Experimental Study on Rats with Critical-Size Bone Defects Comparing Effects of Autologous Bone Graft, Equine Bone Substitute Bio-Gen® Alone or in Association with Platelet-Rich Fibrin (PRF).

BACKGROUND: A critical-sized bone defect (CsBD) is considered one that will not heal spontaneously and requires reconstruction. This study aims to compare the results of using different bone reconstructive techniques and to study the potential of platelet-rich fibrin (PRF) to enhance the healing properties of a bone substitute (BS). METHODS: In this experimental study on rats, the treatment of critical-sized bone defects was carried out by analysing four groups: a control group in which the bone defect was left empty; a group treated with Bio-Gen®; another group in which the defect was treated with PRF in combination with Bio-Gen®; and the last that was treated with autologous bone graft (ABG). The defects were evaluated by microcomputed tomography (µCT) and then histomorphometrically. RESULTS: From both the histological and imagistic point of view, the best results were registered in the ABG group, followed by the group treated with Bio-Gen® with PRF, Bio-Gen® group, and control group, with statistically significant differences. CONCLUSIONS: A 5 mm defect in the rat radius can be considered critical. ABG showed the best results in treating the bone defect. PRF significantly enhanced the efficacy of Bio-Gen®.

Exploring the Microbial Landscape: Gut Dysbiosis and Therapeutic Strategies in Pancreatitis-A Narrative Review.

The gut microbiota is emerging as an important contributor to the homeostasis of the human body through its involvement in nutrition and metabolism, protection against pathogens, and the development and modulation of the immune system. It has therefore become an important research topic in recent decades. Although the association between intestinal dysbiosis and numerous digestive pathologies has been thoroughly researched, its involvement in pancreatic diseases constitutes a novelty in the specialized literature. In recent years, growing evidence has pointed to the critical involvement of the pancreas in regulating the intestinal microbiota, as well as the impact of the intestinal microbiota on pancreatic physiology, which implies the existence of a bidirectional connection known as the "gut-pancreas axis". It is theorized that any change at either of these levels triggers a response in the other component, hence leading to the evolution of pancreatitis. However, there are not enough data to determine whether gut dysbiosis is an underlying cause or a result of pancreatitis; therefore, more research is needed in this area. The purpose of this narrative review is to highlight the role of gut dysbiosis in the pathogenesis of acute and chronic pancreatitis, its evolution, and the prospect of employing the microbiota as a therapeutic intervention for pancreatitis.

Peri-implant distal radius fracture due to car collision.

Peri-implant fractures have gained increasing importance in orthopedics as the number of surgical procedures involving orthopedic implants rises globally. These fractures pose a significant challenge in terms of diagnosis, treatment, and postoperative management. They manifest as stress fractures distal to the implant site. Developing an effective treatment strategy involves evaluating multiple influencing factors. This article presents a rare case of a peri-implant distal radius fracture in a 63-year-old man, with no comorbidities, resulting from a car accident, classified as C1U in the Michele D'Arienzo system. The surgical intervention included plate fixation for the radius and wire fixation for the ulna. The wire was used for ulna instead of a plate, due to skin injuries, with good results. As life expectancy rises and individuals remain active in their elder years, the incidence of peri-implant fractures is expected to increase. Factors such as the implant type, surgeon's approach, and patient-specific elements may influence peri-implant fracture occurrence. The widespread use of plate fixation for distal radius fractures may also contribute to a parallel increase in such fractures. Providing detailed context and specific case presentation allows better understanding and implications for clinical practice.

A Retrospective analysis of peri-implant fractures: insights from a large volume clinical Study.

