OBJECTIVES:This study aims to define the greater sciatic notch (GSN)-based transcolumnar "magic screw" corridor in the acetabulum and to assess its morphometric characteristics and anatomical feasibility according to quadrilateral plate (QP) morphology. MATERIALS AND METHODS:Between November 2025 and January 2026, three-dimensional morphometric analysis was performed on pelvic CT reconstructions of 90 adults (180 acetabulae) with intact pelvic bones and no evidence of hip or pelvic pathology. Using Mimics, pelvic models were reconstructed and a virtual 6.5-mm cannulated screw was advanced from the midpoint of the GSN toward the anterior column along a transcolumnar intraosseous trajectory. Bilateral trajectory length, angulation, and QP thickness were recorded. Differences by sex and side, age associations, and anatomical feasibility ("easy" versus "hard") were analyzed based on anatomical corridor constraints. RESULTS:Of the patients included in the study, 42 were male and 48 were female with a mean age of 49.88 ± 17.18 (range, 19 to 86) years. The defined GSN-based transcolumnar screw corridor was anatomically feasible in 94.44% of cases. Mean posterior acetabular screw length was 74.16 ± 7.49 mm right and 73.21 ± 6.90 mm left. Mean GSN entry segment length was 22.95 ± 4.14 mm right and 23.48 ± 4.34 mm left. Mean acetabular screw angles were 125.86° ± 6.05° right and 124.26° ± 5.24° left, with a small but significant right-left difference (p = 0.004). The QP morphology demonstrated substantial variability: mean maximum thickness was 14.87 ± 2.75 mm right and 14.77 ± 2.82 mm left, while minimum thickness was 3.46 ± 1.37 mm right and 3.48 ± 1.32 mm left. Men had significantly greater superior and posterior acetabular screw lengths and markedly thicker QP parameters compared with women (all p ≤ 0.027), with large effect sizes for QP thickness (d > 1.0). CONCLUSION:A GSN-based transcolumnar magic screw corridor appears anatomically feasible in most adult pelves and provides a quantifiable intraosseous trajectory reaching both acetabular columns. Quadrilateral plate thickness emerges as the main anatomical limiting factor, particularly in female pelves and in cases categorized as corridor-constrained.
OBJECTIVES:This study aims to evaluate the effects of BPC-157, synthetic thymosin beta-4 (TB-500), and their combination on Achilles tendon healing using biomechanical, histopathological, histochemical, and immunohistochemical analyses in a rat model. MATERIALS AND METHODS:Thirty-two male Sprague-Dawley rats, each aged 12 weeks and weighing approximately 330 g, underwent standardized Achilles tendon transection and repair and were randomly assigned to four groups, with eight rats in each group: control, BPC-157 (10 µg/kg/day), TB-500 (60 µg/kg/day), and combined BPC-157 + TB-500 (BPC + TB). Treatments were administered intraperitoneally for four weeks postoperatively. At four weeks, tendons were harvested for biomechanical testing or histological evaluation. Maximum load to failure was assessed biomechanically. Histological and histochemical analyses included hematoxylin-eosin, Masson trichrome, Alcian blue, and Sirius red staining and were evaluated using Bonar and Movin scoring systems. Expression of collagen types I and III was assessed immunohistochemically and semiquantified using H-score analysis. RESULTS:Biomechanical testing revealed higher maximum load to failure values in the BPC-157 and TB-500 groups compared to controls, reaching statistical significance in the TB-500 group (p < 0.05). Histopathological evaluation demonstrated significantly lower total Bonar scores in the TB-500 group (p = 0.016) and significantly lower total Movin scores in the TB-500 and BPC + TB groups (p = 0.017 and p = 0.040, respectively) relative to controls, indicating improved tendon architecture, collagen alignment, and reduced degenerative changes. The BPC-157 group showed numerically lower scores without reaching statistical significance for total scores. Sirius red birefringence analysis showed increased type I collagen organization and altered type III collagen distribution in treatment groups, particularly in the TB-500 group, suggesting progression toward matrix maturation. Immunohistochemical analysis revealed no significant differences in collagen type I expression among groups, whereas collagen type III expression differed significantly, consistent with histochemical findings. Combined BPC-157 and TB-500 treatment did not confer additional benefits compared to either agent alone. CONCLUSION:In this exploratory rat model study, both BPC-157 and TB-500 were associated with improved histopathological parameters and extracellular matrix organization during early Achilles tendon repair, with TB-500 additionally demonstrating a significant biomechanical advantage at four weeks. The absence of additive effects with combination therapy may reflect convergence on shared downstream pathways; however, this hypothesis requires further experimental confirmation. These preliminary findings indicate that both peptides warrant further investigation as candidate adjuncts to tendon repair, pending dose-optimization and longer-term studies.
