Abstract Background Hip fractures in older adults have become a global public health challenge. Such fractures not only carry a high mortality rate but also severely impair patients' mobility. Although it is known that fear of falling affects mobility recovery, existing evidence has largely focused on short-term outcomes within the first year post-surgery. The persistent impact of preoperative fear of falling on long-term mobility at three years post-surgery remains unclear. This study aims to evaluate the impact of preoperative fear of falling on mobility and health-related quality of life at three years postoperatively in elderly patients with hip fractures. Methods A post-hoc analysis of a prospective study was done. Patients aged 65 years and above with hip fractures who underwent surgical treatment at Beijing Jishuitan Hospital between November 2018 and November 2019 were enrolled. Preoperative fear of falling was assessed using the Modified Fall Effectiveness Scale (MFES). Patients were categorized into low (MFES ≥ 8) and high (MFES < 8) fear groups. The primary outcome of this study was mobility at 3-year post-surgery. Secondary outcomes comprised mobility at 30-day, 120-day, and 1-year post-surgery, alongside quality of life at 30-day, 120-day, 1-year, and 3-year post-surgery. Results A total of 683 patients were ultimately included in the analysis. There were statistically significant differences between the two groups in age, gender, educational level, hypertension, stroke, pre-fracture mobility, anesthesia method, and length of hospital stay (all P < 0.05). There were no significant differences in mobility or EQ-5D index between groups within first year post-surgery (all adjusted P > 0.05). However, statistically significant differences in mobility and EQ-5D index were observed between the two groups at the 3-year follow-up. Patients with low preoperative fear of falling demonstrated higher mobility and EQ-5D index at 3 years (all adjusted P < 0.001). Conclusion The preoperative fear of falling was significantly associated with mobility and quality of life three years postoperatively in elderly hip fracture patients.

The prevalence and incidence of osteoarthritis (OA) increase significantly in women after menopause, indicating an important role of estrogen in the pathogenesis of OA. This type of OA is termed postmenopausal OA. This study aimed to investigate the feasibility of using bilateral ovariectomy (OVX) in adult SD rats to simulate the human postmenopausal OA model and evaluate the effect of early raloxifene (RAL) intervention on this model. Twenty-four SD rats were randomly divided into 4 groups: Baseline group, Sham + V group, OVX + V group, and OVX + RAL group. Rats in the Baseline group were euthanized for sample collection at the start of the experiment. Rats in the OVX + V and OVX + RAL groups underwent bilateral OVX, while those in the Sham + V group received a sham operation without actual ovarian resection. After surgery, the OVX + RAL group was given RAL (6.2 mg/kg·day) by gavage, and the OVX + V and Sham + V groups received an equal volume of normal saline. Samples were collected 3 months after drug administration. Micro-CT was used to determine the bone histomorphometry of the right proximal tibia. Following Micro-CT analysis, the right knee joints of all animals were decalcified for 8-12 weeks, embedded in paraffin, and sectioned. The sections were subjected to toluidine blue staining and immunohistochemical staining for collagen-II, Caspase-3, and matrix metalloproteinase-13 (MMP-13). The toluidine blue-stained sections were scored using the OARSI histological scoring system, and the positive protein expression in immunohistochemical staining was evaluated using the IOD. The OARSI score revealed that the degree of cartilage degeneration in the OVX + V group was more severe than that in the Sham + V group and the OVX + RAL group. The expression of collagen-II in the OVX + V group was significantly lower than that in the Sham + V group and the OVX + RAL group, while the expressions of MMP-13 and Caspase-3 increased. Micro-CT revealed that the microstructure of subchondral bone in the OVX + V group deteriorated compared with the Sham + V group, while that in the OVX + RAL group improved compared with the OVX + V group. Compared with the Baseline group, the microstructure of subchondral bone and cartilage in the Sham + V group was somewhat degraded. We reached a conclusion that OVX-induced degeneration of subchondral bone and articular cartilage is relatively mild, suggesting that 6-month-old OVX rats are a mild model of postmenopausal OA. RAL can delay OVX-induced postmenopausal subchondral bone and cartilage degeneration. Notably, this study further clarifies the protective effect of RAL on the medial joint capsule and refines the regulatory mechanism of RAL on subchondral bone microstructure in mild postmenopausal OA, which supplements the existing research on RAL in OA intervention.

