Search Results (160)

Background and Objective: This study presents a combined osteometric and biomechanical analysis of a Korean female cadaver exhibiting bilateral lower limb bone asymmetry with abnormal curvature and callus formation on the left femoral midshaft. Methods: To investigate bilateral bone length differences, osteometric measurements were conducted at standardized landmarks. Additionally, we developed three gait models using Meta Motivo, an open-source reinforcement learning platform, to analyze how skeletal asymmetry influences stride dynamics and directional control. Results: Detailed measurements revealed that the left lower limb bones were consistently shorter and narrower than their right counterparts. The calculated lower limb lengths showed a bilateral discrepancy ranging from 39 mm to 42 mm—specifically a 6 mm difference in the femur, 33 mm in the tibia, and 36 mm in the fibula. In the gait pattern analysis, the normal model exhibited a straight-line gait without lateral deviation. In contrast, the unbalanced, non-learned model demonstrated compensatory overuse and increased stride length of the left lower limb and a tendency to veer leftward. The unbalanced, learned model showed partial gait normalization, characterized by reduced limb dominance and improved right stride, although directional control remained compromised. Conclusions: This integrative approach highlights the biomechanical consequences of lower limb bone discrepancy and demonstrates the utility of virtual agent-based modeling in elucidating compensatory gait adaptations. Full article

Previous research on the jumping structures of insects with strong leaping abilities mainly focused on overall jumping mechanisms. Our study reveals that the unilateral jumping structures (UJSs) of L. delicatula has relative functional autonomy. The UJSs consist of three distinct but interconnected parts: (1) energy storage component: it comprises the pleural arch and trochanteral depressor muscles, with the deformation zone extending about two-thirds of the pleural arch from the V-notch to the U-notch; (2) coupling component: made up of the coxa and trochanter, it serves as a bridge between the energy and lever components, connecting them via protuberances and pivots; and (3) lever component: it encompasses the femur, tibia, and tarsus. A complete jumping action lasts from 2.4 ms to 4.6 ms. During a jump, the deformation length of the pleural arch is 0.96 ± 0.06 mm. The angles ∠ct (angle between coxa and trochanter), ∠fp (angle between femur and pleural arch), and ∠ft (angle between femur and tibia) change by 57.42 ± 1.60, 101.40 ± 1.59, and 36.06 ± 2.41 degrees, respectively. In this study, we abstracted the jumping structures of L. delicatula and identified its critical components. The insights obtained from this study are anticipated to provide valuable inspiration for the design and fabrication of biomimetic jumping mechanisms. Full article

Monitoring fetal growth throughout pregnancy is essential for early detection of developmental abnormalities. This study developed a Taiwan-specific fetal growth reference using a web-based data collection platform and polynomial regression modeling. We analyzed ultrasound data from 980 pregnant women, encompassing 8350 prenatal scans, to model six key fetal biometric parameters: abdominal circumference, crown–rump length, estimated fetal weight, head circumference, biparietal diameter, and femur length. Quadratic regression was selected based on a balance of performance and simplicity, with R² values exceeding 0.95 for most parameters. Confidence intervals and real-time anomaly detection were implemented through the platform. The results demonstrate the potential for efficient, population-specific fetal growth monitoring in clinical settings. Full article

Background and Clinical Significance: Prader–Willi syndrome (PWS) is a rare genetic disease caused by imprinted gene dysfunction, typically involving deletion of the chromosome 15q11.2-q13 region, balanced translocation, or related gene mutations in this region. PWS presents with complex and varied clinical manifestations. Abnormalities can be observed from the fetal stage and change with age, resulting in growth, developmental, and metabolic issues throughout different life stages. Case Presentation: We report the prenatal characteristics observed from the second to third trimester of pregnancy in a neonate with PWS. Prenatal ultrasound findings included a single umbilical artery, poor abdominal circumference growth from 26 weeks, normal head circumference and femur length growth, increased amniotic fluid volume after 30 weeks, undescended fetal testicles in the third trimester, small kidneys, and reduced fetal movement. The male infant was born at 38 weeks of gestation with a birth weight of 2580 g. He had a weak cry; severe hypotonia; small eyelid clefts; bilateral cryptorchidism; low responsiveness to medical procedures such as blood drawing; and poor sucking, necessitating tube feeding. Blood methylation-specific multiple ligation-dependent probe amplification (MS-MLPA) showed paternal deletion PWS. Notably, this case revealed two previously unreported prenatal features in PWS: a single umbilical artery and small kidneys. Conclusions: Through literature review and our case presentation, we suggest that a combination of specific sonographic features, including these newly identified markers, may aid clinicians in the early diagnosis of PWS. Full article

