Osteology

Fractures of the lateral process of the talus have been associated with snowboarding, so much so that they have earned the nickname “snowboarder’s ankle”; these typically occur with relatively low-energy injuries when compared with fractures of the talar head, neck, and body. We have observed that snowboarding portends a higher risk of talus fractures when compared with skiing and can include higher energy injury patterns. This study describes a series of talar head, neck, and body fractures caused by snowboarding, their treatment, and outcomes. A retrospective chart review was performed on all surgical cases collected from 2007 to 2012 to include talar head, neck, body, or lateral process fractures sustained while snowboarding. Radiographs were reviewed and the fractures were characterized. Questionnaires, including the Foot and Ankle Disability Index (FADI), were mailed to the patients. The pre-operative reports, surgical treatments, and outcomes were evaluated. Nine patients were identified with fractures of the talus caused by a snowboarding injury. One patient sustained an isolated talar head fracture, three sustained isolated talar neck fractures, one patient had an isolated talar body fracture, and two patients had isolated lateral process fractures. Two patients had a combination of talar injuries. At 2.5 years mean follow-up (range 6 months to 5 years), none of the patients developed avascular necrosis, nonunion/malunion, or required subsequent surgery. FADI scores indicated good to excellent results post-operatively. Full article

The standard surgical approach for the fusion of the tarsometatarsal (TMT) joint involves a two-incision approach. Philpott et al. proposed a modified, single-incision dorsal approach that yields a similar exposure. This study compares the joint preparation between the standard and modified dorsal approach. Ten fresh frozen cadaver specimens were randomly assigned to receive either a standard or modified dorsal operative approach to the TMT joint. The joint surface was prepared, and the joint was disarticulated. Image analysis, using ImageJ, was performed by two blinded reviewers to assess the joint surface preparation and this was compared by surgical approach. There was no significant difference in the amount of joint prepared when comparing the standard versus modified dorsal approach for TMT joints one through three (p = 0.548, p = 0.310, p = 0.548). First, TMT was 67.6% prepared by the standard approach vs 71.7% by the modified dorsal approach, second TMT was 67.9% vs. 65.7%, and third TMT was 65.9% vs. 59.6%. With our findings, we demonstrate that a modified dorsal approach with a single incision did not limit the ability to prepare the joint space. This study adds credibility backed by data to those set forth by Philipott et al. Full article

Resilience is a dynamic construct defined as the ability to recover from stress. There is no literature examining the impact of resilience on outcomes following foot and ankle surgery. Retrospective analysis of patients who underwent first MTP arthrodesis from September 2011 to May 2020 were reviewed for patient characteristics and union status. PROMIS Physical Function (PF), Pain Interference (PI), Depression (D), and Foot Function Index (FFI) were collected. Resilience was measured using the Brief Resilience Scale. A multivariable linear regression analysis examining the impact of resilience on patient reported was conducted. At an average of 3.4 years postoperatively, resilience was found to independently affect patient reported outcomes across all instruments, except the FFI pain subscale. In the first study examining the impact of resilience following foot and ankle surgery, we found that resilience has an independent positive effect on overall physical function, disability, pain, and mental health following MTP arthrodesis. Preoperative resilience scores could be used to predict postoperative functional outcomes following MTP arthrodesis and guide postoperative rehabilitation. These findings help establish the role of early positive psychosocial characteristics within orthopaedic foot and ankle population. Full article

