Calcium montmorillonite (CMM) clay, a naturally occurring mineral-rich volcanic clay has garnered scientific attention for its detoxification properties, gastrointestinal (GI) support, skin benefits, and potential metabolic modulation. Recent advances in pharmaceutical-grade formulation and mechanistic understanding have renewed clinical interest in CMM as a low-risk, non-systemic adjunct in modern medical practice. General practitioners and surgeons may find it particularly useful as a safe adjunct in gut health, topical recovery, and inflammatory modulation. With supporting data from preclinical and clinical research, including studies on aflatoxin binding, microbiome modulation, and treatment of radiation enteritis and pediatric diarrhea, CMM represents a promising natural therapeutic mineral for integration into modern health protocols. This narrative review summarizes the biological properties, clinical safety, indications, and emerging efficacy data surrounding CMM, with a focus on potential perioperative and wellness applications.
BACKGROUND:Tarsometatarsal (TMT) joint arthrodesis is essential for managing surgical management of severe bunion deformities, complex midfoot trauma, and osteoarthritis. Various fixation methods and bone grafting types have been described, but the impact of the number of joints fused on union rates remains unclear. This study aimed to evaluate whether fusing multiple joints affects arthrodesis rates and to compare union outcomes among different fixation constructs and grafting techniques. METHODS:We conducted a single-center retrospective cohort study of 582 TMT fusions, comparing single- vs multiple-joint fusions involving medial and central columns. The average follow-up was 15.5 months. Two fellowship-trained foot and ankle surgeons assessed radiographs and computed tomographic (CT) scans. Radiographic union was evaluated at 8 and 12 weeks as well as the specific fixation constructs and bone graft used across each joint. RESULTS:Single-TMT-joint surgeries had a significantly greater proportion of fusions occurring by 12 weeks than the multiple-TMT-joint surgeries, 74.9% vs 67.0%, respectively, P = .0002. Ultimate union rates were similar for single-joint fusions (80.3%) and multiple-joint fusions (82.6%. Many nonunions were asymptomatic; the combined asymptomatic nonunion and union rate was 95.4%. The revision rate for all nonunions was 25.5%. Staple fixation was associated with higher nonunion rates in the second (46.15%) and third (37.5%) TMT joints, whereas screw fixation showed the highest nonunion at the first TMT joint (54.6%). The lowest nonunion rates were observed with combined interfragmentary screw fixation and plating across all joints. Diabetic patients and current smokers experienced higher complication and nonunion rates. CONCLUSION:Although the radiographic nonunion rate (18.2%) exceeded prior reports, symptomatic nonunion was rare (4.6%). Multiple-TMT-joint surgeries required more time to confirm radiographic union than single joint surgeries. Among the modifiable factors, implant and graft choice were associated with differences in union rates.
BACKGROUND:Abaloparatide treatment for 12 months led to significant and rapid increases in bone mineral density (BMD) in the lumbar spine, total hip, and femoral neck compared with placebo in the phase 3 ATOM study (NCT03512262) in men with osteoporosis. METHODOLOGY:Acetabular BMD and femur strength were analyzed in separate analyses using dual energy X-ray absorptiometry (DXA) scans from men in the abaloparatide and placebo groups. First, acetabular BMD was calculated in the DeLee and Charnley zones. Second, DXA scans were processed through 3D-Shaper software to generate three-dimensional (3D) patient-specific femur models and calculate femur strength based on a finite element analysis simulating sideways falls. RESULTS AND CONCLUSIONS:At 6 and 12 months, mean acetabular BMD significantly increased from baseline in all DeLee and Charnley zones with abaloparatide, while little change was noted with placebo. In the second analysis, mean percent change from baseline in femur strength was significantly increased in the abaloparatide treatment group at 6 and 12 months, largely attributable to significant strength increases in the trabecular bone of the femur. Femur and femoral trabecular strength remained near baseline levels in the placebo group. Femoral cortical strength numerically increased in the abaloparatide group at 12 months, though the change was not significant.d The anatomical distribution of changes in major principal stress at failure at 6 and 12 months indicated that the stress at which failure occurs increased at the upper aspect of the femur neck in the abaloparatide group.e In conclusion, abaloparatide improved measured properties in men with osteoporosis on acetabular and femoral sides of the hip joint, increasing acetabular BMD and improving femur strength parameters. Additional research into abaloparatide's role in managing bone loss at the hip is justified.
