Search Results (188)

In the context of bone fractures, the influence of the mechanical environment on the healing outcome is widely accepted, while its influence at the cellular level is still poorly understood. This study explores the influence of mechanical load on naïve mesenchymal stem cell (MSC) differentiation, focusing on hypertrophic chondrocyte differentiation. Unlike primary bone healing, which involves the direct differentiation of MSCs into bone-forming cells, endochondral ossification uses an intermediate cartilage template that remodels into bone. A high-throughput uniaxial bioreactor system (StrainBot) was used to apply varying percentages of strain on naïve MSCs encapsulated in GelMa hydrogels. This research shows that cyclic uniaxial compression alone directs naïve MSCs towards a hypertrophic chondrocyte phenotype. This was demonstrated by increased cell volumes and reduced glycosaminoglycan (GAG) production, along with an elevated expression of hypertrophic markers such as MMP13 and Type X collagen. In contrast, Type II collagen, typically associated with resting chondrocytes, was poorly detected under mechanical loading alone conditions. The addition of chondrogenic factor TGFβ1 in the culture medium altered these outcomes. TGFβ1 induced chondrogenic differentiation, as indicated by higher GAG/DNA production and Type II collagen expression, overshadowing the effect of mechanical loading. This suggests that, under mechanical strain, hypertrophic differentiation is hindered by TGFβ1, while chondrogenesis is promoted. Biochemical analyses further confirmed these findings. Mechanical deformation alone led to a larger cell size and a more rounded cell morphology characteristic of hypertrophic chondrocytes, while lower GAG and proteoglycan production was observed. Immunohistology staining corroborated the gene expression data, showing increased Type X collagen with mechanical strain. Overall, this study indicates that mechanical loading alone drives naïve MSCs towards a hypertrophic chondrocyte differentiation path. These insights underscore the critical role of mechanical forces in MSC differentiation and have significant implications for bone healing, regenerative medicine strategies and rehabilitation protocols. Full article

Background/Objectives: Osteoporosis is a systemic disease associated with reduced bone mass, impaired bone microarchitecture, and thus an increased risk of bone fractures. Moreover, patients with osteoporosis are more likely to experience periodontal diseases and tooth loss. Some indices have been proposed to detect osteoporosis on dental panoramic radiographs. The aim of our retrospective study was to investigate the association between osteoporosis and the loss of alveolar bone and teeth and to evaluate the validity of several dental radiomorphometric indices for assessing osteoporosis. Methods: In patients with and without osteoporosis, tooth loss, alveolar bone loss, the panoramic mandibular index (PMI), mental index (MI), and mandibular cortical index (MCI) were determined. Results: Compared with the non-osteoporotic group, patients with osteoporosis showed more tooth loss and more severe alveolar bone loss. PMI and MI were lower in patients with osteoporosis than in the non-osteoporotic group. Analysis of MCI showed that category C3 (cortical layer forms strong endosteal cortical residues and is clearly porous) was significantly more common in patients with osteoporosis. Conclusions: Osteoporosis is associated with more tooth and alveolar bone loss. Furthermore, various dental radiomorphometric indices are altered in osteoporosis and could thus help to better assess osteoporosis of the jaw. Full article

Pediatric fracture overgrowth is an unpredictable complication of long bone fractures in children, leading to excessive growth of the injured limb and resulting in limb length discrepancies (LLDs) and angular deformities that impact mobility and quality of life. Traditional methods struggle to predict at-risk children, hindering early detection and management. Artificial intelligence (AI), including machine learning and deep learning, offers advanced data analysis capabilities to enhance predictive accuracy and personalize treatment strategies. This comprehensive review explores the current understanding of pediatric fracture overgrowth, examines AI applications in medicine and orthopedics, evaluates potential AI applications specific to fracture overgrowth, and discusses ethical considerations and patient-centric approaches. We highlight how AI can improve diagnostic precision, facilitate early intervention, and optimize clinical outcomes. Though direct studies on AI in fracture overgrowth are limited, evidence from related areas underscores its potential. Embracing AI could revolutionize pediatric fracture management, leading to earlier detection, targeted interventions, and better outcomes for affected children. Full article

