A biomechanical study of the role of sitagliptin on the bone characteristics of diabetic rats

An experimental protocol is described aiming to explore the in­fluence of Type 2 Diabetes Mellitus on the biomechanical response of the bone tissue and, also, to quantify the potential beneficial role of a pharma­ceutical treatment, based on sitagliptin, a diabetes drug that increases the levels of natural substances called incretins. Twenty eight male, 10-week old Wistar rats were used, divided into three groups, i.e., the control one, the group including the diabetic rats and, finally, the group including the diabetic rats which were treated using sitagliptin. The biomechanical study was based on a series of three-point bending tests of the femora of the sacrificed rats and the analysis of the experimental data was implemented in terms of the actual geometry of the fractured cross-section. It was concluded that diabetic bones undertake larger forces despite the fact that the “diameter” of their cross-section was some­­how smaller. On the contrary, the slope of the load-deflection curve (cor­responding to a measure of the stiffness) of diabetic bones is slightly lower compared to the control bones. Finally, it seems that treating diabetic animals with sita­gliptin only partly reverses the effect of Type 2 Diabetes Mellitus on their bone tissue, at least concerning its strength and stiffness

Hematogenous Long Bone Osteomyelitis by Prevotella (Bacteroides) Melaninogenicus

Anaerobic infections are difficult to recognize and may lead to life threatening complications. We present the case of an acute Prevotella hematogenous infection of the humerus in a previously healthy adult patient, treated with a two-stage surgical treatment, emphasizing on the importance of the radical surgical debridement and the selection of the appropriate antimicrobial agents. To our knowledge, such an acute hematogenous infection has not been previously reported in the literature

Chronic Undiagnosed Brucellosis Presenting as Sciatica

Brucellosis is a common zoonotic disease in southern Europe. Although having the potential to harm several anatomic regions and systems, musculoskeletal manifestations are rare, usually involving the spine and the sacroiliac joints. hi the literature, the reports (Ship manifestations are sporadic. We present a case report of chronic, undiagnosed brucellosis indirectly affecting the hip joint. A 51-years-old male patient was admitted to our department with acute onset sciatica. His medical history was remarkable for incomplete cauda equina syndrome of unknown etiology and concomitant dura mater disruption, creating local sinuses resulting at the right buttock. On radiological evaluation, we demonstrated multiple abscesses of the lower lumbar spine and the ipsilateral sacroiliac joint, along with sinuses communicating with the right hip joint capsule. Soft and osseous tissue cultures obtained from the area of the lesion were negative for common bacteria. Considering the patient's history, chronicity of the disease, and the lesional pattern, we suspected brucellosis as a possible etiological factor. Laboratory evaluation with the serum agglutination test confirmed the diagnosis. The patient denied the surgical treatment, so we proceeded with chronic suppression antibiotics schemes. On 12-month follow-up, the patient has no clinical signs of infection relapse; he has reasonable pain control and a normal gait. Indirect hip infection due to chronic brucellosis is rare, and physicians should be very suspicious of the disease's characteristic radiological manifestations to reach a correct diagnosis

The use of core track endoscopy to document accurate decompression of the femoral head

The aim of this study is to evaluate the role of endoscopy as diagnostic and prognostic method for Ficat and Steinberg stage IIIA and IIIB lesions by assessing the efficacy, risks and complications of this method. In a prospective study from January 2008 until September 2013, nine patients ( 13 hips) were assessed. In nine hips the disease was stage II, in three hips stage III and in one hip stage IV. Evaluation included x-rays, magnetic resonance and bone scintigraphy. After femoral head decompression, the borders of the removed necrotic area were investigated under direct visualisation by means of endoscopy in order to assess the vitality status of the surrounding bone. Endoscopic evaluation was successful in nine hips. The visualisation of healthy bone borders after removing the necrotic bone was not possible in four cases. The preoperative MRI findings were in correlation to our endoscopic findings in five out of nine cases. There were no cases of cartilage perforation, femoral neck fracture and other intra and postoperative complications. Endoscopic evaluation of the removed necrotic bone can greatly improve the therapeutic effect by visualising the borders of the decompressed bone area and provide information regarding the necessity for bone graft and the type of graft required

A Systematic Approach for Stronger Documentation of Anterior Cruciate Ligament Graft Choice.

