nitrile rubber. The proposed approach is also based on the application of a sample pre-strained during the puncture/cutting test in order to remove the contribution of friction. It was validated with two different pointed blade angles of 22.5° and 35°. Results show that the applied total fracture energy corresponding to puncture/cutting is controlled by three energies, one is the fracture energy or the intrinsic strength of the material, the other reflects the friction energy between a pointed blade and the material. For an applied pre-strain energy (or tearing energy) of high value, the friction energy is completely removed. Without friction, the total fracture energy is constant. In that case, the fracture contribution of the tearing energy is marginal. Growth of the crack is thus completely caused by the puncture/cutting by a pointed blade. Finally, results suggest that the value of the fracture energy corresponding to puncture/cutting by pointed blades is obtained at a frictional contribution of zero.

Keywords: elastomer, energy, fracture, friction, pointed blades

Procedia PDF Downloads 305

Authors: D. Remache, M. Semaan, C. Baron, M. Pithioux, P. Chabrand, J. M. Rossi, J. L. Milan

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A good understanding of the mechanical properties of the bone implies a better understanding of its various diseases, such as osteoporosis. Berkovich nanoindentation tests were performed on the human cortical bone to extract its orthotropic parameters. The nanoindentation experiments were then simulated by the finite element method. Different configurations of interactions between the tip indenter and the bone were simulated. The orthotropic parameters of the material were identified by the inverse method for each configuration. The friction effect on the bone mechanical properties was then discussed. It was found that the inverse method using the finite element method is a very efficient method to predict the mechanical behavior of the bone.

Keywords: mechanical behavior of bone, nanoindentation, finite element analysis, inverse optimization approaches

Procedia PDF Downloads 389

Authors: M. Wigwe, M. Y Soloman, E. Pirayesh, R. Eghorieta, N. Stegent

Abstract:

The moving reference point (MRP) technique has been used in the analyses of the first three stages of two fracturing jobs. The results obtained verify the proposition that a hydraulic fracture in shale grows in spurts rather than in a continuous pattern as originally interpreted by Nolte-Smith technique. Rather than a continuous Mode I fracture that is followed by Mode II, III or IV fractures, these fracture modes could alternate throughout the pumping period. It is also shown that the Nolte-Smith time parameter plot can be very helpful in identifying the presence of natural fractures that have been intersected by the hydraulic fracture. In addition, with the aid of a fracture length-time plot generated from any fracture simulation that matches the data, the distance from the wellbore to the natural fractures, which also translates to the actual fracture length for the stage, can be determined. An algorithm for this technique is developed. This procedure was used for the first 9 minutes of the simulated frac job data. It was observed that after 7mins, the actual fracture length is about 150ft, instead of 250ft predicted by the simulator output. This difference gets larger as the analysis proceeds.

Keywords: shale, fracturing, reservoir, simulation, frac-length, moving-reference-point

Procedia PDF Downloads 754