Postmenopausal osteoporosis (PMOP) is a bone disease characterized by bone thinning and an increased risk of fractures due to estrogen deficiency. Current PMOP therapies often result in adverse side effects. The traditional medicinal plant Curculigo capitulata is commonly used to strengthen bones and support kidney function, but its role in treating PMOP is not well understood. This study aims to investigate the therapeutic effects of the total extract of Curculigo capitulata (Eocc) on PMOP and to explore the underlying mechanisms. The major components of the extract were identified using HPLC. Transcriptomics was employed to predict potential targets. An osteogenic differentiation model of MC3T3-E1 cells was used in vitro. The osteogenic potential of the Eocc was assessed through CCK-8 cell viability assays, alkaline phosphatase (ALP) staining, Alizarin Red staining, Western blotting, and qPCR. MCF-7 and HEK-293 cells were utilized to evaluate the estrogen-like activity of Eocc. Apoptosis rates were detected by flow cytometry. In vivo, a bilateral ovariectomized mouse model of PMOP was used to further validate the in vitro findings through histopathological analysis and WB results. The results demonstrated that the Eocc promoted the proliferation of MC3T3-E1 cells, increased ALP activity, and stimulated the formation of osteogenic mineralized nodules. It also upregulated the expression of osteogenic markers (Runx2, OCN, OPN, and BSP) at both the protein and mRNA levels. The Eocc induced the activation of ERα both in vitro and in vivo, initiating the Src/PI3K/AKT signaling pathway, leading to the phosphorylation of GSK3β and subsequent osteogenesis. The activation of this pathway also stimulated the phosphorylation of mTOR and p70S6K while downregulating cleaved caspase-3 and caspase-9. Additionally, the Eocc reduced apoptosis during osteogenic differentiation and promoted cell proliferation. These findings suggest that the Eocc facilitates osteoblast proliferation and differentiation, improving bone integrity in PMOP mice, and may represent a promising therapeutic candidate for managing PMOP. Full article

Introduction: Clavicle fractures are among the most common in children, typically treated conservatively, with standard radiographs used to diagnose and monitor healing. Recently, infrared thermography (IRT) has been proposed as an alternative method for fracture detection, but no study has correlated the temperature changes during callus formation. Materials and Methods: Children aged 4–18 with X-ray-diagnosed clavicle fractures were included in the study. IRT measured temperatures above the fracture and contralateral healthy side on the 1st, 4th, 8th, 15th, and 22nd day after the injury. Along with IRT, an ultrasound was used to assess callus formation. Results: The study included 27 patients with an average age of 12.4 years, mostly boys. The left side was more often affected than the right side (33%). We found a correlation between callus formation and the ∆T. A maximum temperature difference of an average of 0.7 °C was noted during the proliferative phase of callus formation. After the formation of the fibrocartilaginous callus (4th to 8th day), the temperature above the fracture declined until it was equal (22nd day) to that of the healthy side. The average temperature difference between the broken and the healthy sides was statistically significant on the 4th and 8th days (during callus formation). Conclusions: The increased skin temperature above the fracture correlates with the inflammatory phase of bone healing. After the callus is visible on ultrasound, the temperature linearly drops with no statistical difference between the injured and the healthy sides. The standard protocol for clavicle fracture treatment typically involves using X-rays to assess callus formation during follow-up. IRT has shown potential in diagnosing callus formation in children with clavicle fractures, potentially reducing the need for traditional X-rays. Full article

