Osteosynthesis development with collagenic nanobiostructures

Universitatea de Medicină şi Farmacie ”Iuliu Haţieganu”, Clinica de Ortopedie şi Traumatologie Cluj-Napoca, Secţia a II-a, Conferinţa a XI-a Naţională a ortopezilor-traumatologi din Republica Moldova “POLITRAUMATISME – CONCEPŢII CONTEMPORANE DE DIAGNOSTIC ŞI TRATAMENT”Cercetările în sfera biomaterialelor şi a biomecanicii reprezintă puncte cheie ale progresului în nanomedicină. Nanobiostructurile sunt de mare interes în chirurgia ortopedică în tratamentul unor variate leziuni osteoarticulare: fracturi, pseudartroze, fracturi pe teren patologic (tumori osoase sau osteoporoză), infecţii osoase, artroze etc. Nanobiostructurile conţin colagen, cu sau fără alt polimer, hidroxiapatită nanostructurată, unele peptide (factori de creştere), fosfat de calciu, bisfosfonaţi şi alţi ingredienţi auxiliari. Aplicarea nanobiostructurilor pe diferite suporturi (plăci, tije) favorizează procesele biologice ale consolidării osoase, osteogeneza şi remodelarea osoasă, în condiţiile unei stabilităţi mecanice asigurate prin fixarea internă a fracturii. Aplicabilitatea clinica a tehnologiilor poate contribui in mod semnificativ la dezvoltarea tratamentelor multor boli musculoscheletale. The research in the field of biomaterials and biomechanics represents the key-point of progress in nanomedicine. Nanobiostructures are at high interest in the surgical treatment of various orthopedic conditions: fractures, non-unions, pathologic fractures (bone tumors or osteoporosis), bone infections, osteoarthritis etc. Nanobiostructures are made of collagen, with or without other polymer, nanostructured hydroxyapatite, some peptides (growth factors), calcium phosphate, bisphosphonates and other ingredients. The addition of nanobiostructures to various implants (plates, rods) enhances the biological processes of bone healing, bone growth and remodeling, being protected by the mechanical stability of the internal fixation of fractures. Clinical applicability of the technologies can significantly contribute to improvement of the treatment of several muscular and skeletal diseases

Hip arthroplasty complete revision

Universitatea de Medicină şi Farmacie ”Iuliu Haţieganu”, Clinica de Ortopedie şi Traumatologie Cluj-Napoca, Secţia a II-a, Conferinţa a XI-a Naţională a ortopezilor-tramatologi din Republica Moldova “Politraumatisme – concepţii contemporane de diagnostic şi tratament”, 21 mai 2009, Chișinău, Republica MoldovaArtroplastia totală de şold este descrisă ca una dintre cele mai importante realizări în asigurarea stării de sănătate. Durata medie de viaţă a crescut, tot mai mulţi pacienţi dezvoltând leziuni degenerative ale articulaţiei şoldului care impun o intervenţie de artroplastie. În prezent un număr tot mai mare de pacienţi beneficiază de o artroplastie primară de şold, mulţi dintre ei sperând în continuare la menţinerea unui nivel ridicat de activitate. Din aceste motive chiar şi cu o rată de succes foarte mare a intervenţiilor chirurgicale primare, numărul reviziilor este în continuă creştere. Acest studiu face o analiză a cauzelor insuccesului artroplastiei primare şi ia în calcul şi posibilitatea efectuării artroplastiei şoldului cu o proteză de revizie şi în alte afecţiuni în afara coxartrozei, cum ar fi fracturile trohanteriene după eşecul fixării interne, cu pierdere mare de masă osoasă.Total hip arthroplasty is considered one of the most important achievements in healthcare. Life span has extended and thus more and more patients develop degenerative osteoarthritis lesions of the hip that require arthroplasty intervention. Nowadays a growing number of patients benefit from primary total hip replacement, many of them expecting to maintain an increased level of activity. Even with a high rate of success of the primary surgery, due to this reason the number of revisions is still growing. The present study analyses the causes of primary arthroplasty failure and discusses the possibility of using revision hip arthroplasty in other affections, for example in trochanteric fractures after failure of internal fixation with great bone mass loss

