Trends in Cemented Fixation in Hemiarthroplasty for Hip Fractures in Canada.

Bacground: The use of cemented fixation is widely recommended in hip arthroplasty for hip fractures, although it is not used universally. Methods: We describe the trends in cementing prevalence in hemiarthroplasty for hip fractures in Canada for patients ≥55 years old between April 2017 and March 2022. Results: The national prevalence of cemented fixation increased from 43% in 2017/18 to 58% in 2021/22, but there was a large variety of both the baseline prevalence and the trends across the country and between individual hospitals. The proportion of surgeons only performing cementless fixation fell from 30% to 21% between 2018/19 and 2021/22. Conclusions: As cemented fixation is now universally recommended, more coordination is needed to track these trends and to help drive implementation of this evidence-based practice across Canada.

Curettage of lesion combined with reconstruction of intramedullary nail and bone cement for the treatment of subtrochanteric metastatic tumors of the femur.

This study investigated subtrochanteric femoral metastases using a retrospective approach by analyzing data from 109 patients with bone metastases (2015-2019). Surgical methods were compared: curettage with intramedullary nail and bone cement versus prosthetic reconstruction. Post-surgical assessments included joint function, bone metastasis-related serum markers, and complications. Univariate and multivariate logistic regression analysis was used to screen independent risk factors affecting patients' prognosis. R language was used to construct a nomogram model for predicting patients' 1- and 2-year survival, which was validated through ROC curves and the calibration chart. Patients treated with curettage showed superior postoperative outcomes, exhibiting significantly higher Karnofsky Performance Status (KPS) scores (80.00 vs. 70.00, P < 0.001) and Musculoskeletal Tumor Society Scores (MSTS) (23.86 ± 2.57 vs. 21.67 ± 3.24, P < 0.001). Both methods demonstrated comparable efficacy in pain control (VAS: 3.00 vs. 3.00, P > 0.05) and bone metabolism impact (ALP: 85.93 ± 14.44 vs. 83.19 ± 21.19; CTX-I: 3.03 ± 1.56 vs. 3.15 ± 1.75; PINP: 10.30 ± 4.41 vs. 11.57 ± 3.90; all P > 0.05). Cox regression identified treatment regimen, age, diabetes, and pre-treatment KPS score as significant survival factors (all P < 0.05). The nomogram model demonstrated high accuracy in predicting one-year and two-year survival (AUC: 0.821 and 0.790, respectively). In conclusion, curettage with intramedullary nail and bone cement enhances postoperative functional recovery and quality of life for subtrochanteric femoral metastases patients, representing a promising treatment method.

Cure State Sensing of Polymethylmethacrylate Using a Vibrating Axial Probe.

A new axially vibrating sensor based on an audio voice coil transducer and a lead zirconate titanate (PZT) piezoelectric disc microphone was developed as a probe for the measurement of in vitro rheological fluid properties, including curing progress for polymethylmethacrylate (PMMA) mixtures with important uses as bone cement in the field of orthopedics. The measurement of the vibrating axial sensor's acoustic spectra in PMMA undergoing curing can be described by a damped harmonic oscillator formalism and resonant frequency (ca. 180 Hz) shift can be used as an indicator of curing progress, with shifts to the blue by as much as 14 Hz. The resonant frequency peak was measured in 19 different 4.0 g PMMA samples to have a rate of shift of 0.0462 ± 0.00624 Hz·s-1 over a period of 400 s while the PMMA was in a dough state and before the PMMA transitioned to a hard-setting phase. This transition is unambiguously indicated by this sensor technology through the generation of a distinct circa 5 kHz high-Q under-damped ring-down response.

Biomechanical evaluation of screw and cement placement strategies for treating medial uncontained tibial defects in total knee arthroplasty: A finite element analysis.