PURPOSE: Peri-implant fractures (PIFs) are a concept in evolution for which different diagnostic criteria have been proposed and modified over time. They have not been extensively reported. PIFs are usually located in the distal part of previous osteosynthesis, where fragile bone is in contact with the rigid implant and are a significant complication after orthopaedic surgery, which requires careful management and treatment. This clinical study presents findings from a retrospective analysis of PIF's, providing description of characteristics and outcomes. They provide information about the associated risk factors and description of the effectiveness of various treatments. MATERIALS AND METHODS: A retrospective analysis was performed in a clinical study involving patients with PIFs. Data from medical records, radiographic images, and surgical reports were collected and analyzed. The study included patients with refracture of pre-existing osteosynthesis admitted to the hospital between 2015 and 2022. Demographic information, fracture characteristics, surgical interventions, and post-operative outcomes were assessed. Each case was followed for a minimum of one year after surgery, and a critical analysis was performed by senior surgeons. Furthermore, the PIFs were classified according to the type of initial implant and the position of the new fracture in relation to the original implant. RESULTS: Between 2015 and 2022, out of 18,813 fractures treated at a Level 1 traumatology hospital, a total of 85 patients with PIF's were identified. Fracture characteristics varied, including location, fracture pattern, and implant type. Most of the PIFs, 71 cases (83.53%), occurred in the femur. Additionally, there were seven cases (8.24%) involving the humerus, four cases (4.71%) affecting the tibia/fibula, two cases (2.35%) in the radius, and one case (1.18%) involving the clavicle. Surgical management was the primary attitude in treatment. Various techniques were used, including the use of longer and stronger implants to achieve high-quality fixation, facilitating early rehabilitation and return to previous activities. Postoperative complications after surgery for PIFs were observed in 16 cases (18.8%). CONCLUSIONS: Peri-implant fractures (PIF) are a distinct topic and a challenging condition with a high rate of postoperative complications. Complications after the second surgery may be severe and life threatening in older patients. A classification can be useful to make decisions about the optimal treatment in different anatomic areas and type of implant used for primary osteosynthesis. Currently there are no standardized protocols for management, therefore each case should be carefully discussed and planned before surgery.

Pain Intensity and Degree of Disability after Fragility Fractures of the Pelvis.

Background and objectives: Fragility fractures of the pelvis (FFP) are of increasing interest lately, being associated with a loss of mobility and affecting the quality of life. The aim of our study was to investigate the effect of FFP on disability and pain in patients, after one year since injury. Materials and Methods: In the study, we included 76 patients diagnosed with FFP, who were admitted to our trauma department between January 2016 and January 2019, and were above 65 years of age. The Von Korff pain intensity and disability scores were calculated in the hospital at 6 months and after 1 year. Results: Fifty-four patients were female (71%), with an average age of 75.9 ± 7.19 years. Twenty-two patients were male (29%) and had a mean age of 77.22 ± 7.33 years. We did not record significant differences regarding age between the men and women (p > 0.05). Significant improvements appeared between the baseline and the 6 month follow-up; the average pain intensity score at 6 months was 44.94 (SD 21.20) (p < 0.001), and the disability score was 54.30 (SD 21.62). The following average pain intensity and disability scores after 12 months were similar to the values at6 months: 44.48 (SD 21.74) for pain intensity and 52.36 (SD 24.53) for disability. The Von Korff pain score at 6 months and after 1 year depends on gender and on the initial Von Korff pain score (p = 0.02). The Von Korff disability score at 6 months depends on gender, the baseline pain score and the baseline disability score (p = 0.001). Conclusions: our patients reported long-lasting pain that had a severe effect on their daily routines, and they could not return to their normal status prior to injury.

Connections between Orthopedic Conditions and Oxidative Stress: Current Perspective and the Possible Relevance of Other Factors, Such as Metabolic Implications, Antibiotic Resistance, and COVID-19.

The general opinion in the literature is that these topics remain clearly understudied and underrated, with many unknown aspects and with controversial results in the respective areas of research. Based on the previous experience of our groups regarding such matters investigated separately, here we attempt a short overview upon their links. Thus, we summarize here the current state of knowledge regarding the connections between oxidative stress and: (a) orthopedic conditions; (b) COVID-19. We also present the reciprocal interferences among them. Oxidative stress is, of course, an interesting and continuously growing area, but what exactly is the impact of COVID-19 in orthopedic patients? In the current paper we also approached some theories on how oxidative stress, metabolism involvement, and even antibiotic resistance might be influenced by either orthopedic conditions or COVID-19. These manifestations could be relevant and of great interest in the context of this current global health threat; therefore, we summarize the current knowledge and/or the lack of sufficient evidence to support the interactions between these conditions.

Treatment of C1.1 (AO-41) tibial plateau fracture: A finite element analysis of single medial, lateral and dual plating.