In Vitro Sensitivity Research Concerning Some Microorganisms at Hydroxyquinoline and Cupric Derivatives Deposited onto Hydroxyapatite

ABSTRACT Introduction: The preparations based on hydroxyquinoline, in various combinations, are used in medicine, being shown to have an inhibitory effect against bacteria, molds, fungi, parasites, and viruses, but also having other beneficial effects mentioned in other medical conditions (anti-cancer, anti-degenerative, anti-inflammatory). Aims: In vitro susceptibility testing of microorganisms: bacteria (Gram positive and Gram negative), yeast (Candida spp.,) and unicellular algae (Prototheca spp.) at the preparations based on hydroxyquinoline (HQ) and its cupric derivatives deposited on hydroxyapatite (HAP). Materials and methods: There were tested microbial strains of the following genera: Escherichia, Staphylococcus, Micrococcus, Bacillus, Candida, and Prototheca. The tested products (developed in the Laboratory for Nanobiomaterials Synthesis, Center of Physical Chemistry, Faculty of Chemistry and Chemical Engineering, UBB Cluj-Napoca) were developed in three versions: 1) HQ-Cu2+-HAP1; 2) HQ-Cu2+-HAP2; and 3) NHQ-Cu2+-HAP2, where NHQ stands for nitro hydroxyquinoline. Determination of the inhibitory effect was conducted by diffusion technique in nutrient agar, according to CLSI 2013 standards, with necessary adaptations for testing of products made in the form of suspensions. Results: Following interpretation, it was found that the inhibition zones, arising from the antimicrobial effect of the tested products showed variability in size, depending on the test product and the microbial strain: Escherichia coli (8-10 mm), Staphylococcus sp. (17.6 - 23.2 mm), Micrococcus spp. (24.4 - 27.6 mm), Bacillus spp. (14.0 - 16.0 mm), Candida spp. (20.4 - 25.2 mm), Prototheca spp. (20.8 - 30.0 mm). From the three tested products, the best efficacy was found at the product no. 3 (NHQ - Cu2+ - HAP2), followed by no. 1 (HQ- Cu2+-HAP1) and no. 2 (HQ-Cu2+-HAP2). Conclusions: The inhibitory effect was bactericidal, manifested more intensively against Gram-positive bacteria, yeasts, and prototheca. Such products, prepared in the form of suspensions, may have practical application in the prevention and treatment of skin or hooves disorders. No resistance phenomena are recorded. Keywords: copper, hydroxyapatite, hydroxyquinoline, microorganisms, sensitivity

Enhancement of bone consolidation using high-frequency pulsed electromagnetic fields (HF-PEMFs): An experimental study on rats

In vitro studies showed that high-frequency pulsed electromagnetic fields (HF-PEMFs) increase the activity/expression of early and late osteogenic markers and enhance bone mineralization. The main aim of this study was to investigate the in vivo effects of HF-PEMFs on fracture healing using a rat model. A femur fracture was established by surgery in 20 male Wistar rats. Titanium nails were implanted to reduce and stabilize the fracture. After surgery, 20 rats were equally divided into untreated control and treated group (from the first postoperative day HF-PEMFs at 400 pulses/sec [pps] were applied for 10 minutes/day, for two weeks). Quantitative and qualitative assessment of bone formation was made at two and eight weeks following surgery and included morphological and histological analysis, serological analysis by ELISA, micro-computed tomography (micro-CT), and three-point bending test. At two weeks in HF-PEMF group, soft callus was at a more advanced fibrocartilaginous stage and the bone volume/total tissue volume (BV/TV) ratio in the callus area was significantly higher compared to control group (p = 0.047). Serum concentration of alkaline phosphatase (ALP) and osteocalcin (OC) was significantly higher in HF-PEMF group (ALP p = 0.026, OC p = 0.006) as well as the mechanical strength of femurs (p = 0.03). At eight weeks, femurs from HF-PEMF group had a completely formed woven bone with dense trabeculae, active bone marrow, and had a significantly higher BV/TV ratio compared to control (p = 0.01). HF-PEMFs applied from the first postoperative day, 10 minutes/day for two weeks, enhance bone consolidation in rats, especially in the early phase of fracture healing