Total knee arthroplasty faces challenges in the management of medial uncontained tibial defects, affecting prosthesis stability and implant survival. The use of screws and bone cement is a preferred approach; however, optimal screw insertion techniques lack consensus in the existing literature. The present study aimed to address this gap by exploring optimal screw and cement placement strategies, focusing on their biomechanical implications. The present study conducted a finite element analysis using a knee prosthesis model with a defined uncontained tibial defect. Various parameters were systematically adjusted, including the number of screws (1, 2 or 3 screws), screw lengths (10, 18, 30 or 40 mm), lateral-medial screw positions (2, 4 or 6 mm laterally) and abduction rotation angles (0, 5, 10 or 15 degrees). These adjustments were made to evaluate their specific and combined impacts on the vertical displacement and abduction angles of the tibial tray. The results revealed that incorporating three-screw reinforcement markedly reduced vertical displacement, while the single screw in the middle position exhibited superior performance in preventing the deformation of abduction angles compared to scenarios with two screws at anterior and posterior positions without a middle screw. Longer screws and smaller abduction angles contributed to decreased movement of the tibial component. Furthermore, the lateral adjustment of the screw position led to an increase in vertical displacement values, reaching ~1.5% when shifted 6 mm laterally. On the whole, the finite element analysis in the present study suggests that, for the treatment of medial uncontained tibial defects, three-screw reinforcement is advantageous for larger defects. Longer screws and a smaller abduction angle are deemed favorable. Moreover, the results underscore the superiority of medial screw placement over lateral placement. It is imperative to note that further clinical validation is essential to corroborate the biomechanical implications observed herein.

Comparable bone penetration between antibiotic-loaded and plain bone cement in total knee arthroplasty.

INTRODUCTION: One of the main concerns around the use of antibiotic-loaded bone cement (ALBC) is the potential reduction in the mechanical properties of the cement when antibiotics are admixed. The purpose of this study was to determine whether there is a difference between plain cement and ALBC in terms of radiological intrusion into the bone in total knee arthroplasties (TKAs). METHODS: Prospective randomized study of 80 consecutive patients who underwent TKA. Depending on the cement used, patients were divided into two groups by a computer-generated randomization programme: the cement without antibiotic (Group 1) or the ALBC (Group 2). Cement intrusion was measured in postoperative radiographs in eight different regions in the tibial component and six regions in the femoral component. RESULTS: The average cement intrusion was similar in both groups (p = nonsignificance [n.s.]). Group 1 (plain cement) had an average cement intrusion in the femur of 1.4 mm (±0.4) and 2.4 mm (±0.4) in the tibia. In Group 2 (ALBC), the average cement intrusion in the femur came to 1.6 (±0.5) and 2.4 mm (±0.5) in the tibia. In 80% of the patients, the cement intrusion in the tibia averaged a minimum of 2 mm, being similar in both groups (p = n.s.). CONCLUSION: There are no differences in bone intrusion when comparing plain cement to ALBC. Therefore, the use of ALBC in primary TKA may be indicated, achieving optimal bone penetration. LEVEL OF EVIDENCE: Level I.

Antibiotic-loaded bone cement is associated with a reduction of the risk of revision of total knee arthroplasty: Analysis of the Catalan Arthroplasty Register.

PURPOSE: The purpose of this study was to analyse the impact on peri-prosthetic joint infection (PJI) rate and prosthetic survival using antibiotic-loaded bone cement (ALBC) versus plain cement during total knee arthroplasty (TKA). METHODS: A retrospective cohort study was conducted. The main data source was the Catalan Arthroplasty Register (RACat). TKAs with surgery date between 1 January 2011 and 31 December 2020 were analysed and followed up until 31 December 2023. The main variable of interest was the type of cement (ALBC vs. plain cement), and several endpoints (septic revision, aseptic revision, and all-cause revision) were considered. The analysed outcomes were revision rates, survival rates and risk factors' hazard ratios (HR). RESULTS: A total of 22,781 TKAs were analysed, 13,125 (57.6%) of them with plain cement and 9656 (42.4%) with ALBC. The septic revision rate was lower in the ALBC group after 3 months of follow-up (0.52% vs. 0.78%, p value = 0.04). Prosthetic survival with respect to the aseptic revision endpoint was also higher for the ALBC group during the whole follow-up period (~158 months). Regarding risk factors for infection, ALBC showed a protective effect, HR: 0.53 (0.44, 0.63), while sex (being male) and the analysed comorbidities increased the risk. CONCLUSIONS: ALBC is associated with a reduction in both the septic revision and the aseptic revision rate after TKA, and thus with higher prosthetic survival. LEVEL OF EVIDENCE: Level III, Therapeutic, retrospective.

Preparation and efficacy of antibacterial methacrylate monomer-based polymethyl methacrylate bone cement containing N-halamine compounds.