OBJECTIVES:This study aims to evaluate the feasibility, safety, and peri-implant bone formation of augmenting a proximal femoral nail (PFN) helical blade with a calcium sulfate/hydroxyapatite (CaS/HA) biomaterial combined with systemic zoledronic acid (ZA). PATIENTS AND METHODS:This single-center, two-arm, parallel-group, randomized-controlled pilot study included a total of 20 patients with osteoporotic trochanteric fractures (TFs) between December 2023 and January 2025. The patients were randomized into a control group receiving standard PFN or an intervention group receiving PFN augmented with CaS/HA biomaterial. All patients received cefazoline and doxycycline for infection prophylaxis. On postoperative Day 7, both groups received a single intravenous infusion of ZA. The primary outcome was the change in bone mineral density (BMD) defined by previously published peri-implant regions-of-interest at one week and six months postoperatively. Secondary outcomes included tip-apex distance (TAD) for assessing blade migration and the Harris Hip Score (HHS) for functional evaluation. RESULTS:Of a total of 20 patients included in the study, 6 were male and 14 were female with a median age of 81 (range, 65 to 90) years. Regarding intervention delivery, all 10 randomly assigned patients received their intended treatment. While 19 of the 20 randomly assigned patients received the intended treatment; one patient died within the first week and did not receive ZA. The required data for clinical analysis (change in peri-implant BMD, TAD, fracture union, and HHS) could only be extracted for five patients in the control group and five patients in the intervention group. There were no intraoperative complications, and no adverse effects related to the CaS/HA biomaterial were reported. Ten patients were included for the outcome analysis. The intervention group demonstrated a more pronounced increase in peri-implant BMD compared to controls. Additionally, TAD changed more in the control group. Functional evaluation revealed that the intervention group demonstrated a slightly greater HHS improvement. CONCLUSION:Our study results suggest that augmentation using the CaS/HA and ZA is a feasible and safe procedure for patients with osteoporotic TF. Preliminary findings indicate a potential trend toward enhanced peri-implant bone formation in the intervention group.
OBJECTIVES:This study aims to compare the rates of medical complication and mortality following initial bipolar hemiarthroplasty (bHA) and reoperation procedures, as well as between different causes of reoperation (nonseptic vs. septic). PATIENTS AND METHODS:The retrospective study included 118 patients undergoing reoperation after bHA for femoral neck fractures between January 2002 and December 2022. The primary outcomes included in-hospital complications, readmission, and mortality events, while secondary outcomes included length of hospital stay, transfusion rates, and estimated blood loss. These outcomes were compared between each patient's initial bHA and their subsequent reoperation procedure. The two cohorts were matched using propensity scores based on age, sex, and Charlson Comorbidity Index to compare outcomes between nonseptic and septic causes of reoperation. RESULTS:Of the 118 patients, 64 were male and 54 were female. The mean age was 77.8 ± 7.9 years, with a range of 61 to 98 years. The in-hospital complication rate was higher after reoperation than after initial bHA (15.3% vs. 1.7%, p < 0.001). Conversely, the readmission rate was higher after the initial procedure (60.2% vs. 23.7%, p < 0.001), mainly due to surgical complications. Patients undergoing reoperation had longer hospital stays, higher transfusion requirements, and more frequently received general anesthesia compared to the initial procedure (p < 0.05). In the matched cohort, septic group had higher in-hospital complication rates than the nonseptic group (23.5% vs. 3.9%, p = 0.004), while readmission and mortality rates were comparable. CONCLUSION:Reoperations after bHA carry a higher risk of medical complications. This risk is particularly pronounced in cases related to septic conditions, underscoring the greater impact of reoperation and careful clinical attention.
OBJECTIVES:This study aims to investigate whether second metacarpal cortical percentage (2MCP) and psoas muscle index (PMI) were associated with loss of reduction after closed reduction and cast immobilization. PATIENTS AND METHODS:A total of 91 adult female patients with distal radius fractures (DRFs) treated with closed reduction and cast immobilization between January 2014 and June 2025 were retrospectively analyzed. Patients with standardized serial radiographs and lumbar computed tomography (CT) performed within ± 3 months of injury were included. Clinical characteristics, AO/OTA fracture type, Lafontaine instability criteria, lumbar CT densitometry T-scores, 2MCP, and PMI were evaluated. Loss of reduction was defined radiographically during follow-up. Multivariate logistic regression was performed using predefined cut-off values, and receiver operating characteristic (ROC) curve analysis was used to explore cut-off values for 2MCP and PMI. RESULTS:The mean age was 63.0 ± 8.2 (range, 44 to 84) years. Loss of reduction occurred in 23 patients (25.3%). In group comparisons, AO/OTA Type C fracture pattern, Lafontaine instability, CT densitometry-defined osteoporosis, 2MCP-defined osteoporosis, and low PMI were more frequent among patients with loss of reduction. In the multivariate analysis, 2MCP-defined osteoporosis was independently associated with loss of reduction (adjusted OR = 7.22; 95% CI: 1.16-45.06; p = 0.034). Low PMI was also independently associated with loss of reduction (adjusted OR = 25.52; 95% CI: 5.33-122.14; p < 0.001). The ROC curve analysis identified cut-off values of 48% for 2MCP and 3.65 for PMI. CONCLUSION:Our study results showed that 2MCP-defined osteoporosis and low PMI were independently associated with loss of reduction after non-operative treatment of DRFs in female patients. These imaging-based parameters may support exploratory risk stratification.
