An investigation of composition, morphology, mechanical properties, and microdamage accumulation of human type 2 diabetic bone.

This study investigates the biomechanics of type 2 diabetic bone fragility through a multiscale experimental strategy that considers structural, mechanical, and compositional components of ex vivo human trabecular and cortical bone. Human tissue samples were obtained from the femoral heads of patients undergoing total hip replacement. Mechanical testing was carried out on isolated trabecular cores using monotonic and cyclic compression loading and nanoindentation experiments, with bone microdamage analysed using micro-computed tomography (CT) imaging. Bone composition was evaluated using Raman spectroscopy, high-performance liquid chromatography, and fluorometric spectroscopy. It was found that human type 2 diabetic bone had altered mechanical, compositional, and morphological properties compared to non-type 2 diabetic bone. High-resolution micro-CT imaging showed that cores taken from the central trabecular region of the femoral head had higher bone mineral density (BMD), bone volume, trabecular thickness, and reduced trabecular separation. Type 2 diabetic bone also had enhanced macro-mechanical compressive properties under mechanical loading compared to non-diabetic controls, with significantly higher apparent modulus, yield stress, and pre-yield toughness evident, even when properties were normalised against the bone volume. Using nanoindentation, there were no significant differences in the tissue-level mechanical properties of cortical or trabecular bone in type 2 diabetic samples compared to controls. Through compositional analysis, higher levels of furosine were found in type 2 diabetic trabecular bone, and an increase in both furosine and carboxymethyl-lysine (an advanced glycation end-product) was found in cortical bone. Raman spectroscopy showed that type 2 diabetic bone had a higher mineral-to-matrix ratio, carbonate substitution, and reduced crystallinity compared to the controls. Together, this study shows that type 2 diabetes leads to distinct changes in both organic and mineral phases of the bone tissue matrix, but these changes did not coincide with any reduction in the micro- or macro-mechanical properties of the tissue under monotonic or cyclic loading.

Single-surgeon perspective: is there ever a need to open extension-type supracondylar fractures?

BACKGROUND: Supracondylar humerus fractures (SCHFs) represent the most common pediatric elbow fracture, constituting approximately 12-17% of all pediatric fractures. The vast majority of operative supracondylar humerus fractures are treated with closed reduction and percutaneous pinning (CRPP); however, the estimated rate of SCHFs requiring open reduction is approximately 12.7%. AIM: This study aims to analyze the likelihood of open reduction in pediatric extension-type SCHFs and to reaffirm the traditional teaching of reduction techniques described by Smith and Rang. METHODS: A single-surgeon retrospective analysis of 56 operative pediatric SCH cases (51 extension-type, 6 flexion-type) who underwent either CRPP or open reduction over a 16-year period was performed. All cases were performed using the aforementioned reduction technique. The Modified Gartland's classification was utilized in the analysis of extension-type SCHF radiographs. RESULTS: Gartland IIA fractures constituted 38% of SCHFs, 9% of Gartland IIB, 43% of Gartland III, and 7% of flexion-type. The rate of open reduction in SCHFs was 1.8% (1 out of 56 cases), performed in a flexion-type injury. All extension-type fractures were successfully managed with either CRPP or manipulation and casting alone. Of the cases requiring CRPP, 45% were divergent lateral wires, and 55% were crossed wires. CONCLUSIONS: In our series, a 1.8% rate of open reduction was indicated in flexion-type SCH fractures. All 52 cases of extension-type SCHFs were successfully managed with closed reduction with or without percutaneous pinning. Successful closed reduction using the concept of intact periosteal hinge to aid and maintain reduction is crucial.

Spinal metastasis: The rise of minimally invasive surgery.

INTRODUCTION: Bone is the third most common site of metastatic cancer, of which the spine is the most frequently involved. As metastatic cancer prevalence rises and surgical techniques advance, operative intervention for spinal metastases is expected to rise. In the first operative cohort of spinal metastasis in Ireland, we describe the move towards less invasive surgery, the causative primary types and post-operative survival. METHODS: This is a retrospective cohort study of all operative interventions for spinal metastasis in a tertiary referral centre over eight years. Primary spinal tumours and local invasion to the spine were excluded. Median follow up was 1895 days. RESULTS: 225 operative procedures in 196 patients with spinal metastasis were performed over eight years. Average cases per year increased form 20 per year to 29 per year. Percutaneous procedures became more common, accounting for the majority (53%) in the final two years. The most common primary types were breast, myeloma, lung, prostate and renal. Overall survival at 1 year was 51%. Primary type was a major determinant of survival, with breast and the haematological cancers demonstrating good survival, while lung had the worst prognosis. CONCLUSION: This is the first descriptive cohort of operative interventions for spinal metastasis in an Irish context. Surgery for spinal metastasis is performed at an increasing rate, especially through minimally-invasive means. The majority of patients survive for at least one year post-operatively. Prudent resource planning is necessary to prepare for this growing need.