Bicondylar tibial plateau fractures pose many challenges in surgical treatment. The aim of the present study was to analyze three methods of reduction, single medial, single lateral, and dual plating, for the treatment of a bicondylar tibial plateau fracture, through finite element analysis (FEA). A simple metaphyseal fracture, type C1.1 (AO-41) was modeled on a CT-derived 3D model of the knee. Lateral and medial proximal tibial polyaxial plates with screws were modeled and placed accordingly for the three methods of reduction. Simulation of physiological type loading corresponding to the maximal weight acceptance phase during a slow walking gait cycle was performed using FEA. Values of stress and strain were recorded near the fracture lines. Dual plating provided a decrease of stress and strain in the tibial plateau area. However, the differences in the values among the three cases were small. The stress concentration areas were located in the vicinity of the fracture, predominantly in the area of the tibial plateau. Considering the limitations of the present study, the results revealed that dual plating leads to smaller stress and strain values near the fracture lines in the tibial plateau area. However, values obtained for single lateral plating are close in range. Considering the complexity of the surgical approach for dual plating, single lateral plating may be a solution for good reduction with fewer surgical risks and complications. Further studies on the C1.1 fracture (AO-41) are needed to analyze the complex issue of reducing and stabilizing such a fracture and to characterize the postoperative state while providing predictable parameters for an optimal result.

An original method of simulating the articular cartilage in the context of in vitro biomechanical studies investigating the proximal femur.

Biomechanical testing is a necessity given the development of novel implants used in the osteosynthesis of hip fractures. The purpose of biomechanical testing is to recreate realistic conditions similar to the in vivo conditions. Although biomechanical testing of hip arthroplasty has been standardized since the 1970s, there is no consensus at present on testing methodology for osteosynthesis of hip fractures. Most biomechanical studies examining the fractures of the proximal femur in order to optimize implants opt for loading the bone-implant ensemble directly on the femoral head or using a metallic loading part. This loading technique fails to perform a mechanical stress distribution similar to in vivo conditions, which could alter the outcome. The present study aimed to design loading/unloading cups with mechanical properties that resemble those of the cartilage at the hip level. Through the impression and scanning of the cast models obtained, a digital 3D model was created in STL format and this was processed in order to obtain the computer numerical control (CNC) trajectories of the printing head. For prototyping using additive manufacturing technology, a thermoplastic polymer with biochemical properties, such as tensile strength, that resemble those of the adult hip and a Stratasys FORTUS 250 mc CNC machine were used. Loading/unloading cups with similar anatomy and biomechanical forces compared with those of the adult hip were created, which allowed the experimental simulation of the conditions during walking.

The pregnancy rate among Romanian adolescents: an eleven years (2009--2020) observational, retrospective study from a single center.

OBJECTIVES: It has been recently documented that Romania has the highest prevalence of adolescent pregnancy in Europe. MATERIAL AND METHODS: Therefore, the present study aims to offer a conclusive view of the current situation by assessing a series of parameters in the last 11 years. RESULTS: Throughout the present manuscript, we showed that 1788 pregnancies occurred in the last 11 years in just one center from the northeastern region of Romania. The Kolmogorov-Smirnov test (p < 0.05) performed suggests that gestational age does not follow a normal distribution; an interval during which 899 (50.27%) male and 889 (49.72%) female babies were born. There were a total of 1383 (86.00%) deliveries at full-term and 225 (13.99%) were under 37 weeks. Of 1788 teenage girls, 1467 (82.04%) were from the rural area, whereas 321 (17.95%) from the urban area. CONCLUSIONS: Fortunately, one common feature that we observed was that starting from 2017 there was a significant reduction within the last 2 studied parameters, the situation being much more fluctuating until 2014.

Biocompatibility assessment of biomaterials used in orthopedic devices: An overview (Review).

Biocompatibility is one of the mandatory requirements for the clinical use of biomaterials in orthopedics. It refers to the ability of a biomaterial to perform its function without eliciting toxic or injurious effects on biological systems but producing an appropriate host response in a specific case. Today, the biocompatibility concept includes not only bio-inertia, but also biofunctionality and biostability. High biocompatibility and functional properties are highly desirable for new biomaterials. The chemical, mechanical, structural properties of biomaterials, their interaction with biological environment or even the methodology of assessment can influence the biocompatibility. The biological evaluation of biomaterials includes a broad spectrum of in vitro and in vivo tests related to the cytocompatibility, genotoxicity, sensitization, irritation, acute and chronic toxicity, hemocompatibility, reproductive and developmental toxicitity, carcinogenicity, implantation and degradation as specified in different international standards. A brief review of the main assays used in the biocompatibility testing of orthopedic biomaterials is presented. In addition, their main biocompatibility issues are overviewed.