Biomimetic Composite Coatings for Activation of Titanium Implant Surfaces: Methodological Approach and In Vivo Enhanced Osseointegration

Innovative nanomaterials are required for the coatings of titanium (Ti) implants to ensure the activation of Ti surfaces for improved osseointegration, enhanced bone fracture healing and bone regeneration. This paper presents a systematic investigation of biomimetic composite (BC) coatings on Ti implant surfaces in a rat model of a diaphyseal femoral fracture. Methodological approaches of surface modification of the Ti implants via the usual joining methods (e.g., grit blasting and acid etching) and advanced physicochemical coating via a self-assembled dip-coating method were used. The biomimetic procedure used multi-substituted hydroxyapatite (ms-HAP) HAP-1.5 wt% Mg-0.2 wt% Zn-0.2 wt% Si nanoparticles (NPs), which were functionalized using collagen type 1 molecules (COL), resulting in ms-HAP/COL (core/shell) NPs that were embedded into a polylactic acid (PLA) matrix and finally covered with COL layers, obtaining the ms-HAP/COL@PLA/COL composite. To assess the osseointegration issue, first, the thickness, surface morphology and roughness of the BC coating on the Ti implants were determined using AFM and SEM. The BC-coated Ti implants and uncoated Ti implants were then used in Wistar albino rats with a diaphyseal femoral fracture, both in the absence and the presence of high-frequency pulsed electromagnetic shortwave (HF-PESW) stimulation. This study was performed using a bone marker serum concentration and histological and computer tomography (micro-CT) analysis at 2 and 8 weeks after surgical implantation. The implant osseointegration was evaluated through the bone–implant contact (BIC). The bone–implant interface was investigated using FE-SEM images and EDX spectra of the retrieved surgical implants at 8 weeks in the four animal groups. The obtained results showed significantly higher bone–implants contact and bone volume per tissue volume, as well as a greater amount of newly formed bone, in the BC-coated Ti implants than in the uncoated Ti implants. Direct bone–implant contact was also confirmed via histological examination. The results of this study confirmed that these biomimetic composite coatings on Ti implants were essential for a significant enhancement of osseointegration of BC-coated Ti implants and bone regeneration. This research provides a novel strategy for the treatment of bone fractures with possible orthopedic applications

Clinical outcomes after arthroscopically assisted talus fracture fixation

International audiencePurpose: The purpose of this article is to describe the novel technique of arthroscopic-assisted reduction and internal fixation (ARIF) of talar neck fractures, presenting also the outcomes of this treatment method in a series of four patients. Methods: Between 2011 and 2019, we have treated in our service a number of four patients with talar neck fractures, by the arthroscopic technique. The surgical intervention consists in arthroscopic exploration of tibiotalar and subtalar joints, arthroscopic lavage and debridement, reduction, and osteosynthesis with two cannulated screws under both arthroscopic and fluoroscopic control. Post-operative care consists in non-weightbearing immobilization for 6 weeks, followed by partial loading under the protection of a walking brace for the next six weeks and ROM exercises. The patients were followed up at three months, when a CT scan was performed, and at one year, when X-ray images showed the consolidation of fractures. Results: Normal or slightly reduced ROM of the ankle and hindfoot was noted in three out of four patients, absence of any pain, or disability (3 patients). The AOFAS’ Ankle-Hindfoot scale showed good and excellent results; mean score was 92.75 points (86–98p) at one year after the surgery. Conclusion: Arthroscopic-assisted management of talar fractures offers the advantages of minimally invasive surgery combined with good visualization of the fracture, good control of anatomic reduction, and the possibility to treat associated lesions. Main disadvantages of the method are technical difficulties, requires a prolonged learning curve, and offers limited fixation alternatives