Introduction: Our objective in this study was to prepare a novel type of polymethyl methacrylate (PMMA) bone cement, analyze its material properties, and evaluate its safety and antibacterial efficacy. Methods: A halamine compound methacrylate antibacterial PMMA bone cement containing an N-Cl bond structure was formulated, and its material characterization was determined with Fourier transform infrared spectroscopy (FT-IR) and 1H-NMR. The antibacterial properties of the material were studied using contact bacteriostasis and releasing-type bacteriostasis experiments. Finally, in vitro and in vivo biocompatibility experiments were performed to analyze the toxic effects of the material on mice and embryonic osteoblast precursor cells (MC3T3-E1). Results: Incorporation of the antibacterial methacrylate monomer with the N-halamine compound in the new antibacterial PMMA bone cement significantly increased its contact and releasing-type bacteriostatic performance against Staphylococcus aureus. Notably, at 20% and 25% additions of N-halamine compound, the contact and releasing-type bacteriostasis rates of bone cement samples reached 100% (p < 0.001). Furthermore, the new antibacterial bone cement containing 5%, 10%, and 15% N-halamine compounds showed good biocompatibility in vitro and in vivo. Conclusion: In this study, we found that the novel antibacterial PMMA bone cement with N-halamine compound methacrylate demonstrated good contact and releasing-type bacteriostatic properties against S. aureus. In particular, bone cement containing a 15% N-halamine monomer exhibited strong antibacterial properties and good in vitro and in vivo biocompatibility.

Analgesic eluting bone cement: A novel approach for targeted pain management in total knee arthroplasty - An in-vitro study.

BACKGROUND: The average rate of patient dissatisfaction following total knee arthroplasty (TKA) is 10%. Multi-modal analgesia is the present standard of pain management after TKA. Studies show that with multi-modal analgesia, approximately 60% of patients experience severe knee pain following surgery, while around 30% experience moderate pain. To date, there is no literature available on targeted pain management using bone cement. OBJECTIVES: To investigate the feasibility of incorporating anti-inflammatory medications and identify the analgesic with the best release pharmacokinetics from bone cement for application in pain management. METHODS: In an in-vitro study, 100 mg of five drugs (aceclofenac, diclofenac, naproxen, paracetamol and methyl prednisolone) were incorporated into bone cement (Palacos). Cement cubes holding each drug were made and allowed to harden for 30 min. Each drug-containing cube was placed in a beaker with saline for 72 h. Fractions of 10 ml were collected at 0, 6, 24, 48 and 72 h and analysed using high-pressure liquid chromatography to measure the percentage release of the drug from bone cement. RESULTS: Naproxen showed superior elution from bone cement, with 10.9% at 24 h and 9.08% at 72 h. Paracetamol showed 4.9% at 24 h and 3.78% at 72 h, aceclofenac 0.2% at 24 h and 0.4% at 72 h, diclofenac 3.03% at 24 h and 1.99% at 72 h, and methylprednisolone 0.26% at 24 h and 0.32% at 72 h. CONCLUSIONS: Polymethylmethacrylate bone cement can elute analgesics in vitro. Among the five drugs studied, naproxen had the best release kinematics from polymethylmethacrylate bone cement. Analgesic eluting bone cement is a novel approach for targeted postoperative pain management in TKA.

Rheological Analysis and Evaluation of Measurement Techniques for Curing Poly(Methyl Methacrylate) Bone Cement in Vertebroplasty.

Vertebroplasty is a minimally invasive surgical procedure used to treat vertebral fractures, which conventionally involves injecting poly(methyl methacrylate) (PMMA) bone cement into the fractured vertebra. A common risk associated with vertebroplasty is cement leaking out of the vertebra during the injection, which may occur due to a lack of understanding of the complex flow behavior. Therefore, experiments to quantify the cement's flow properties are necessary for understanding and proper handling of the bone cement. In this study, we aimed to characterize the behavior of PMMA bone cement in its curing stages to obtain parameters that govern the flow behavior during injection. We used rotational and oscillatory rheometry for our measurements, as well as a custom-made injector setup that replicated a typical vertebroplasty setting. Our results showed that the complex viscoelastic behavior of bone cement is significantly affected by deformations and temperature. We found that the results from rotational tests, often used for characterizing the bone cement, are susceptible to measurement artifacts caused by wall slip and "ridge"-like formations in the test sample. We also found the Cox-Merz rule to be conditionally valid, which affects the use of oscillatory tests to obtain the shear-thinning characteristics of bone cement. Our findings identify important differences in the measured flow behavior of PMMA bone cement when assessed by different rheological methods, an understanding that is crucial for its risk-free usage in downstream medical applications.