Background: metatarsal fractures are a commonly encountered musculoskeletal injury. Scant literature exists to support current treatment guidelines and few studies describe the functional or occupational outcomes of patients with lesser metatarsal fractures. The purpose of this study is to describe occupational outcomes for traumatic lesser metatarsal fractures in relation to current treatment guidelines. Methods: a retrospective review of metatarsal fractures in adult military patients 18 years and older was performed. Data included: patient demographics, fracture angulation and displacement, treatment modality, associated injuries, rate of return to active duty, requirement for additional surgeries, ability to run a 2-mile physical fitness test, and presence of permanent activity limitations. Treatment guideline criteria were applied and compared with the occupational outcomes measured. Results: 38 fractures were included. The mean age was 27.2 ± 7.8 (19–48). Here, 28 fractures were initially treated non-operatively. Fractures selected for non-operative treatment had a mean displacement of 1.7 +/− 1.1 mm and a mean angulation of 3.3 +/− 3.5° at initial presentation. Fractures selected for operative treatment had a mean displacement of 4.5 +/− 2.4 mm and a mean angulation of 15.7 +/− 13.8° at initial presentation. The return to run rate was 89% in non-operatively treated patients and 50% in operatively treated patients (p = 0.02). Non-operative patients returned to running at a mean of 119 +/− 103 days and operative patients returned to running at a mean of 306 +/− 191 days (p = 0.0039). 50% of operatively treated patients and 11% of non-operatively treated patents were unable to remain in the military due to their metatarsal fractures. Conclusions: patients treated non-operatively were more likely to return to running and returned to running sooner than operatively treated patients. Current treatment guidelines could not be supported or refuted based upon the study results. The occupational and functional outcomes demonstrated in this study may assist surgeons in counseling patients on their planned treatment and anticipated recovery following a lesser metatarsal fracture. Full article

While Achilles tendon injuries are common amongst the general population, there are very few cases in which simultaneous bilateral injuries occur. Medial malleolar fractures at the time of Achilles tendon rupture have been cited in the literature and are commonly missed. The following case outlines the presentation, treatment, and outcome of a United States Army Soldier with simultaneous bilateral Achilles tendon ruptures in addition to a unilateral right medial malleolar fracture. This patient was able to completely return to duty within 1 year after being treated with ORIF of the medial malleolus, bilateral end-to-end repair of the AT, and accelerated rehabilitation beginning at 2 weeks on the left and 6 weeks on the right. Full article

Rotator cuff (RC) disease, defined as any pathological state of the rotator cuff, is one of the most common shoulder conditions worldwide. It accounts for 70% of shoulder pain and dysfunction in adults and is the third most prevalent musculoskeletal disorder. Currently, the main issue with rotator cuff disease is that surgery represents the most common treatment performed. However, rotator cuff surgeries have a high failure rate positively correlated with the severity of the tear, and a high re-tear rate. This review will focus on the current research perspectives of rotator cuff repairs as well as new advances in the field. Current research is shifting its focus to target the healing and tendon repair process in an aim to decrease the failure rates. The bulk of research right now is within biologic methods based on growth factors, repair scaffolds, and stem cells that promote healing. Among this, researchers are continuously trying to improve surgical techniques. The complement of both methods should pave the way for much more effective, longer-lasting rotator cuff repairs. Full article

Shoulder surgery has radically evolved within the last 70 years, from a marginal orthopedic sub-specialty to an area of great research and advancement; consequently, anesthetic techniques have undergone important development. In fact, a wide variety of anesthetic strategies have emerged, to provide anesthesia and post-operative analgesia: general anesthesia (GA), regional anesthesia (RA), or combined GA and RA. A literature review on online databases was carried out about the different anesthetic approaches for shoulder surgery and their evolution through the years, taking in consideration papers from 1929 to 2021. A comprehensive preoperative assessment of patients undergoing shoulder surgery allows to identify and modify potential risk factors and complications of general anesthesia. Moreover, the use of ultrasound-guided regional blocks could improve the effectiveness of these techniques and bring better postoperative outcomes. Anesthetic management for shoulder surgery has progressed drastically during the last century. More studies are needed to finally standardize anesthetic techniques for specific procedure. Full article