Numerous studies have focused on determining the optimal choice between the two most used anterior cruciate ligament (ACL) reconstruction autografts. In order to address this matter, we performed a systematic review of every meta-analysis published on the PubMed platform between 2001 and 2020, comparing the functional outcomes, the static stability parameters, as well as the postoperative and long-term complications of the patellar tendon (BPTB) autograft and hamstrings (HT). We retrieved a total of 26 meta-analyses that met our criteria, and the characteristics and outcomes of every meta-analysis, as well as subgroup analysis regarding the type of the study design, number of strands of HT autograft, and fixation method, were extensively recorded. The majority of the meta-analyses showed that there were no significant differences between BPTB and HT in terms of functional outcomes and static stability parameters while HT autografts seem to be superior to BPTB regarding kneeling pain and anterior knee pain. Other outcomes seem to be affected by the number of strands of the HT autograft, the fixation technique, and the type of study design, indicating superiority of the four-strand HT autograft with the use of an extra-cortical button fixation. Overall, there is no clear superiority of BPTB over HT autografts for ACL reconstruction, as both types present similar outcomes in the majority of postoperative parameters. Autograft selection should be individualized according to each patient's needs and more RCTs are warranted in order to reach safer results on the appropriate autograft type

Confronting hip resurfacing and big femoral head replacement gait analysis

Improved hip kinematics and bone preservation have been reported after resurfacing total hip replacement (THRS). On the other hand, hip kinematics with standard total hip replacement (THR) is optimized with large diameter femoral heads (BFH-THR). The purpose of this study is to evaluate the functional outcomes of THRS and BFH-THR and correlate these results to bone preservation or the large femoral heads. Thirty-one patients were included in the study. Gait speed, postural balance, proprioception and overall performance. Our results demonstrated a non-statistically significant improvement in gait, postural balance and proprioception in the THRS confronting to BFH-THR group. THRS provide identical outcomes to traditional BFH-THR. The THRS choice as bone preserving procedure in younger patients is still to be evaluated

Musculoskeletal Manifestations in Sjogren’s Syndrome: An Orthopedic Point of View

Sjogren’s syndrome (SS) is a frequent entity with a broad symptomatology spectrum, mainly affecting the salivary and lachrymal glands. The disease also affects the musculoskeletal system targeting bones, specific joints, muscles, and the peripheral nerve system. Disease related clinical manifestations canhave an accumulative impact, as the syndrome is commonly associated with other rheumatic diseases. A literature review was performed with the aim to assess the in-depth association of Sjogren’s syndrome and its treatment agents with the musculoskeletal system and further investigate its potential relevance with common orthopedic postoperative complications

Double lag-screw compression for optimal fixation of intertrochanteric fractures with large fragment gap: A technical note

Cephalomedullary nailing of unstable intertrochanteric fractures has been established as a fruitful surgical approach with relatively limited complications. Anatomic fracture reduction and proper implant positioning are vital to attaining a favorable long-term surgical outcome. Appropriate intraoperative fracture compression augments stability and invigorates healing. The amount of compression permitted by cephalomedullary nails cannot always adequately reduce large fragment gaps. This paper presents a novel technical trick of double compression of the fracture site, in order to achieve the essential extra compression and reduction when required, thus decreasing the risk of postoperative implant cut-out. The technique was used in 14 out of 277 peritrochanteric fractures treated with cephalomedullary nailing in our trauma center for 12 months, with satisfactory outcomes regarding both fracture site union and postoperative functional capacity