Transmission electron microscopy and histological analysis of the peridural membrane.

INTRODUCTION: While first described in 1904, the characterisation of the peridural membrane, which is frequently encountered, yet usually unnoticed, during lumbar decompression surgery, remains inconclusive. This relatively little known membrane is continuous with the posterior longitudinal ligament and lines the epidural space. In this study, we are comparing the membrane and ligamentum flavum from patients to analyse the variations of the histological and ultrastructural compositions. MATERIALS AND METHODS: We took samples of the membrane and ligamentum flavum from five separate patients who were undergoing lumbar spine decompression surgery for herniated discs which were then analysed with transmission electron microscopy and stained with H&E (morphology), trichrome (collagen content), and Verhoeff-Van Gieson (elastin content). RESULTS: Upon analysis of the peridural membrane, we observed tightly packed collagen fibres, interspaced with elastin fibres and very few fibroblasts. While the ligamentum flavum showed a significantly higher elastin to collagen ratio and looser arrangement of collagen fibres with a larger extracellular matrix. The peridural membrane was similar in appearance and constituent parts to the dura mater. CONCLUSION: The peridural membrane is a distinctive and important membrane in the spinal canal, and given its high collagen to elastin ratio and it tightly packed nature, we conclude that it forms a protective layer around the spinal cord which may help in minimising the compressive nature of intervertebral disc herniation.

Occipitocervical fusion - An epidemiological drift experienced in an Irish tertiary spinal referral center: Twenty-year follow-up study.

BACKGROUND: Occipitocervical disease is common in the elderly population, and is on the rise due to an increasingly aging population. METHODS: We retrospectively reviewed all patients who underwent occipitocervical fusion in our institution over a 20 year period (1996-2016) at a tertiary spinal referral centre. Patients were divided in 2 groups. Group A included all patient who underwent OCF in the first decade between 1996 and 2005. Group B was all patients who underwent OCF in the second decade between 2006 and 2016. RESULTS: A total of 23 patients underwent occipitocervical fusion between 1996 until 2016 at our institution. Instability secondary to Rheumatoid arthritis was the leading factor in group A, responsible for 43 percent of cases. In group B, trauma was the leading burden accounting for 44 percent of the cases. In contrast to Group A however, only 19 % of OCFs occurred secondary to RA in group B. Our fusion rate was 96 percent with a survival rate of 67 percent. CONCLUSION: We noticed a clear epidemiological drift in the cervical spine pathologies requiring OCF during the first and second decade of study period with an increase in prevalence of pathological fractures secondary to metastatic disease. In addition, a drop in rheumatoid cervical disease requiring OCF has been noted.

Do "Myths" of low back pain exist among Irish population? A cross-sectional study.

INTRODUCTION: Low back pain remains major public health problem in the Western industrialized world. The known prevalence of low back pain in Ireland is approximately 13 %. It is one of the leading causes of sickness compensation and disability pension in our justification. We hypothesized that there is a widespread misconception about the perception of low back pain among the Irish population. The aim of this study was to investigate whether the "Myths" of low back pain existed among the Irish population. MATERIALS AND METHODS: We carried out a cross-sectional study in the Republic of Ireland from April 2013 to August 2013. The Irish population who visited Galway University Hospital, Galway, Ireland, was contacted randomly at point of entry to the hospital. During the survey, the authors obtained verbal consent before handing the questionnaire, which contained the Deyo's seven myths. The responders were asked to mark their response in a three-point scale (agree, unsure, disagree) to the seven statements. RESULTS: Out of 500 responders, 59 (11.8 %) people answered none of the questions correctly. Fifty-six (11.2 %) answered one question correctly, 106 (21.2 %) answered two questions correctly, 85 (17 %) people disagreed with three myths, 88 (17.6 %) disagreed with four myths, 55 (11 %) people answered five questions correctly, and 34 (6.8 %) answered six questions correctly. Therefore, only 17 (3.4 %) people disagreed with all the seven myths. CONCLUSION: In conclusion, this cross-sectional study showed that myths of low back pain widely exist among Irish population studied . The level of education played an important role. The findings from this study suggest that public health information regarding low back pain is inadequate and has not affected attitudes to low back pain in an Irish population.

Irreducible Pulled Elbow in an Adolescent. A Case Report.

We present a case of pulled elbow in an adolescent patient that required open reduction.