Static study and numerical simulation of the influence of cement distribution in the upper and lower adjacent vertebrae on sandwich vertebrae in osteoporotic patients: Finite element analysis.

Objective: We analyzed the influence of the location of the upper and lower cement on the sandwich vertebrae (SV) by computer finite element analysis. Materials and Methods: A finite element model of the spinal segment of T11-L1 was constructed and 6 mL of cement was built into T11 and L1 simultaneously. According to the various distributions of bone cement at T11 and L1, the following four groups were formed: (i) Group B-B: bilateral bone cement reinforcement in both T11 and L1 vertebral bodies; (ii) Group L-B: left unilateral reinforcement in T11 and bilateral reinforcement in L1; (iii) Group L-R: unilateral cement reinforcement in both T11 and L1 (cross); (iv) Group L-L: unilateral cement reinforcement in both T11 and L1 (ipsilateral side). The maximum von Mises stress (VMS) and maximum displacement of the SV and intervertebral discs were compared and analyzed. Results: The maximum VMS of T12 was in the order of size: group B-B < L-B < L-R < L-L. Group B-B showed the lowest maximum VMS values for T12: 19.13, 18.86, 25.17, 25.01, 19.24, and 20.08 MPa in six directions of load flexion, extension, left and right lateral bending, and left and right rotation, respectively, while group L-L was the largest VMS in each group, with the maximum VMS in six directions of 21.55, 21.54, 30.17, 28.33, 19.88, and 25.27 MPa, respectively. Conclusion: Compared with the uneven distribution of bone cement in the upper and lower adjacent vertebrae (ULAV), the uniform distribution of bone cement in the ULAV reduced and uniformed the stress load on the SV and intervertebral disc. Theoretically, it can lead to the lowest incidence of sandwich vertebral fracture and the slowest rate of intervertebral disc degeneration.

Related factors of severe osteoporotic vertebral compression fracture and clinical outcomes of percutaneous kyphoplasty: A retrospective study.

BACKGROUND: Osteoporosis is the most common disease in postmenopausal women and the elderly, which can lead to vertebral compression fracture. OBJECTIVE: To investigate the related factors of severe osteoporotic vertebral compression fracture (SOVCF) and evaluate the long-term outcomes of percutaneous kyphoplasty (PKP) for treating SOVCF through comparison with mild OVCF (MOVCF). METHODS: From September 2015 to March 2019, 294 osteoporotic vertebral compression fracture (OVCF) patients treated with PKP were analyzed. Compression of the anterior margin of the fractured vertebral body beyond 2/3 of the original height was defined as SOVCF. Baseline data, clinical and imaging findings before and after surgery and at the last follow-up were recorded. Numerical Rating Scale (NRS) was used to evaluate low back pain, the Oswestry Disability Index (ODI) was used to evaluate activity of daily life. Anterior vertebral height (AVH) and local kyphosis angle (LKA) was used to evaluate radiographic outcomes. During the follow-up, patients with recurrent back pain were examined by MRI to identify new fractures and the incidence of adjacent vertebral fracture (AVF) was recorded. Age, sex, body mass index (BMI), dual energy X-ray absorptiometry based T value, duration of symptom, history of trauma, steroid use, and fracture site were collected for univariate logistic regression analysis Variables with a P-value of less than 0.05 were then included in multivariate analysis to determine the related factors for SOVCF. RESULTS: Logistic regression analysis indicated that longer duration of symptom (OR = 1.109, 95%CI: 1.038-1.185, P= 0.002), lower T value (OR = 0.332, 95%CI: 0.139-0.763, P= 0.001), and steroid use (OR = 31.294, 95%CI: 1.020-960.449, P= 0.049) were related factors of SOVCF. Compared with the MOVCF group, the SOVCF group had longer operation time (57.3 ± 13.51 minutes vs 44.9 ± 8.13 minutes, P< 0.001), more radiation exposure (39.9 ± 7.98 times vs 25.5 ± 4.01 times, P< 0.001), and higher cement leakage rate (55.81% vs 18.73%, P< 0.001). At the last follow-up, the SOVCF group had higher NRS (2.28 ± 0.85 vs 1.30 ± 0.71, P< 0.001), and ODI (16.23 ± 4.43 vs 12.88 ± 3.34, P< 0.001). After operation and at the last follow-up, the SOVCF group had higher LKA and lower AVH (all P< 0.05). The AVF rate at the last follow-up was higher in the SOVCF group at the last follow-up (4.78% vs 18.60%, P< 0.001). CONCLUSION: Lower T value, longer duration of disease, and steroid use were related factors of SOVCF. Compared with MOVCF, PKP for SOVCF had longer operation time, more radiation exposure, and higher cement leakage rate, and the long-term outcomes were worsen.