The zygomatic bone, a fundamental structure in facial anatomy, is exposed to fractures in impact situations, such as traffic accidents or contact sports. The installation of zygomatic implants can also alter the distribution of forces in this region, increasing the risk of fractures. To evaluate this situation, the first step is to develop a complex anatomical model from the stomatognathic point of view so that simulations in this sense can be validated. This study uses numerical simulation using a finite-element method (FEM) to analyze the behavior of the zygomatic bone under impacts of different velocities, offering a more realistic approach than previous studies by including the mandible, cervical spine, and masticatory muscles. Methods: An FEM model was developed based on 3D scans of actual bones, and simulations were performed using Abaqus Explicit 2023 software (Dassault Systemes, Vélizy-Villacoublay, France). The impact was evaluated using a steel cylinder (200 mm length, 40 mm diameter, 2 kg weight) impacted at speeds of 5, 10, 15, and 20 km/h. Zygomatic, maxillary, and mandibular bone properties were based on dynamic stiffness parameters, and bone damage was analyzed using ductile fracture and fracture energy criteria. Results: The results show that at impact velocities of 15 and 20 km/h, the zygomatic bone suffered crush fractures, with impact forces up to 400 kg. At 10 km/h, a combination of crushing and bending was observed, while at 5 km/h, only local damage without complete fracture was detected. The maximum stresses were concentrated at the zygoma–jaw junction, with values above 100 MPa at some critical points. Conclusion: The FEM model developed offers a detailed representation of the mechanical behavior, integrating the main structures of the stomatognathic apparatus of the zygomatic bone under impact, providing valuable information to, for example, advance injury prevention and zygomatic implant design. Higher impact velocities result in severe fractures, underscoring the need for protective measures in clinical and sports settings. Full article

Inflammation has been recognized as major factor for successful bone regeneration. On the other hand, a prolonged or overshooting inflammatory response can also cause fracture healing failure. The nucleotide-binding oligomerization domain (NOD)-like receptor protein (NLRP)3 inflammasome plays a crucial role in inflammatory cytokine production. However, its role during fracture repair remains elusive. We investigated the effects of Nlrp3 deficiency on the healing of closed femoral fractures in Nlrp3^−/− and wildtype mice. The callus tissue was analyzed by means of X-ray, biomechanics, µCT and histology, as well as immunohistochemistry and Western blotting at 2 and 5 weeks after surgery. We found a significantly reduced trabecular thickness at 2 weeks after fracture in the Nlrp3^−/− mice when compared to the wildtype animals. However, the amount of bone tissue did not differ between the two groups. Additional immunohistochemical analyses showed a reduced number of CD68-positive macrophages within the callus tissue of the Nlrp3^−/− mice at 2 weeks after fracture, whereas the number of myeloperoxidase (MPO)-positive granulocytes was increased. Moreover, we detected a significantly lower expression of vascular endothelial growth factor (VEGF) and a reduced number of microvessels in the Nlrp3^−/− mice. The expression of the absent in melanoma (AIM)2 inflammasome was increased more than 2-fold in the Nlrp3^−/− mice, whereas the expression of the pro-inflammatory cytokines interleukin (IL)-1β and IL-18 was not affected. Our results demonstrate that Nlrp3 deficiency does not markedly affect femoral fracture healing in mice. This is most likely due to the unaltered expression of pro-inflammatory cytokines and pro-osteogenic growth factors. Full article