OBJECTIVES:To identify practices for treating interprosthetic femur fracture (IFFs) and determine factors that positively impact patient outcomes. METHODS:Design: Retrospective cohort study. SETTING:Fifteen trauma centers in the United States. PATIENT SELECTION CRITERIA:Patients aged 50 to 90 years who underwent operative fixation of an AO/OTA 32 A-B-C type IFF fracture from 2011 to 2021 were included. Patients who underwent revision arthroplasty at the time of fixation or were non-ambulatory were excluded. OUTCOME MEASURES AND COMPARISONS:The primary outcome was union rate. Secondary outcomes included post-operative complications, revision surgery, mortality, and change in ambulation status. Univariate analyses using Chi-square tests, Fisher's exact tests, and analysis of variance were performed to detect associations between demographic, injury, and surgical characteristics with post-operative outcomes. RESULTS:One hundred thirty-nine patients were included, with 110 (79%) females and median age 78 [range, 57-90]. Distal one-third fractures were most common 68% (N=95). One hundred eighteen (85%) patients were treated with a lateral plate, 8% (N=11) were treated with nail-plate combination and 7% (N=10) were treated with dual plates. The median time to full-weight bearing (FWB) was 2.5 months. Dual plate combination was associated with the fastest time to FWB (p = 0.048) at two weeks. 61% (n=85) of patients returned to baseline ambulation status (100% [11] IMN/plate, 60% [71] lateral plate and 25% [3] dual plate) with patients treated with nail-plate had higher rates of return to baseline function (p = 0.009). The overall mortality rate was 13% and associated with greater than 1 comorbidity (p = 0.022). CONCLUSIONS:A spanning lateral plate was the most common fixation of IFF in our study. Patients with dual fixation were more likely to return to baseline ambulatory status, particularly those with intramedullary nail/plate combination. The mortality rate at one year was 11% and comorbidity burden was associated with higher risk of mortality. LEVEL OF EVIDENCE:Therapeutic Level III.
BACKGROUND:A previous randomized controlled trial (RCT) evaluating operative versus nonoperative treatment of acute flail chest injuries revealed more ventilator-free days in operatively treated patients who had been ventilated at the time of randomization. It has been suggested that surgery for these injuries may also improve a patient's pain and function. Our goal was to perform a secondary analysis of the previous RCT to evaluate pain and postinjury opioid requirements in patients with operatively and nonoperatively treated unstable chest wall injuries. METHODS:We analyzed data from a previous multicenter RCT that had been conducted from 2011 to 2019. Patients who had sustained acute, unstable chest wall injuries were randomized to operative or nonoperative treatment. In-hospital pain medication logs were evaluated, and daily morphine milligram equivalents (MMEs) were calculated. The patients' symptoms were also assessed, including generalized pain, chest wall pain, chest wall tightness, and shortness of breath. Additionally, patients completed the 36-Item Short Form Health Survey (SF-36), and they were followed for 1 year postinjury. RESULTS:In the original trial, 207 patients were analyzed: 99 patients received nonoperative treatment, and 108 received operative treatment. There were no significant differences in pain medication usage between the 2 groups at any of the examined time points (p = 0.477). There were no significant differences in generalized pain, chest wall pain, chest wall tightness, or shortness of breath at any time postinjury in the 2 groups. There were also no significant differences in the SF-36 scores. CONCLUSIONS:This secondary analysis of a previous RCT suggested that operative treatment of patients with flail chest injuries does not reduce in-hospital daily opioid requirements. There were also no reductions in generalized pain, chest wall pain, chest wall tightness, or shortness of breath with operative treatment. The SF-36 scores were similar for both groups. Further work is needed to identify those patients most likely to benefit from operative treatment of flail chest injuries. LEVEL OF EVIDENCE:Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