[Therapeutic effect of calcaneal beak-like fracture secondary to calcaneal osteomyelitis caused by diabetic foot].

OBJECTIVE: To explore clinical effect of vancomycin calcium sulfate combined with internal fixation on calcaneal beak-like fracture secondary to calcaneal osteomyelitis caused by diabetic foot. METHODS: From April 2018 to October 2021, a retrospective analysis was performed on 5 patients with calcaneal bone osteomyelitis secondary to diabetic foot, including 2 males and 3 females, aged from 48 to 60 years old;diabetes course ranged from 5 to 13 years;the courses of diabetic foot disease ranged from 18 to 52 days;5 patients were grade Ⅲ according to Wagner classification. All patients were treated with debridement, vancomycin bone cement implantation, negative pressure aspiration at stageⅠ, vancomycin calcium sulfate and internal fixation at stageⅡfor calcaneal beak-like fracture. Surgical incision and fracture healing time were recorded, and the recurrence of osteomyelitis was observed. American Orthopedic Foot Andankle Society (AOFAS) score and exudation at 12 months after operation were evaluated. RESULTS: Five patients were successfully completed operation without lower extremity vascular occlusion, and were followed up for 16 to 36 months. The wound healing time after internal fixation ranged from 16 to 26 days, and healing time of fractures ranged from 16 to 27 weeks. AOFAS score ranged from 65 to 91 at 12 months after operation, and 2 patients got excellent result, 2 good and 1 fair. Among them, 1 patient with skin ulcer on the back of foot caused by scalding at 5 months after operation (non-complication), was recovered after treatment;the wound leakage complication occurred in 2 patients, and were recovered after dressing change. No osteomyelitis or fracture occurred in all patients. CONCLUSION: Vancomycin calcium sulfate with internal fixation in treating calcaneal osteomyelitis secondary to calcaneal osteomyelitis caused by diabetic foot could not only control infection, but also promote fracture healing, and obtain good clinical results.

Influence of the Advanced One-Step Mixing System Under Non-Vacuum on the Mechanical Properties of Acrylic Bone Cement.

Background: The specific aim of this study was to evaluate the mechanical properties of cement prepared with the advanced one-step mixing system and whether the addition of vacuum conditions yielded an appreciable improvement in the biomechanical strength or overall quality of bone cement. Methods: The advanced one-step mixing system was used. Twelve specimens were prepared by mixing under vacuum conditions and 12 specimens were prepared by mixing without a vacuum. Radiographs of cement specimens were analyzed to determine the porosity of the test region. Tensile testing of the specimens was performed with a loading rate of 2.54mm/min at room temperature. The ultimate tensile strength (UTS) and the tensile elastic modulus (E) were determined for each sample. Results: The UTS of the bone cement samples mixed under vacuum conditions were not significantly different than those mixed without vacuum (vacuum: 39±6MPa; non-vacuum: 35±6MPa; p=0.637). The E of samples mixed under vacuum conditions was significantly higher than the bone cement mixed without vacuum (vacuum: 2.78±0.06GPa; non-vacuum: 2.63±0.15GPa; p=0.019). Radiographic images showed samples mixed under vacuum conditions contained fewer defects than the samples mixed without vacuum (vacuum: 3.5%±3.3% (range: 0.0%-9.0%); non-vacuum: 6.9%±1.0% (range: 4.6%-8.2%)). Conclusion: Mixing bone cement with the advanced one-step mixing system under vacuum conditions does not produce an appreciable difference in the UTS of the bone cement in a bench biomechanical testing model compared to the bone cement mixed without vacuum. It does, however, create a less porous cement mixture with a higher E compared to cement mixed without vacuum. Level of Evidence: V.