Background: Fracture healing is strongly influenced by mechanical loading conditions, whereas hindlimb unloading induces bone loss and may further compromise skeletal repair. However, the metabolic remodeling of bone tissue under fracture, unloading, and their combination remains insufficiently characterized. This study aimed to investigate metabolic alterations in mouse bone tissue under fracture (Fx), tail-suspension hindlimb unloading group (HU), and fracture combined with tail-suspension hindlimb unloading group (Fx + HU) using untargeted metabolomics. Methods: Male mice were randomly assigned to four groups: sham control (Sham), Fx, HU, and Fx + HU. Mechanical unloading was induced using a tail-suspension hindlimb unloading model, and fracture was established using a standardized murine fracture procedure. After 3 weeks of intervention, proximal tibial bone tissues were collected for micro-computed tomography (micro-CT) and untargeted metabolomics analysis. Multivariate statistical analyses, including principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA), and orthogonal PLS-DA (OPLS-DA), were performed to identify metabolic differences among groups. Differential metabolites and enriched pathways were further analyzed. Results: Micro-CT analysis showed significant deterioration of trabecular bone mass and microarchitecture in the Fx, HU, and Fx + HU groups compared with the Sham group (all p < 0.001), with the Fx + HU group showing the most pronounced impairment. Untargeted metabolomics demonstrated robust analytical reproducibility in both positive and negative ion modes. PCA and supervised multivariate analyses showed clear separation among the four groups, and the Fx + HU group exhibited the greatest metabolic divergence from the others. Differential metabolite screening and pathway enrichment analysis revealed marked alterations in metabolic pathways associated with amino acid metabolism, lipid metabolism, energy metabolism, and oxidative stress-related processes. Conclusions: Fracture and hindlimb unloading each induced substantial metabolic remodeling in mouse bone tissue, while their combination produced more profound and distinct metabolic perturbations. These findings suggest that mechanical unloading may aggravate bone metabolic dysregulation after fracture and provide exploratory metabolomic evidence for understanding skeletal deterioration under combined injury and unloading conditions.

PURPOSE:To compare the mobility and health-related quality of life (HRQoL) for femoral neck fractures (FNFs) in the elderly treated with either hemiarthroplasty (HA) or total hip arthroplasty (THA). METHODS:This study constitutes a post hoc analysis of a prospective cohort study. In this secondary analysis, we enrolled patients aged ≥ 65 years who underwent arthroplasty for FNFs at a tertiary hospital in Beijing, China, between 2018 and 2019. Patients were stratified into the HA group and THA group based on the surgical type. All patients were followed up via telephone at 30, 120, and 365 days postoperatively. The Fracture Mobility Score (FMS) was utilized to assess patients' mobility, while the EuroQol 5-Dimension (EQ-5D) instrument was adopted to evaluate their HRQoL. Intergroup comparisons, multivariate logistic regression models, and linear regression models were used to compare outcomes between the two groups and analyze the impact of surgical type on these outcomes. RESULTS:Among 416 eligible patients, 333 completed all three follow-up evaluations, including 250 patients in the HA group and 83 in the THA group. Multivariate logistic regression models adjusted for potential confounders indicated that patients in the THA group were significantly more likely to achieve unrestricted mobility at 120 and 365 days postoperatively compared with the HA group (OR [95% CI] = 2.407 [1.210-4.788], p.adj = 0.012; OR [95% CI] = 2.410 [1.120-5.183], p.adj = 0.024), with no significant difference observed at the 30-day follow-up. In addition, multivariate linear regression models adjusted for 12 covariates demonstrated that the THA group achieved significantly higher EQ-5D scores at 30 and 120 days postoperatively (p.adj = 0.003 and p.adj = 0.003, respectively). However, this advantage was not sustained at the 365-day follow-up (p.adj = 0.100). CONCLUSION:THA may yield a higher probability of independent mobility recovery and better postoperative HRQoL than HA in elderly patients with FNFs.