Sarcopenia and osteoporosis are associated with morbidity and mortality. The development and progression of these two interrelated conditions are related to genetic and lifestyle factors, including nutrition and physical activity. Restrictions placed on individuals due to the COVID-19 pandemic and infection have led to widespread lifestyle modifications, with data suggesting a negative impact on physical activity levels. There is an urgent need to understand the effect of the pandemic on musculoskeletal health in older adults, at a time when COVID-19 infection and restrictions remain a barrier to research studies. We tested the feasibility of recruiting local community-dwelling older people to establish a new cohort investigating musculoskeletal health—the Southampton Longitudinal Study of Ageing (SaLSA). We invited 1993 community-dwelling older adults registered at the Living Well GP partnership in Southampton, UK, to participate in a study. Questionnaires were completed by participants on health, lifestyle, medication use, comorbidities, physical activity, nutrition, sarcopenia, osteoporosis, and quality of life. Permission was sought for future contact. Descriptive statistics were used on the initial pilot of 175 returned questionnaire data. The median age of participants was 80.4 years in both sexes, 81.3 years (77.9–84) in females, and 81.1 years in males (77.3–83.6). The majority (N = 168/171, 98%) of participants were of white Caucasian background; 36/53 (68%) female participants and 38/119 (32%) male participants lived alone. Over 80% (295/353) consented to be contacted for future studies. Recruitment of participants from a primary care practice into a research study was feasible. The next steps are to perform detailed musculoskeletal phenotyping through physical performance measures, grip strength dynamometry, DXA scanning, high-resolution peripheral quantitative computed tomography (HRpQCT), thigh ultrasound, and muscle biopsy, in a subset of participants. Our vision for SaLSA is to build a platform for discovery science and mechanistic studies, with the goal of improving the health care of older people. Full article

Objective: This study aimed to investigate the barriers to adopting lifestyle factors other than physical activity important for optimal peak bone mass (PBM) acquisition—namely, dietary factors, avoidance of cigarette smoking, and keeping alcohol consumption within recommended limits. Materials and Methods: University students and staff aged 18–35 years were recruited. Six semi-structured, in-depth focus group interviews were conducted with a total of 28 participants. The interviews were digitally recorded and transcribed. A thematic approach for data analysis using a constant comparative method was performed using NVivo software. Results: Three major themes emerged: socio-cultural barriers (peer pressure and cultural norms); personal barriers (time, cost, and diet preferences); and other barriers (medical illness and lack of symptoms associated with low bone mass density). Conclusions: We identified several barriers to adoption of lifestyle behaviours that might be beneficial to PBM acquisition. These data might facilitate the development of public health interventions designed to help young adults embrace osteoprotective lifestyles, and hence reduce the burden of osteoporotic fracture in later life. Full article

Osteogenesis imperfecta (OI) often results in recurrent fractures and/or progressive bowing of the long bones, including the arms. Upper extremity deformity has been shown to negatively impact function. The objective of this retrospective case series is to assess the ability to correct deformity, improve function and evaluate the complications and revision rates in our patients with OI who have undergone forearm deformity correction. A retrospective study, approved by The University of Nebraska Medical Center Institutional Review Board, was conducted with OI patients who underwent forearm osteotomy and fixation of one or both forearm bones between December 2011 and August 2018. There were no exclusion criteria. The electronic medical records were reviewed for patient demographics, surgical details, revisions and complications. A total of 48 procedures on 27 forearms in 18 patients were performed during the study. Surgery was performed in children with forearm deformity and recurrent fractures that were interfering with function. Half of the patients had surgery on one forearm and half had surgery on both forearms. The majority of the patients have Type III OI. There were multiple complications, the most common being wire migration which required either replacement or advancement of the wire. In conclusion, forearm deformity in OI is possible, with good healing of osteotomies and fractures, although many patients may require multiple surgical interventions. Full article

MicroRNAs (miRNA) are a class of short noncoding RNA that play important roles in controlling gene expression. Many miRNAs have been identified as being important regulators of bone cell function, thus affecting the bone remodeling processes. In addition to being expressed in specific tissues and exerting intracellular effects, miRNAs can enter the blood where they can be taken up by other tissues. These circulating miRNAs (c-miRNA) also have clinical significance as biomarkers of musculoskeletal diseases as they are tissue-specific, are stable and easily detectable, and require minimally invasive procedures. This mini-review discusses miRNAs with regulatory roles in bone metabolism and c-miRNA responses to acute bouts of resistance exercise. MiRNA responses (e.g., upregulation/downregulation of expression) vary depending on the resistance exercise protocol characteristics and the age of the participants. There are gaps in the literature that need to be addressed as most of the resistance exercise studies focused on miRNAs that regulate skeletal muscle in male participants. Full article