Treatment of a Brodie's abscess manifesting as persistent pain after a twisting ankle injury: A case report.

INTRODUCTION: Cystic lesions in long bones are the radiological presentation of various bone pathologies, they can easily be misdiagnosed and thus mistreated; treatment varies from observation to aggressive surgical interventions based on the nature and characteristics of the lesion. CASE PRESENTATION: A 25-year-old male had a twisting injury to his ankle and his radiographs showed a cystic lesion in the distal tibia that was asymptomatic until he injured his ankle. he had persistent pain since then. and after conservative methods failure, a two-stage surgical intervention was done; first, we curetted the lesion and filled it with antibiotics cement; then the cement was removed with autologous bone grafting. The patient eventually healed and returned to his normal activity level. DISCUSSION: Brodie's abscess has a similar radiological appearance to other bone neoplasms and tumor-like lesions. Clinically, it is minimally symptomatic, and often initially misdiagnosed; surgical treatment is very effective, but it depends on the size, location, and aggressiveness of the lesion; the goal is to eliminate the infection, refill the residual gap, and restore the normal function, especially in weight-bearing bones. CONCLUSION: Brodie's abscess is a hideous lesion that is hard to diagnose. It could mimic other tumor-like lesions. However, applying bone cement and a second stage of bone grafting might help maximize the treatment efficiency.

Do High Doses of Multiple Antibiotics Loaded into Bone Cement Spacers Improve the Success Rate in Staphylococcal Periprosthetic Joint Infection When Rifampicin Cannot Be Employed?

Rifampicin is one of the mainstays in treating staphylococcal prosthetic joint infection (PJI). However, discontinuation due to intolerance, drug interactions, and adverse events is common. Two-stage revision surgery remains the gold standard, with the number of revision arthroplasties steadily increasing. This study aims to evaluate the effectiveness and safety of a novel two-stage revision protocol for staphylococcal prosthetic joint infection (PJI) utilizing bone cement spacers loaded with multiple high doses of antibiotics. Additionally, it seeks to analyze outcomes in patients ineligible for rifampicin treatment. A retrospective review of 43 cases of staphylococcal hip and knee prosthetic joint infections (PJIs) from 2012 to 2020 was conducted. In all instances, a commercial cement containing 1 g of gentamicin and 1 g of clindamycin, augmented with 4 g of vancomycin and 2 g of ceftazidime, was employed to cast a spacer manually after thorough surgical debridement. We report an eradication rate of 82%, with no significant differences observed (p = 0.673) between patients treated with (84%, n = 19) and without rifampicin (79%, n = 24). There were no disparities in positive culture rates (7%), spacer replacement (18%), or survival analysis (p = 0.514) after an average follow-up of 68 months (range 10-147) in the absence of systemic toxicity and surgical complications superimposable to those previously reported. In conclusion, two-stage revision with local high doses of ceftazidime, vancomycin, gentamicin, and clindamycin demonstrates high effectiveness in treating staphylococcal PJIs. Notably, systemic rifampicin does not influence the outcomes. This protocol, with multiple high doses of antibiotics loaded into the bone cement spacer, is presented as a viable and safe alternative for patients unsuitable for rifampicin treatment.

Quality of cementing in hemiarthroplasty for elderly neck of femur fractures does not affect short term functional outcomes.