Background Most hip-fracture studies lack repeated pre-event assessments and contemporaneous controls, complicating separation of fracture-associated change from functional ageing. To assess functional loss associated with first-reported hip fracture relative to contemporaneous ageing and heterogeneity in longer-term patterns. Methods We analysed five waves (2011–2020) of the China Health and Retirement Longitudinal Study. T 0 was the survey wave in which hip fracture was first reported. The primary analysis included 220 fracture participants and 12,611 contemporaneous control records from 5,215 people; 206 fracture participants entered trajectory analysis. Overlap weighting and inverse-probability-of-observation weighting addressed measured baseline differences and potentially informative missingness. Generalised estimating equations compared ADL/IADL disability trajectories, and piecewise latent class mixed models identified longer-term patterns. Results Pre-T 0 trends in total ADL/IADL disability did not differ between groups (difference in slope: β = 0.00, 95% CI − 0.38 to 0.39; P = 0.988). At T 0 , the fracture group had an additional 1.07-point increase in total disability relative to controls (95%CI: 0.40 to 1.74; P = 0.002). The mean between-group difference subsequently narrowed by 0.36 points per survey wave (95%CI: −0.68 to − 0.04). Among fracture participants, 57.3% followed a low-disability maintenance pattern, whereas 35.4% remained persistently highly disabled. Conclusions First-reported hip fracture was associated with additional ADL/IADL disability beyond contemporaneous ageing. Population-average recovery concealed substantial heterogeneity, with over one-third of fracture participants remaining highly disabled. These findings support repeated functional assessment after hip fracture and require validation in clinical cohorts with verified fracture dates.

Purpose:To assess the effect of orthogeriatric co-management care on the geriatric hip fracture patients with high ASA score. Patients and Methods:A post-hoc analysis of a prospective multicenter study was done. Patients with an ASA score of 3 or 4 were selected from the database for analysis. Patients were divided into the orthogeriatric co-management group (CM group) and traditional consultation mode group (TC group) depending on the management mode. With mortality as the primary outcome, multivariate regression analyses were performed to adjust for confounders. Mobility and quality of life were compared between groups. Results:A total of 628 patients were included, 593 of whom completed follow-up (388 in CM group, 205 in TC group). The in-hospital mortality, 30-day mortality, 120-day mortality in CM group were significantly lower than those in TC group after adjustment (P < 0.05). The difference of 1-year mortality in the two groups was not statistically significant after adjustment (P > 0.05). The surgical intervention rate, the early surgery rate, preoperative waiting time, hospital length of stay (LOS), 30-day mobility, 30-day EuroQol-5 Dimensions (EQ-5D) index, 30-day EuroQol-Visual Analog Scale (EQ-VAS), 120-day EQ-5D index, the total incidence of clinical adverse events, as well as deep vein thrombosis (DVT) and cardiac complication between the two groups were statistically significantly different after adjustment (P < 0.05). The difference of 120-day mobility was not statistically significant after adjustment (P < 0.05). There was no significant difference in the in-hospital total cost, the incidence of other clinical adverse events, 120-day EQ-VAS, 1-year reoperation rate, 1-year mobility, 1-year EQ-5D index, 1-year EQ-VAS between the two groups (P > 0.05). Conclusion:Compared with the traditional consultation mode, orthogeriatric co-management care significantly reduced early mortality and enhanced early mobility and quality of life in geriatric hip fracture patients with high ASA score.

Objective: To investigate the role and mechanism of chondrocyte-specific knockout of signal transducer and activator of transcription 3 (STAT3) in medial meniscus instability (DMM)-induced osteoarthritis (OA) in mice. Methods: A tamoxifen-induced conditional knockout (cKO) mouse model (COL-II-Cre + /STAT3 flox/flox ) was established, and OA was induced by DMM surgery. Littermate (STAT3 flox/flox ) mice served as controls. Samples were collected at 4 and 8 weeks post-surgery. Cartilage pathology was evaluated using safranin-O-green staining and Mankin scoring. Subchondral bone changes were assessed by micro-computed tomography (CT). Enzyme-linked immunosorbent assay (ELISA) was performed to determine the serum interleukin (IL)-1b, IL-6, and tumor necrosis factor-alpha (TNF-α). Immunohistochemistry was performed to detect Aggrecan, COL-II, STAT3, p-STAT3, IL-6, TNF-α, matrix metalloproteinase-13 (MMP13), and A Disintegrin And Metalloproteinase with Thrombospondin motifs-4 (ADAMTS-4) expressions in the cartilage. Gene expression was analyzed using quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). For in vitro studies, primary chondrocytes from control mice were transduced with Cre recombinase to generate STAT3-deficient cells and stimulated with IL-1β to establish an OA model. The gene and protein expression were examined by qRT-PCR and Western blotting. Results: Compared with control DMM mice, cKO-DMM mice exhibited significantly reduced cartilage degeneration and lower serum levels of IL-1β, IL-6, and TNF-α ( P < 0.05). In cartilage tissues, cKO-DMM mice showed increased COL-II and Aggrecan expression, along with downregulation of IL-1β, IL-6, TNF-α, MMP13, ADAMTS-4, JAK2, and the p-STAT3/STAT3 ratio ( P < 0.05). Chondrocyte apoptosis was also reduced. Micro-CT analysis demonstrated that STAT3 knockout attenuated subchondral osteosclerosis at 8 weeks post-DMM, with significant reductions in BV/TV and BMD ( P < 0.001). In vitro, STAT3 deletion alleviated IL-1β–induced COL-II and Aggrecan loss, while suppressing IL-6, TNF-α, and JAK2/STAT3 pathway activation ( P < 0.05). Conclusion: Chondrocyte-specific STAT3 knockout effectively mitigates DMM-induced OA progression in mice. The protective mechanism involves suppression of inflammatory cytokine release, downregulation of MMP13/ADAMTS-4 and JAK2/STAT3 signaling, and the preservation of cartilage integrity.