OsteogenesisImperfecta (OI) is a rare disease with respiratory problems, which are usually attributed to the secondary effects of scoliosis and rib fractures and to severe restrictive pulmonary disease. Conventional morphometry has already been studied in OI patients but three-dimensional geometric morphometrics (3D GMM) has never been used to assess how the thoracic spine shape changes during maximal breathing. A total of 6 adult subjects with OI type III and 16 healthy controls underwent a spirometric study and two computed tomography scans in maximal inspiration and expiration. Shape data by means of 3D GMM and Cobb angle values of scoliosis and kyphosis were obtained and their relationship with spirometric values was analysed using regressions and mean shape comparisons. No differences in kyphosis (p = 0.285) and scoliosis Cobb values (p = 0.407) were found between inspiration and expiration in OI patients. The 3D GMM analysis revealed significant shape differences between OI and control subjects (p < 0.001) that were related to the inspiration (p = 0.030) and not to the expiration (p = 0.079). Nevertheless, no significant relation was found between thoracic spine shape, scoliosis, kyphosis and breathing outcomes in both OI patients and controls. There were thoracic spine shape differences during maximal breathing between OI patients and controls that were mainly related to the inspiration. Full article

Background: Due to the aging of the world population, the number of joint diseases, along with the number of arthroplasties, has increased, simultaneously increasing the amount of complications, including periprosthetic joint infection (PPI). In this study, to combat a PPI, we investigated the antimicrobial properties of the new composite cover for titanium implants, silver-doped carbyne-like carbon (S-CLC) film. Methods: The first assay investigated the antimicrobial activity against Pseudomonas aeruginosa and releasing of silver ions from S-CLC films into growth media covered with S-CLC with a thickness of 1, 2, and 4 mm. The second assay determined the direct antibacterial properties of the S-CLC film’s surface against Staphylococcus aureus, Enterococcus faecalis, or P. aeruginosa. The third assay studied the formation of microbial biofilms of S. aureus or P. aeruginosa on the S-CLC coating. Silver-doped carbyne-like carbon (S-CLC)-covered or titanium plates alone were used as controls. Results: S-CLC films, compared to controls, prevented P. aeruginosa growth on 1 mm thickness agar; had direct antimicrobial properties against S. aureus, E. faecalis, and P. aeruginosa; and could prevent P. aeruginosa biofilm formation. Conclusions: S-CLC films on the Ti surface could successfully fight the most common infectious agent in PPI, and prevented biofilm formation. Full article

Due to the high prevalence of opioid prescription following orthopedic procedures, there is a growing need to establish an animal model system to evaluate the effects of opioids on bone remodeling. Rabbits have been employed as model organisms in orthopedic research as they exhibit well-defined cortical bone remodeling similar to humans. Existing research in rabbits has been limited to modes of opioid administration that are short-acting and require repeated application. Here, we present data from a proof-of-principle longitudinal study employing two opioid analgesic administration routes (subcutaneous injection and transdermal patch) to evaluate the efficacy of studying chronic opioid exposure in a rabbit model. Skeletally mature male New Zealand White rabbits (Oryctolagus cuniculus) were divided into three groups of seven animals: morphine, fentanyl, and control. Experimental treatments were conducted for eight weeks. Preparation of the skin at the fentanyl patch site and subsequent patch removal presented experimental difficulties including consistent skin erythema. Though noninvasive, the patches further caused acute stress in fentanyl animals. We conclude that though transdermal fentanyl patches may be preferred in an acute clinical setting, this method is not feasible as a means of long-term pain relief or opioid delivery in a laboratory context. Full article

Cellular therapy offers regeneration which curbs osteoarthritis of the knee. Among cellular therapies, mesenchymal stromal cells (MSCs) are readily isolated from various sources as culture expanded and unexpanded cellular population which are used as therapeutic products. Though MSCs possess a unique immunological and regulatory profile through cross-talk between MSCs and immunoregulatory cells (T cells, NK cells, dendritic cells, B cells, neutrophils, monocytes, and macrophages), they provide an immunotolerant environment when transplanted to the site of action. Immunophenotypic profile allows MSCs to escape immune surveillance and promotes their hypoimmunogenic or immune-privileged status. MSCs do not elicit a proliferative response when co-cultured with allogeneic T cells in vitro. MSCs secrete a wide range of anti-inflammatory mediators such as PGE-2, IDO, IL-1Ra, and IL-10. They also stimulate the resilient chondrogenic progenitors and enhance the chondrocyte differentiation by secretion of BMPs and TGFβ1. We highlight the various mechanisms of MSCs during tissue healing signals, their interaction with the immune system, and the impact of their lifespan in the management of osteoarthritis of the knee. A better understanding of the immunobiology of MSC renders them as an efficient therapeutic product for the management of osteoarthritis of the knee. Full article