Objectives: The aim of this study was to evaluate the diagnostic performance, image quality, and inter- and intra-observer agreement of the 3D T1 multi-echo fast field echo (mFFE) sequence in cervico-thoraco-lumbar vertebral fractures compared with conventional computed tomography (CT) as the gold standard. Methods: We conducted a prospective single-centre study including 29 patients who underwent spinal magnetic resonance imaging (MRI) at the surgeon’s request, in addition to CT for vertebral fracture assessment and classification. A 3D T1 mFFE sequence was added to the standard MRI protocol. Consecutively, two readers analyzed the 3D mFFE sequence alone, the 3D mFFE sequence with the entire MRI protocol, including the STIR and T1 sequences, and, finally, the CT images in random order and 1 month apart. A standardized assessment was performed to determine the presence or absence of a fracture, its location, its classification according to the Genant and AO classifications for traumatic and osteoporotic fractures, respectively, the loss of height of the anterior and posterior walls of the vertebral body, and the presence of concomitant disco-ligamentous lesions. Contingency tables, intraclass correlation coefficients, and Cohen’s kappa tests were used for statistical analysis. Results: A total of 25 fractures were recorded (48% cervical, 20% thoracic, and 32% lumbar), of which 52% were classified A, according to the AO classification system. The quality of the 3D mFFE image was good or excellent in 72% of cases. Inter-observer agreement was near perfect (0.81–1) for vertebral body height and for AO and Genant classifications for all modalities. Intra-observer agreement was strong-to-near perfect between CT and the 3D mFFE sequence. Regarding the diagnostic performance of the 3D mFFE sequence, the sensitivity was 0.9200 and 0.9600, the specificity was 0.9843 and 0.9895, and the accuracy was 0.9861 and 0.9769 for Readers 1 and 2, respectively. In addition, up to 40% of intervertebral disc lesions and 33% of ligamentous lesions were detected by the 3D mFFE sequence compared to CT, allowing four AO type A fractures to be reclassified as type B. Conclusions: The 3D mFFE sequence allows accurate diagnosis of vertebral fractures, with superiority over CT in detecting disco-ligamentous lesions and a more precise classification of fractures, which can prompt clinicians to adapt their management despite an image quality that still requires improvement in some cases. Key points: Vertebral fractures and disco-ligamentous lesions can be assessed using CT-like MRI sequences, with 3D T1 mFFE being superior to CT for the detection of disco-ligamentous lesions. CT-like images using the 3D T1 mFFE sequence improve the diagnostic accuracy of bone structures in MRI. Full article

Objective: Scaphoid fractures, particularly occult and non-displaced fractures, are difficult to detect using traditional X-ray methods because of their subtle appearance and variability in bone density. This study proposes a two-stage CNN approach to detect and classify scaphoid fractures using anterior–posterior (AP) and lateral (LA) X-ray views for more accurate diagnosis. Methods: This study emphasizes the use of multi-view X-ray images (AP and LA views) to improve fracture detection and classification. The multi-view fusion module helps integrate information from both views to enhance detection accuracy, particularly for occult fractures that may not be visible in a single view. The proposed method includes two stages, which are stage 1: detect the scaphoid bone using Faster RCNN and a Feature Pyramid Network (FPN) for region proposal and small object detection. The detection accuracy for scaphoid localization is 100%, with Intersection over Union (IoU) scores of 0.8662 for AP views and 0.8478 for LA views. And stage 2: perform fracture classification using a ResNet backbone and FPN combined with a multi-view fusion module to combine features from both AP and LA views. This stage achieves a classification accuracy of 89.94%, recall of 87.33%, and precision of 90.36%. Results: The proposed model performs well in both scaphoid bone detection and fracture classification. The multi-view fusion approach significantly improves recall and accuracy in detecting fractures compared to single-view approaches. In scaphoid detection, both AP and LA views achieved 100% detection accuracy. In fracture detection, using multi-view fusion, the accuracy for AP views reached 87.16%, and for LA views, it reached 83.83%. Conclusions: The multi-view fusion model effectively improves the detection of scaphoid fractures, particularly in cases of occult and non-displaced fractures. The model provides a reliable, automated approach to assist clinicians in detecting and diagnosing scaphoid fractures more efficiently. Full article

