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

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

Low-Molecular-Weight Heparins (LMWH) and Synthetic Factor X Inhibitors Can Impair the Osseointegration Process of a Titanium Implant in an Interventional Animal Study

Background and objectives: Cementless total hip arthroplasty is a common surgical procedure and perioperative thromboprophylaxis is used to prevent deep vein thrombosis or pulmonary embolism. Osseointegration is important for long-term implant survival, and there is no research on the effect of different thromboprophylaxis agents on the process of osseointegration. Materials and Methods: Seventy rats were allocated as follows: Group I (control group), Group II (enoxaparin), Group III (nadroparin), and Group IV (fondaparinux). Ovariectomy was performed on all subjects, followed by the introduction of an intramedullary titanium implant into the femur. Thromboprophylaxis was administered accordingly to each treatment group for 35 days postoperatively. Results: Group I had statistically significantly lower anti-Xa levels compared to treatment groups. Micro-CT analysis showed that nadroparin had lower values compared to control in bone volume (0.12 vs. 0.21, p = 0.01) and percent bone volume (1.46 vs. 1.93, p = 0.047). The pull-out test showed statistically significant differences between the control group (8.81 N) compared to enoxaparin, nadroparin, and fondaparinux groups (4.53 N, 4 N and 4.07 N, respectively). Nadroparin had a lower histological cortical bone tissue and a higher width of fibrous tissue (27.49 μm and 86.9 μm) at the peri-implant area, compared to control (43.2 μm and 39.2 μm), enoxaparin (39.6 μm and 24 μm), and fondaparinux (36.2 μm and 32.7 μm). Conclusions: Short-term administration of enoxaparin, nadroparin, and fondaparinux can reduce the osseointegration of titanium implants, with nadroparin having the most negative effect. These results show that enoxaparin and fondaparinux are preferred to be administered due to a lesser negative impact on the initial implant fixation