To evaluate the accuracy and reliability of a novel automated 3D CT-based method for measuring femoral neck anteversion (FNA) compared to three traditional manual methods. A total of 126 femurs from 63 full-length CT scans (35 men and 28 women; average age: 52.0 ± 14.7 years) were analyzed. The automated method used a deep learning network for femur segmentation, landmark identification, and anteversion calculation, with results generated based on two axes: Auto_GT (using the greater trochanter-to-intercondylar notch center axis) and Auto_P (using the piriformis fossa-to-intercondylar notch center axis). These results were validated through manual landmark annotation. The same dataset was assessed using three conventional manual methods: Murphy, Reikeras, and Lee methods. Intra- and inter-observer reliability were assessed using intraclass correlation coefficients (ICCs), and pairwise comparisons analyzed correlations and differences between methods. The automated methods produced consistent FNA measurements (Auto_GT: 17.59 ± 9.16° vs. Auto_P: 17.37 ± 9.17° on the right; 15.08 ± 9.88° vs. 14.84 ± 9.90° on the left). Intra-observer ICCs ranged from 0.864 to 0.961, and inter-observer ICCs between Auto_GT and the manual methods were high, except for the Lee method. No significant differences were observed between the two automated methods or between the automated and manual verification methods. Moreover, strong correlations (R > 0.9, p < 0.001) were found between Auto_GT and the manual methods. The novel automated 3D CT-based method demonstrates strong reproducibility and reliability for measuring femoral neck anteversion, with performance comparable to traditional manual techniques. These results indicate its potential utility for preoperative planning, postoperative evaluation, and computer-assisted orthopedic procedures. Not applicable.

Abstract This review aimed to provide a comprehensive analysis of the etiology, epidemiology, pathology, and conventional treatment of heterotopic ossification (HO), especially emerging potential therapies. HO is the process of ectopic bone formation at non-skeletal sites. HO can be subdivided into two major forms, acquired and hereditary, with acquired HO predominating. Hereditary HO is a rare and life-threatening genetic disorder, but both acquired and hereditary form can cause severe complications, such as peripheral nerve entrapment, pressure ulcers, and disability if joint ankylosis develops, which heavily contributes to a reduced quality of life. Modalities have been proposed to treat HO, but none have emerged as the gold standard. Surgical excision remains the only effective modality; however, the optimal timing is controversial and may cause HO recurrence. Recently, potential therapeutic strategies have emerged that focus on the signaling pathways involved in HO, and small molecule inhibitors have been shown to be promising. Moreover, additional specific targets, such as small interfering RNAs (siRNAs) and non-coding RNAs, could be used to effectively block HO or develop combinatorial therapies for HO.