Background: Osteoporosis and vertebral fractures (VFs) are frequently observed in males living with HIV (MLWH). While bisphosphonates seem effective on bone mineral density (BMD) in MLWH, data on VFs are lacking. In this real-life longitudinal study performed on 118 MLWH (median age 53) who were followed-up for a median of 7 years, we aimed to evaluate the long-term efficacy of oral bisphosphonates on VFs in MLWH. Methods: The inclusion criteria were age >18, stable HIV infection, bisphosphonate-naïve, blood samples from the same laboratory, and three densitometries and morphometries performed with the same densitometer. Results: At baseline, VFs were detected in 29/118 patients (24.6%). Patients with VFs were older (p. 0.042), had longer HIV infection duration (p. 0.046) and antiretroviral exposure (p. 0.025), and demonstrated higher luteinizing hormone levels (LH, p. 0.044). Of the 29 patients with VFs at inclusion, 11 developed new VFs, of which 8 were under oral bisphosphonates (p. 0.018). Among the 89 without basal VFs, 11 developed VFs, of which 2 were under oral bisphosphonates. Patients with a worsened bone condition (regarding BMD and/or new VFs, n. 32) had more frequently high LH levels (>9.4 mIU/mL, p. 0.046) and higher HCV co-infection compared to patients with a stable bone condition (p. 0.045). It should be noted that 38.6% of patients discontinued oral bisphosphonates due to medical indication or personal choice, and 14.0% never started them. Conclusions: In conclusion, we found that oral bisphosphonates were not completely effective in preventing VFs, especially in patients with VFs at baseline; this is probably due to the multifactorial pathogenesis of fragility fractures in this population. A poor adherence to treatment and attention to gonadal function are also important issues in this population. Full article

To evaluate the advantages of dual-energy computed tomography (DECT) virtual non-hydroxyapatite color mapping (VNHAP) in combination with standard bone CT (BCT) in the identification of subtle or occult traumatic fractures referred to emergency and acceptance departments (DEAs). Forty patients (22 men; mean age 83 ± 23.7 y) with suspected traumatic fractures referred to our emergency department and examined with a fast kilovoltage-switching single-source spectral CT scan between January and October 2023 were retrospectively reviewed. The BCT and VNHAP images were blindly evaluated by two radiologists with >10 years and <2 years of experience in musculoskeletal imaging. Both techniques were evaluated in terms of sensitivity (SE), specificity (SP), positive and negative predictive values (PPVs and NPVs) and accuracy for fracture detection, as confirmed at a 3-month clinical–instrumental follow-up. Inter-observer agreement and examination times were also analyzed. Fractures were confirmed in 18/40 cases. The highest values of diagnostic performance for VNHAP images were obtained in terms of SP (90.9% and 95%) and PPV (87.5% and 92.8%) and for the less experienced operator. No statistically significant differences were observed between the diagnostic accuracy of the two readers in the evaluation of VNHAP images. Inter-observer agreement was moderate (κ = 0.536) for BCT and substantial (κ = 0.680) for VNHAP. Comparing the two operators, a significantly longer examination time for BCT and no significant difference for VNHAP were registered. Our preliminary experience may encourage the employment of VNHAP maps in combination with BCT images in emergency settings. Their use could be time-saving and valuable in terms of diagnostic performance, especially for less experienced operators. Full article

Artificial intelligence (AI)-assisted computer vision is an evolving field in medical imaging. However, accuracy and precision suffer when using the existing AI models for small, easy-to-miss objects such as bone fractures, which affects the models’ applicability and effectiveness in a clinical setting. The proposed integration of the Hybrid-Attention (HA) mechanism into the YOLOv8 architecture offers a robust solution to improve accuracy, reliability, and speed in medical imaging applications. Experimental results demonstrate that our HA-modified YOLOv8 models achieve a 20% higher Mean Average Precision (mAP 50) and improved processing speed in arm fracture detection. Full article

