Development of a risk-predicting score for hip preservation with bone grafting therapy for osteonecrosis

Summary: Identification and differentiation of appropriate indications on hip preserving with bone grafting therapy remains a crucial challenge in the treatment of osteonecrosis of the femoral head (ONFH). A prospective cohort study on bone grafting therapy for ONFH aimed to evaluate hip survival rates, and to establish a risk scoring derived from potential risk factors (multivariable model) for hip preservation. Eight variables were identified to be strongly correlated with a decreased rate of hip survival post-therapy, and a comprehensive risk scoring was developed for predicting hip-preservation outcomes. The C-index stood at 0.72, and the areas under the receiver operating characteristics for the risk score’s 5- and 10-year hip failure event predictions were 0.74 and 0.72, respectively. This risk score outperforms conventional methods in forecasting hip preservation. Bone grafting shows sustained benefits in treating ONFH when applied under the right indications. Furthermore, the risk scoring proves valuable as a decision-making tool, facilitating risk stratification for ONFH treatments in future

Improve the Efficiency of Surgery for Femoral Shaft Fractures with A Novel Instrument: A Randomized Controlled Trial

<div><p>Objective</p><p>To improve the efficacy of closed reduction and wire guiding during intramedullary nail internal fixation in femoral shaft fractures.</p><p>Methods</p><p>A novel instrument was designed and manufactured. Sixty-eight patients were enrolled from February 2011 to December 2013. The instrument designed was used during the operation in the experimental group, but not in the control group.</p><p>Results</p><p>All patients exhibited fracture union, excluding 1 patient in the experimental group and 2 in the control group who had non-union; all of whom achieved fracture union with reoperation. There were no statistically significant differences in operative blood loss or duration of hospital stay between the groups (P > 0.05). The operative time, frequency of wire drilling, and number of open reduction cases, were significantly smaller in the experimental group than in the control group (P < 0.05).</p><p>Conclusion</p><p>Femoral shaft fractures are difficult to reduce using general methods; the novel instrument showed high clinical value and proved effective and safe in assisting with closed reduction and intramedullary nail fixation for femoral shaft fractures.</p><p>Trial Registration</p><p>ChiCTR <a href="http://www.chictr.org.cn/showprojen.aspx?proj=12335" target="_blank">ChiCTR-ICR-15007335</a></p></div

Picture of the instrument developed.

<p>(a) bone forceps, bar, and connectors of the fracture reduction device; (b) column, calibrated bar, and slider of the guidewire-aiming device; (c, d) assembled fracture reduction device on a model of the femur; (e, f) assembled fracture reduction device and guidewire-aiming device on a model of the femur.</p

Radiographs showing application of the instrument in an operation for a femoral shaft fracture.

<p>(a, b) preoperative condition of the fracture (c, d) completed closed reduction with fracture reduction device (e, f) drilling into the proximal femoral medullary cavity using a Kirschner wire (1.5 mm) through the short sleeve (g, h) drilling into the distal femoral medullary cavity using a Kirschner wire.</p

Details of all patients, in both groups, with femoral shaft fracture.

<p>Details of all patients, in both groups, with femoral shaft fracture.</p

Comparison of the operative time, operative blood loss, frequency of drilling, number of open reduction cases, and hospitalization time between groups.

<p>Comparison of the operative time, operative blood loss, frequency of drilling, number of open reduction cases, and hospitalization time between groups.</p

Free vascularised fibular grafting in the treatment of large skeletal defects due to osteomyelitis

Treatment of skeletal defects secondary to osteomyelitis is a challenging problem. The purpose of this study was to present our experience of the use of free vascularised fibular grafts to treat such defects. Ten patients with a mean age of 31 years (range 16–50 years) and a skeletal defect with a mean length of 9.5 cm (range 6–17 cm) were managed with a protocol which included radical debridement of the lesion and a vascularised fibular graft. The mean follow-up time was 26 months. Union of the graft occurred in all patients, at a mean of 4.5 months. No recurrence of osteomyelitis was observed. The mean time to full weight bearing was ten months, and all patients were pain-free and able to walk without supportive devices. A free vascularised fibular graft is a viable option for the management of large skeletal defects resulting from osteomyelitis