To evaluate and compare the effectiveness of an intelligent fracture reduction robotic system in assisting closed reduction and intramedullary nailing of femoral shaft fractures with that of conventional fluoroscopy-assisted manual reduction and fixation. In this prospective, non-randomized controlled study, 30 patients with newly diagnosed femoral shaft fractures were enrolled, with 15 cases in the experimental group (robot-assisted) and 15 cases in the control group (conventional). The experimental group utilized an orthopaedic surgical navigation system to assist in closed reduction and intramedullary nailing, while the control group underwent fluoroscopy-assisted manual reduction and fixation. The reduction time, total operation time, intraoperative fluoroscopy count, blood loss, and reduction error were compared between the two groups. Baseline characteristics were similar across both groups. The experimental group required significantly fewer intraoperative fluoroscopies (36.67 ± 25.41 vs. 117.26 ± 61.28, P < 0.001). Postoperative femoral length discrepancy (1.74 ± 1.37 mm) and anteversion difference (3.66 ± 3.37°) were significantly smaller in the experimental group compared to the control group (4.16 ± 2.67 mm, P = 0.004; 13.81 ± 9.58°, P = 0.001). Intraoperative blood loss was comparable between groups (experimental group: 207.33 ± 119.91 mL vs. control group: 240.00 ± 139.13 mL, P = 0.497). Reduction time was not statistically significant (experimental group: 74.27 ± 27.38 min vs. control group: 69.73 ± 34.10 min, P = 0.691). The robot-assisted approach provided more precise fracture reduction, required fewer intraoperative X-ray fluoroscopies, and offered significant advantages over the conventional method for the minimally invasive treatment of femoral fractures.

BackgroundRecent research indicates that the monocyte lymphocyte ratio (MLR), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), C-reactive protein (CRP), and systemic immune-inflammation index (SII) may serve as valuable predictors of early postoperative mortality in elderly individuals with hip fractures. The primary objective of the study was to examine the association between preoperative MLR, NLR, PLR, CRP, and SII levels and 3-year mortality risk in geriatric patients after hip fracture surgery.Patients and methodsThe study included patients aged 65 years or older who underwent hip fracture surgery between November 2018 and November 2019. Admission levels of MLR, NLR, PLR, CRP, and SII were measured. The median follow-up period was 3.1 years. Cox proportional hazards models were used to calculate the hazard ratio (HR) for mortality with adjusting for potential covariates. Time-dependent receiver operating characteristic (ROC) curves were employed to assess the predictive capability of inflammatory indicators for mortality.ResultsA total of 760 patients completed the follow-up (79.4 ± 7.8 years, 71.1% female). A higher preoperative MLR was found to be significantly associated with an increased 3-year postoperative mortality risk (HR 1.811, 95% CI 1.047–3.132, P = 0.034). However, no significant correlations were observed between preoperative NLR, PLR, CRP, SII and 3-year mortality. The areas under the ROC curve (AUCs) of MLR for predicting 30-day, 120-day, 1-year, and 3-year mortality were 0.74 (95% CI 0.53–0.95), 0.70 (95% CI 0.57–0.83), 0.67 (95% CI 0.60–0.74), and 0.61 (95% CI 0.56–0.66), respectively.ConclusionPreoperative MLR is a useful inflammatory marker for predicting 3-year mortality in elderly hip fracture patients, but its predictive ability diminishes over time.

The prognostic nutritional index (PNI) is a useful tool for assessing nutritional status using serum albumin and lymphocyte count. This study indicates that a higher preoperative PNI correlates with improved mobility and health-related quality of life during the initial postoperative period in elderly patients with hip fractures. To investigate the prognostic value of the prognostic nutritional index (PNI) in predicting mobility and health-related quality of life (HRQoL) in elderly hip fracture patients after surgery. We prospectively involved patients aged 65 and above, who could walk freely before injury and underwent surgery between 2018 and 2019. Admission PNI was calculated as serum albumin (g/L) + 5 × total lymphocyte count (× 109/L). Patients were classified into two groups based on PNI median value. All patients were followed up by telephone for four times (30-day, 120-day, 1-year, and 3-year after surgery). The Fracture Mobility Score (FMS) and EuroQol 5-Dimension 5-Level (EQ-5D 5L) were used to evaluate mobility and HRQoL, respectively. Of 705 eligible patients, 487 completed all assessments. Patients in the higher PNI group had a significantly increased possibility of achieving unrestricted mobility at the 120-day follow-up (OR 1.69, 95