Patellar instability is a common pathology of the knee in pediatric patients. The management of this condition can be a challenge for the orthopedic surgeon, and a comprehensive understanding of the anatomy and biomechanics of the structures around the knee is of utmost importance in formulating a treatment plan. Predisposing factors can be related to: trochlear and patellar morphological abnormalities, ligamentous stabilizers, limb geometries in the axial plane, and patellar height abnormalities. Traditionally, first-time dislocators have been treated non-operatively; however, recent evidence suggests that certain factors are related to recurrent instability, and surgical treatment may be considered even after the first dislocation. It is important to keep in mind that younger children with open physes are not suitable candidates for certain surgical techniques. In this comprehensive review, we aimed to focus on the most up-to-date information on this topic and emphasize the importance of individualizing the treatment of pediatric patients. Full article

(1) Objectives: A little is known about the prevalence of the “risk of osteoporosis (RO)” and the factors associated with RO among Bangladeshi adults. Using a cost-effective testing tool, this study aimed to investigate the prevalence of RO and find the association between age, gender, and morbidity with RO among adults in Bangladesh. (2) Results: Among 526 subjects, the prevalence of RO was 37.3%. Gender (p =< 0.001), age (p = 0.003), diabetes (p = 0.003), cardiovascular disease (p =< 0.001) and multimorbidity (p =< 0.001) were associated with RO. The causal relationships, by adjusting confounders in the associations of RO and other variables, were depicted graphically. (3) Conclusion: The pattern of association between gender and age with RO was different and exclusive. Different approaches might be needed to alleviate the high burden of RO considering the subjects’ age, gender, and multimorbidity. Full article

Background: Persistent tendon pain and swelling related to mechanical loading are the main signs of Achilles tendinopathy (AT). This condition is one of the most common tendinopathies of the lower limb affecting mainly athletes involved in running and jumping sports. Methods: we included pivotal papers retrieved from the literature (Pubmed, Google Scholar, PEDro, and Scopus) to present an overview of the management of AT, with a specific focus on conservative management. Results: An accurate and timely diagnosis of AT is necessary to set up early treatments and to manage the problem conservatively. Diagnosis is primarily based on clinical assessment; instrumental imaging may be helpful in confirming the clinical diagnosis. Conservative treatment is effective in most cases, mainly using physical exercise based on eccentric training. Other non-surgical treatments such as extracorporeal shock wave therapy, thermotherapies, and injections can be added to exercise. Surgical treatment is indicated for patients where the conservative treatments of at least six months fails. Conclusions: Conflicting results from numerous studies hamper to identify gold standard treatments asking for further well-conducted level I and II research about the management of AT. Full article

The field of tissue engineering has revolutionized the world in organ and tissue regeneration. With the robust research among regenerative medicine experts and researchers, the plausibility of regenerating cartilage has come into the limelight. For cartilage tissue engineering, orthopedic surgeons and orthobiologists use the mesenchymal stromal cells (MSCs) of various origins along with the cytokines, growth factors, and scaffolds. The least utilized MSCs are of dental origin, which are the richest sources of stromal and progenitor cells. There is a paradigm shift towards the utilization of dental source MSCs in chondrogenesis and cartilage regeneration. Dental-derived MSCs possess similar phenotypes and genotypes like other sources of MSCs along with specific markers such as dentin matrix acidic phosphoprotein (DMP) -1, dentin sialophosphoprotein (DSPP), alkaline phosphatase (ALP), osteopontin (OPN), bone sialoprotein (BSP), and STRO-1. Concerning chondrogenicity, there is literature with marginal use of dental-derived MSCs. Various studies provide evidence for in-vitro and in-vivo chondrogenesis by dental-derived MSCs. With such evidence, clinical trials must be taken up to support or refute the evidence for regenerating cartilage tissues by dental-derived MSCs. This article highlights the significance of dental-derived MSCs for cartilage tissue regeneration. Full article