INTRODUCTION: Cemented hip hemiarthroplasty is a routine surgical option for elderly neck of femur (NOF) fractures. It is uncertain if quality of cementing has any effect on functional outcomes. The aim of this study was to determine if the quality of cementing would affect short term functional outcomes in elderly neck of femur fractures. MATERIALS AND METHODS: Retrospective analysis of 637 single-centre cemented hip hemiarthroplasties from 2014 to 2021 was performed. Each post-operative radiograph was double-read by 2 authors (1 resident and 1 fellowship trained surgeon) to determine quality of cementing via the Barrack grading. Disagreements were reviewed by a third reader. Cement grades were grouped as Optimal (Barrack grade A-B), or Suboptimal (Barrack grade C-D). Functional outcomes were compared using mobility (community- or home-ambulant), assistance required for mobility, and Modified Barthel Index (MBI). Surgical parameters were compared between the groups. RESULTS: There were 429 Optimal and 208 Suboptimal cases of cementing performed. There was no difference in age, American Society of Anesthesiologists score, mobility, assistance required, and MBI score pre-operatively (p > 0.05). Patients in the "Suboptimal" cementing group had a higher Charlson Comorbidity Index (CCI) score (p < 0.001). At 1 year post-operation, there was no significant difference between "Optimal" and "Suboptimal" cementing with regards to the proportion of community ambulators (30.2% vs. 25.7%, p = 0.252), walking independence (independent walkers (19.8% vs.17.3%), independent walkers with aids (41.3%vs.42.1%), walker with caregiver assistance (29.2%vs.33.7%), wheelchair-bound (9.6%vs.6.9%), p = 0.478), and distribution of MBI score (81.1%vs.82.2% achieving MBI > 60, p = 0.767). There was no significant difference in the proportion of patients with postoperative delirium (7.9% vs. 5.8, p = 0.324) or 1-year mortality rates (3.5% vs. 2.9%, p = 0.685). Except for stem design (12.2% tapered vs 20.1% collared; p = 0.011), no other surgical parameters were significantly different. The kappa value for inter-reader agreement was "substantial" at 0.727 (95% CI 0.682-0.772) (p < 0.001). CONCLUSION: Quality of cementing in cemented hip hemiarthroplasty for elderly NOF fractures does not affect the short-term functional outcomes. In low demand patients and patients at risk of BCIS, optimal cementing may not be necessary to achieve similar short-term functional outcomes. Further studies should be conducted to determine the effect of sub-optimal cementing on long-term functional outcomes.

Adamantinoma of the ulna: A case report and literature review.

INTRODUCTION AND IMPORTANCE: Adamantinomas are rare, low-grade, malignant skeletal tumors accounting for only 0.33-0.48 % of primary malignant bone tumors. CASE PRESENTATION: An 11-year-old boy with adamantinoma of the ulna was treated with en bloc resection, kryptonite bone cement, and plate fixation. The surgery resulted in marked pain relief and good functional recovery. No evidence of recurrence was observed for 5 years postoperatively, and the Musculoskeletal Tumor Society score was 93. CLINICAL DISCUSSION: This case of an 11-year-old previously treated for an aneurysmal bone cyst (ABC) illustrates the complexity of diagnosing adamantinoma, especially in atypical locations like the ulna. The successful use of en bloc resection and synthetic bone graft highlights the importance of accurate diagnosis and advanced surgical methods in achieving favorable outcomes in pediatric orthopedic oncology. CONCLUSION: Ulnar adamantinomas are rare and can be difficult to diagnose. The successful treatment of this tumor, as described in this case report, can help guide the management of similar cases in the future.

A Comparative Study of 2 Techniques to Avoid Bone Cement Loosening and Displacement After Percutaneous Vertebroplasty Treating Unstable Kummell Disease.

OBJECTIVE: Percutaneous vertebroplasty (PVP) is currently the most common surgical procedure for unstable Kummell disease (KD), but cement loosening or displacement often occurs after PVP. We had been using percutaneous pediculoplasty (PPP) or a self-developed bone cement bridging screw system to avoid this severe complication. This study intends to compare these novel surgical procedures through a 2-year follow-up evaluation. METHODS: From May 2017 to May 2021, 77 patients with single-level unstable KD were included in the PPP group, and 42 patients received the PVP-bone cement bridging screw system were included in the screw group. The changes in the vertebral body index (VBI), bisegmental Cobb angle, visual analogue scale (VAS) and Oswestry Disability Index (ODI) and the cement loosening rate and displacement rate at different follow-up time points were used to evaluate the clinical efficacy. RESULTS: There was no significant difference in VBI or bisegmental Cobb angle between the 2 groups (p > 0.05) before operation, immediately after operation and at 6-month followup, while at 1-year and 2-year postoperative evaluations, the screw group had higher VBI and bisegmental Cobb angle than the PPP group (p < 0.05). Before operation, immediately after operation, at 6-month and 1-year follow-up, there was no significant difference in VAS or ODI score between the 2 groups (p > 0.05), while at 2-year follow-up, the screw group still had higher VAS and ODI scores than the PPP group (p < 0.05). No bone cement displacement occurred in both groups, but the rate of bone cement loosening was 14.29% in group PPP, and 0 in screw group (p < 0.05). CONCLUSION: This 2-year follow-up study shows that the PVP-bone cement bridging screw system combined therapy had better midterm treatment efficacy than the PVP-PPP combined therapy in patients with unstable KD, and the bone cement bridging screw system is a preferred therapy with better anti cement loosening ability.