BACKGROUND The evidence on use of supplementary titanium cable cerclage (TCC) in treating femoral subtrochanteric fractures (FSF) remains scarce. Therefore, this study aimed to investigate the potential therapeutic effects for FSF patients using TCC. MATERIAL AND METHODS A retrospective study of 68 FSF patients treated by a long intramedullary (IM) nailing with (Observation group, n=41) or without (Control group, n=27) TCC was conducted from January 2020 to December 2021. The primary outcome measure was time to postoperative full weight-bearing. Secondary outcome measures were operation time, intraoperative blood loss, number of blood transfusions needed, varus angle loss, excellent and good rate of fracture reduction, Harris score, and survival rate. RESULTS Patients were followed up for 13 to 36 months. The excellent and good rate of fracture reduction was 100% in the Observation group versus 92.6% in the Control group (P=0.013), and the varus angle loss and time to postoperative full weight-bearing in the Observation group were significantly less than in the Control group (P<0.05). The intraoperative blood loss in the Observation group was significantly higher than in the Control group (P<0.001). No differences were noted between groups for Harris scores and survival rates at last follow-up. CONCLUSIONS TCC fixation combined with IM nailing can improve the excellent and good rate of fracture reduction and reduce varus angle loss, as well as shorten the time to full weight-bearing and promote early functional exercise, which offers an effective treatment option for FSF patients who have failed closed reduction.

BACKGROUND It is unclear whether preoperative thyroid-stimulating hormone (TSH) level is correlated with long-term mortality in the elderly after hip fracture surgery. We aimed to assess the association between TSH levels and 3-year mortality in these patients. MATERIAL AND METHODS We enrolled patients aged 65 and above who had hip fracture surgery and thyroid function tests upon admission from 2018 to 2019. Patients were categorized based on TSH median value, quartiles, or thyroid function status. The median follow-up time was 3.1 years. Cox proportional hazards models were used to examine the correlation between TSH levels and mortality, adjusting for covariates. RESULTS Out of 799 eligible patients, 92.7% (741/799) completed the follow-up, with 20.6% (153/741) of those having died by the end of the follow-up. No statistically significant differences in mortality risks were found when stratified by TSH median value (HR 0.88, 95% CI 0.64-1.22, P=0.448) or quartiles (HR ranging from 0.90 to 1.13, P>0.05). Similarly, when categorized based on admission thyroid function status, patients who presented with hypothyroidism, subclinical hypothyroidism, hyperthyroidism, and subclinical hyperthyroidism upon admission did not demonstrate a statistically significant difference in mortality risk compared to those who were considered euthyroid (HR 1.34, 95% CI 0.72-2.49, P=0.359; HR 0.77, 95% CI 0.38-1.60, P=0.489; HR 1.15, 95% CI 0.16-8.30, P=0.890; HR 1.07, 95% CI 0.34-3.38, P=0.913, respectively). CONCLUSIONS Admission TSH is not significantly associated with 3-year mortality in geriatric patients after hip fracture surgery.

[This corrects the article DOI: 10.3389/fsurg.2024.1440990.].

Background Patellofemoral osteoarthritis (PFJOA) is a subtype of knee OA, which is one of the main causes of anterior knee pain. The current study found an increased prevalence of OA in postmenopausal women, called postmenopausal OA. Therefore, we designed the ovariectomized rat model of patella baja-induced PFJOA. Alendronate (ALN) inhibits osteoclast-mediated bone loss, and has been reported the favorable result of a potential intervention option of OA treatment. However, the potential effects of ALN treatment on PFJOA in the ovariectomized rat model are unknown and need further investigation prior to exploration in the clinical research setting. In this study, the effects of ALN on articular cartilage degradation and subchondral bone microstructure were assessed in the ovariectomized PFJOA rat model for 10 weeks. Methods Patella baja and estrogen withdrawal were induced by patellar ligament shortening (PLS) and bilateral ovariectmomy surgeries in 3-month-old female Sprague–Dawley rats, respectively. Rats were randomly divided into five groups (n = 8): Sham + V; OVX + V, Sham + PLS + V, OVX + PLS + V, OVX + PLS + ALN (ALN: 70 μg/kg/week). Radiography was performed to evaluate patellar height ratios, and the progression of PFJOA was assessed by macroscopic and microscopic analyses, immunohistochemistry and micro-computed tomography (micro-CT). Results Our results found that the patella baja model prepared by PLS can successfully cause degeneration of articular cartilage and subchondral bone, resulting in changes of PFJOA. OVX caused a decrease in estrogen levels in rats, which aggravated the joint degeneration caused by PFJOA. Early application of ALN can delay the degenerative changes of articular cartilage and subchondral bone microstructure in castrated PFJOA rat to a certain extent, improve and maintain the micrometabolism and structural changes of cartilage and subchondral bone. Conclusion The early application of ALN can delay the destruction of articular cartilage and subchondral bone microstructure in castrated PFJOA rat to a certain extent.