Symptomatic Intraosseous Lipoma of the Calcaneum

Intraosseous lipomas are rare bone lesions that can affect any part of the skeleton. In the calcaneum, they are, generally, asymptomatic, but in some cases, patients may complain of pain, swelling or tenderness. Well-conducted radiography and MRI examinations can lead to an accurate diagnosis. In most cases, patients could benefit from conservative means of treatment, but in long-lasting symptomatic cases, surgical treatment may be a good option. The purpose of this article is to increase clinicians’ awareness of this lesion as a possible cause of heel pain and to describe a case of a symptomatic intraosseous lipoma of the calcaneum who underwent curettage and bone cement filling after failure of conservative treatment

Optimization of Functional Toothpaste Formulation Containing Nano-Hydroxyapatite and Birch Extract for Daily Oral Care

This research work aims to develop functional toothpastes with combined enamel remineralization and antibacterial effects using nano-hydroxyapatites (nHAPs) and birch extract. Eleven toothpastes (notated as P1–P11) were designed featuring different concentrations of birch extract and a constant concentration of pure nHAPs or substituted nHAPs (HAP-5%Zn, HAP-0.23%Mg-3.9%Zn-2%Si-10%Sr, and HAP-2.5%Mg-2.9%Si-1.34%Zn). In vitro assessments involved treating artificially demineralized enamel slices and analyzing surface repair and remineralization using Atomic Force Microscopy (AFM). The Agar Disk Diffusion method was used to measure antibacterial activity against Enterococcus faecalis, Escherichia coli, Porphyromonas gingivalis, Streptococcus mutans, and Staphylococcus aureus. Topographic images of enamel structure and surface roughness, as well as the ability of nHAP nanoparticles to form self-assembled layers, revealed excellent restorative properties of the tested toothpastes, with enamel nanostructure normalization occurring as soon as 10 days after treatment. The outcomes highlighted enamel morphology improvements due to the toothpaste treatment also having various efficacious antibacterial effects. Promising results were obtained using P5 toothpaste, containing HAP-5%Zn (3.4%) and birch extract (1.3%), indicating notable remineralization and good antibacterial properties. This study represents a significant advancement in oral care by introducing toothpaste formulations that simultaneously promote enamel health through effective remineralization and bacterial inhibition

Strategies for Improving Bioavailability, Bioactivity, and Physical-Chemical Behavior of Curcumin

Curcumin (CCM) is one of the most frequently explored plant compounds with various biological actions such as antibacterial, antiviral, antifungal, antineoplastic, and antioxidant/anti-inflammatory properties. The laboratory data and clinical trials have demonstrated that the bioavailability and bioactivity of curcumin are influenced by the feature of the curcumin molecular complex types. Curcumin has a high capacity to form molecular complexes with proteins (such as whey proteins, bovine serum albumin, β-lactoglobulin), carbohydrates, lipids, and natural compounds (e.g., resveratrol, piperine, quercetin). These complexes increase the bioactivity and bioavailability of curcumin. The current review provides these derivatization strategies for curcumin in terms of biological and physico-chemical aspects with a strong focus on different type of proteins, characterization methods, and thermodynamic features of protein–curcumin complexes, and with the aim of evaluating the best performances. The current literature review offers, taking into consideration various biological effects of the CCM, a whole approach for CCM-biomolecules interactions such as CCM-proteins, CCM-nanomaterials, and CCM-natural compounds regarding molecular strategies to improve the bioactivity as well as the bioavailability of curcumin in biological systems