Talar avascular necrosis (AVN) is a devastating condition that frequently follows type III and IV talar neck fractures. As 60% of the talus is covered by hyaline cartilage, its vascular supply is limited and prone to trauma, which may eventually lead to AVN development. Early detection of AVN (Hawkins sign, MRI) is crucial, as it may prevent the development of the irreversible stages III and IV of AVN. Alertness is advised regarding non-obvious conditions that may cause this complication (sub chondroplasty, systemic lupus erythematosus, diabetes mellitus). Although, in stages I–II, AVN may be treated with non-surgical procedures (ESWT therapy, non-weight bearing) or joint-sparing techniques (core drilling, bone marrow aspirate injections), stages III–IV require more advanced procedures, such as joint-sacrificing procedures (hindfoot arthrodesis/ankle arthrodesis), or replacement surgery, including total talar replacement (TTR) or combined total ankle replacement (TAR). The advancement of 3D-printing technology and increased access to implant manufacturing are contributing to a rise in the production rates of third-generation total talar prostheses. As a result, there is a growing frequency of alloplasty procedures and combined total ankle replacement (TAR) surgeries. By performing TTR as opposed to deses, the operator avoids (i) delayed union, (ii) a shortening of the limb, (iii) a lack of mobility, and (iv) the stiffening of adjacent joints, which are the main disadvantages of joint-sacrificing procedures. Simultaneously, TTR and combined TAR offer (i) a brief period of weight-bearing restriction, (ii) quick pain relief, and (iii) preservation of the length of the limb. Here, we summarize the most up-to-date knowledge regarding AVN diagnosis and treatment, with a special focus on the role of TTR. Full article

Background: Cystic fibrosis bone disease (CFBD) is a common comorbidity in adult people with cystic fibrosis (pwCF), resulting in an increased risk of bone fractures. This study evaluated the capacity of artificial intelligence (AI)-assisted low-dose chest CT (LDCT) opportunistic screening for detecting low bone mineral density (BMD) in adult pwCF. Methods: In this retrospective single-center study, 65 adult pwCF (mean age 30.1 ± 7.5 years) underwent dual-energy X-ray absorptiometry (DXA) of the lumbar vertebrae L1 to L4 to determine BMD and corresponding z-scores and completed LDCTs of the chest within three months as part of routine clinical care. A fully automated CT-based AI algorithm measured the attenuation values (Hounsfield units [HU]) of the thoracic vertebrae Th9–Th12 and first lumbar vertebra L1. The ability of the algorithm to diagnose CFBD was assessed using receiver operating characteristic (ROC) curves. Results: HU values of Th9 to L1 and DXA-derived BMD and the corresponding z-scores of L1 to L4 showed a strong correlation (all p < 0.05). The area under the curve (AUC) for diagnosing low BMD was highest for L1 (0.796; p = 0.001) and Th11 (0.835; p < 0.001), resulting in a specificity of 84.9% at a sensitivity level of 75%. The HU threshold values for distinguishing normal from low BMD were <197 (L1) and <212 (Th11), respectively. Conclusions: Routine LDCT of the chest with the fully automated AI-guided determination of thoracic and lumbar vertebral attenuation values is a valuable tool for predicting low BMD in adult pwCF, with the best results for Th11 and L1. However, further studies are required to define clear threshold values. Full article

Osteoporosis, a prevalent ailment worldwide, compromises bone strength and resilience, particularly afflicting the elderly population. This condition significantly heightens susceptibility to fractures even from trivial incidents, such as minor falls or impacts. A major challenge in diagnosing osteoporosis is the absence of discernible symptoms, allowing osteoporosis to remain undetected until the occurrence of a fracture event. Early symptom detection and swift diagnosis are critical for preventing severe issues related to bone diseases. Assessing bone turnover markers aids in identifying, diagnosing, and monitoring these conditions, guiding treatment decisions. However, conventional techniques for measuring bone mineral density are costly, time-consuming, and require specialized expertise. The integration of sensor technologies into medical practices has transformed how we monitor, diagnose, and treat various health conditions, including bone health and orthopedics. This review aims to provide a comprehensive overview of the current state of sensor technologies used in bone, covering their integration with bone tissue, various applications, recent advancements, challenges, and future directions. Full article