Objective:To investigate the early clinical effectiveness of using customized 3D printed acetabular augment to repair large acetabular bone defects in delayed total hip arthroplasty after failed treatment of acetabular fractures.Methods:A retrospective study was conducted to analyze the 6 patients who had undergone 3D printed acetabular augment to reconstruct acetabular bone defects in delayed total hip replacement from July 2021 to January 2023 after failed treatment of acetabular fractures. They were all males, with an age of (51.3±15.0) years. Paprosky classification: 2 cases of type ⅡB, 1 case of type ⅡC, and 3 cases of type ⅢA. Recorded were surgical time, intraoperative bleeding, hospitalization time, and visual analogue scale (VAS), and modified Merle d'Aubigné & Postel score, Harris hip score, and leg length discrepancy at the last follow-up.Results:For the 6 patients, the mean surgical time was (222.5±46.9) min, the mean intraoperative bleeding 1,100 (1,000, 2,625) mL, the mean hospitalization time (9.0±4.5) d, and the mean follow-up time (11.8±7.9) months. At the last follow-up, the VAS [(2.5±1.0) points] significantly decreased compared with the preoperative value [(6.2±0.8) points], the modified Merle d'Aubigné & Postel score [(13.2±2.1) points] and Harris hip score [(67.8±15.3) points] significantly increased compared with the preoperative values [(6.7±0.8) and (34.2±8.4) points], the vertical position of center of rotation [(22.5±5.2) mm] and the horizontal position of center of rotation [(40.7±2.6) mm] were significantly reduced compared with the preoperative values [(38.1±14.2) and (53.1±10.0) mm] ( P<0.05). At the last follow-up, the leg length discrepancy was (6.2±3.6) mm, showing no statistically significant difference from the preoperative value [(18.7±1.7) mm] ( P>0.05). At the last follow-up, no clear line at the cup-bone or augment-bone interface, or no possible prosthetic loosening or displacement was observed on the X-ray films. Conclusion:In delayed total hip arthroplasty after failed treatment of acetabular fractures, the customized 3D printed augment for repair of large bone defects in the acetabulum can reconstruct the normal rotation center of the hip joint, provide reliable stability for the cup prosthesis, and enable patients to obtain significant improvements in hip function.

Abstract Background Cement diffusion and cement leakage are key and contradictory problems in the vertebroplasty, so vertebroplasty instruments constantly develop to explore the optimal treatment. The purpose of this study was to evaluate and compare the clinical efficacy of percutaneous vertebroplasty (PVP) with spiral bone cement injector and traditional push-rod injector in the treatment of osteoporotic vertebral compression fractures (OVCF). Methods A retrospective study was conducted on 86 patients with OVCF who respectively received PVP surgeries with spiral injector (Observation group) and traditional pushrod injector (Control group) from February 2017 to February 2019. The preoperative baseline data, postoperative clinical efficacy, complications and imaging data between the two groups were analyzed. Results Follow-up period was two years. The baseline data of the two groups were comparable (all P > 0.05).The anterior edge height and kyphosis angle of the injured vertebrae were significantly improved in both groups after surgery (all P < 0.05). The VAS and ODI in both groups were significantly lower on 3rd day and 2nd year after surgery than those before surgery, and decreased gradually with time (all P < 0.05). The number of fluoroscopy and operation time in the observation group were significantly lower than those in the control group (all P < 0.05). The kyphosis angle and the recovery rates of kyphosis angle, anterior edge height, and posterior edge height in the observation group were significantly improved compared with the control group (all P < 0.05). The rate of bone cement leakage and the diffusion coefficient of bone cement in the observation group were significantly higher than those of the control group (all P < 0.05). The VAS and ODI in the observation group were significantly lower than those in the control group at 3rd day after surgery (P < 0.05), but there was no statistical difference between the two groups at 2nd year after surgery (P > 0.05). Conclusions PVP surgery both with spiral injector and traditional pushrod injector can achieve satisfactory outcomes, which could effectively relieve pain of lower back, improve motor function, obviously restore vertebral height and correct kyphosis. However, the spiral injector can remarkably reduce the number of fluoroscopy, operation time, and the radiation exposure dose of patients and operators. In addition, spiral injector is better than pushrod injector in restoring vertebral height, correcting kyphosis, alleviating pain immediately and improving function. But its rate of bone cement leakage is significantly higher than that of traditional pushrod injector, which requires the surgeons to pay close attention to.