Advantages of unilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures-a systematic review and meta-analysis.

Data from English randomized controlled trials comparing unilateral versus bilateral PKP for the treatment of OVCFs were retrieved and analyzed, and the results showed that unilateral PKP is a better choice for the treatment of patients with OVCFs, which will provide a reliable clinical rationale for the treatment of OVCFs. PURPOSE: To investigate the advantages of unilateral percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures(OVCFs). METHODS: The systematic evaluation program met all program requirements (CRD 42023422383) by successfully passing the PROSPERO International Prospective Systematic Evaluation Registry. Researchers searched the references of English-language randomized controlled trials comparing unilateral and bilateral PKP for the treatment of osteoporotic vertebral compression fractures published between 2010 and 2023 and manually searched for known primary and review articles. The study statistically analyzed data from all the included literature, which primarily included time to surgery, visual pain score(VAS) and Oswestry disability index(ODI) at postoperative follow-up time points, polymethylmethacrylate (PMMA, bone cement) injection dose, cement leakage, radiation dose, and improvement in kyphotic angle. RESULTS: This meta-analysis searched 416 articles published from 2010 to 2023 based on keywords, and 18 articles were finally included in this study. The results of the forest plot showed that unilateral PKP operative time, amount of bone cement used, and radiation dose to the patient were significantly reduced (p < 0.01, p < 0.01, and p < 0.01, respectively), and unilateral and bilateral PKP had comparable cement leakage (p = 0.49, 95% CI = 0.58-1.30), and there was no significant difference in the kyphotic angle between unilateral and bilateral PKP (p = 0.42, 95% CI = - 2.29-0.96). During follow-up, there was no significant difference in pain relief between unilateral and bilateral PKP (p = 0.70, 95% CI = - 0.09-0.06), nor was there a significant difference in ODI (p = 0.27, 95% CI = - 0.35-1.24). CONCLUSIONS: There is no difference in clinical efficacy between unilateral PKP and bilateral PKP, but unilateral PKP has a shorter operative time, a lower incidence of cement leakage, a lower amount of cement, and a lower radiation dose to the patient and operator. Unilateral PKP is a better option for patients with OVCFs.

Feasibility biomechanical study of injectable Biphasic Calcium Phosphate bone cement augmentation of the proximal femoral nail antirotation (PFNA) for the treatment of two intertrochanteric fractures using cadaveric femur.

This study evaluated the feasibility of the femoral bone after fixation using biphasic calcium phosphate cement-augmentation of the proximal femoral nail antirotation (PFNA) compared with PFNA without cement. This study presented to compare the stiffness, fatigue testing, and compressive strength between stable (AO31-A2.1) and unstable (AO31-A3.3) intertrochanteric fractures treated by cement augmented PFNA of the cadaveric femoral. Biphasic calcium phosphate cement was injected to align and compatible with PFNA and the reconstructive procedure was monitored the cement placement using x-ray imaging during operation. The testing demonstrated that the cement could be injected through a small needle (13 G, 16 cm length, 1.8 mm inner diameter) within a suitable operating time. The feasibility study of the biomechanical testing was divided into three tests: stiffness test, fatigue cyclic load, and compression test. The results showed that the cement-augmented specimens exhibited higher stiffness than the control specimens without cement. The cement-augmented specimens also showed lower strain energy during the fatigue test, resulting in higher compressive strength (4730.7 N) compared to the control specimens (3857.4 N). There is a correlation between BMD and fracture load and the increase in compression load of the cement-augmented femoral compared to the controls as well as an increase in strain energy of fatigue cyclic testing was found. Biphasic calcium phosphate cement-augmented of the PFNA biomechanically enhanced the cut-out resistance in intertrochanteric fracture. This procedure is especially efficient for unstable intertrochanteric fracture suggesting the potential benefits of using biphasic calcium phosphate cement in medical applications.