Objective:To elucidate the recent therapeutic efficacy of the intelligent fracture reduction robotic system in managing pelvic fractures.Methods:A retrospective evaluation of 49 pelvic fracture patients treated using the intelligent fracture reduction robotic system at Beijing Jishuitan Hospital's trauma orthopedics department between March 2021 and December 2022 was conducted. The cohort included 30 males and 19 females, with a mean age of 51.51±18.71 years (20-92 years range). Fractures were classified according to the Tile system: B1 type in 2 cases, B2 in 7, B3 in 3, C1 in 30, and C2 in 3. The median interval between injury and surgery was 6 days, with a range of 2-22 days. The robotic system assisted in pelvic fracture reduction and stabilization surgeries. Preoperative and postoperative evaluations involved pelvic CT scans, anteroposterior, inlet, and outlet radiographic images. Fracture displacement and reduction outcomes were assessed via X-ray imagery. Data captured included intraoperative blood loss, duration of surgery, fracture stabilization techniques, and postoperative monitoring period. The Majeed scoring system gauged functional outcomes.Results:Of the patients, 48 underwent minimally invasive interventions with robotic assistance, while one case necessitated open reduction and internal fixation due to an unsuccessful reduction. The duration between injury and operation ranged from 2 to 22 days. Average surgical time stood at 206.5±7.1 minutes (105-440 min range), and median intraoperative blood loss was 100ml (10-600 ml range). Using the Matta reduction criteria, 30 postoperative cases exhibited excellent and 9 good outcomes for posterior pelvic ring displacement, translating to a 93% (38/41) positive rate. For anterior pelvic ring shifts, 45 showed excellent and 3 good outcomes, culminating in a 100% (48/48) success rate. Follow-up for the 48 cases lasted 11.0 months (3-23 months range), with the Majeed functional score averaging 81.9±17.0 points (42-100 point range). 27 cases scored excellent, and 11 good, yielding a combined positive outcome rate of 79.2% (38/48).Conclusion:Employing the intelligent fracture reduction robotic system in pelvic fracture treatments facilitates minimally invasive interventions and yields favorable short-term clinical results.

Purpose To explore the epidemiological trends in acetabular fracture and report the mid-term to long-term clinical outcomes of the elderly treated with operation. Methods Retrospective study. Patients aged ≥ 14 years with operative treatment of the Acetabular fracture from Jan 2010 to Dec 2019 at a level-1 trauma centre were identified to analyze the epidemiological trends, and the difference in fracture patterns between young and elderly patients (≥ 60 years old) were compared. The elderly patients were followed up to evaluate their clinical outcomes and satisfaction degree (worst to best: 0 to10). The patients were divided into the 2010–2014 group and the 2015–2019 group according to the year of admission, and the clinical outcomes of the two groups were compared to verify the stability from mid-term to long-term after surgery for acetabular fracture. Results A total of 1024 patients (mean age 43.35 years, range 14–86 years) with acetabular fractures received operative treatment in this decade. The mean age of the acetabular fracture patients increased from 41.1 years to 47.7 years, and the proportion of elderly patients increased from 5.7% to 24.0%, with some volatility. The ratio of male to female decreased year by year, and the proportion of female patients increased with age. And the anterior fracture patterns were more common in the elderly patients compared to the young patients ( P < 0.001). 118 elderly patients (82 males, 36 females; mean age 66.91 years, range 60–86 years) were followed-up (mean 77.4 months, range 35–152 months). The overall mortality rate of the elderly patients was 7.69% (9/118). The Harris hip score of those alive patients was 90.41 ± 12.91 points (excellent and good rate 84.4%). 87 patients completed the SF-12 with a normal HRQoL (PCS 50.49 ± 8.88 points; MCS 55.66 ± 8.86 points). 90.8% of the patients achieved a satisfaction score of 9 or higher. And there was no significant difference in clinical outcomes between the 2010–2014 group and the 2015–2019 group ( P > 0.05). Conclusions In conclusion, acetabular fractures presented an obvious ageing trend in China, and the fracture patterns of the elderly patients differed from those in the young patients. Operative treatment for elderly acetabular fractures yielded satisfactory and persistent clinical outcomes from mid-term to long-term clinical.