Background: Antenatal ultrasonography measurements of the estimated fetal weight (EFW) are a critical point in the decision-making process of obstetric planning and management to preserve the safety of both the newborn and the mother. This study aims to investigate the accuracy of ultrasonography to measure the EFW in comparison with the actual birth weight (BW) measured immediately after delivery. Methods: In this retrospective study, electronic records of 270 newborns who fulfilled the inclusion criteria were retrieved. A structured data sheet was used to collect the EFW, calculated by the Hadlock A formula using real-time ultrasound imaging on the day of delivery or the day before, and the actual BW immediately after delivery. Results: Out of 270 fetuses, 53.7% (145) were female, and 46.3% (125) were male. The mean BW was 2918.1 ± 652.81 g (range: 880 to 5100). The mean EFW was 3271.55 ± 691.47 g (range: 951 to 4942). The mean gestational age was 38 ± 2.48 weeks (range: 29 to 42). Spearman’s rho correlation test revealed strong compatibility between EFW and BW (r = 0.82, p < 0.001). Linear regression analysis showed a strong correlation between EFW and BW (R = 0.875, R² = 0.766, and p < 0.001). The cross-tabulation test showed 86.8%, 78.4%, and 26.9% compatibility between measurements of EFW and the true BW in group-1 (<2500 g), group-2 (2500–4000 g), and group-3 (>4000 g) fetuses (p< 0.001). Conclusions: EFW using ultrasonography yields high compatibility with the actual BW. Despite the slight overestimation, ultrasonography provides high clinical value in obstetric assessment and subsequent management. Full article

Background: Long bone metastases are common in patients with metastatic renal cell carcinoma (RCC). One potential surgical treatment option is resection and megaprosthetic reconstruction. However, implant complications and survival are poorly understood. This study analyzes patient and implant survival as well as associated risk factors. Methods: This is a retrospective study from a single academic center, analyzing 86 patients that underwent resection and megaprosthetic reconstruction performed between 1993 and 2017. The most common location of megaprosthetic reconstruction was the proximal femur (PFR) in 38% (33 of 86) of patients. We calculated overall patient survival and associated risk factors using the Kaplan–Meier method and implant survivorship using a competing risk analysis. Results: A total of 73% (63/86) of patients died of their disease after a median of 19 (IQR 9–37) months following surgery, and a median of 71 (IQR 31–132) months after the initial diagnosis of RCC. The overall survival probability was 29% (95% CI 18–40%) five years after surgery. The five-year risk of revision surgery (within a competing risk framework) was 18% (95% CI 11–28). A total of 8% (7 of 86) of patients underwent an exchange of the implant itself. Patients with total bone replacements had a higher revision risk (SHR 19.46 (95% CI 6.9–54.9), p < 0.01). Furthermore, the revision risk was higher with increasing reconstruction length per mm (SHR 1.01 (95% CI 1.01–1.02), p = 0.03) and prolonged surgical time per minute (SHR: 1.01 (95% CI 1.0–1.02), p < 0.01). Local postoperative radiation treatment (RTX) was associated with an increased risk for revisions (SHR 2.59 (95% CI 0.96–6.95), p = 0.06). Conclusions: Modular megaprostheses demonstrated a fairly low risk of implant revision although postoperative radiation therapy and total bone replacements are associated with an increased risk. Full article

Background: The optimal treatment for proximal tibial osteosarcoma (OS) in skeletally immature patients remains controversial. A custom hinged endoprosthesis has been used to preserve the growth potential of the distal femur. This study aims to report (1) the 2-year follow-up outcomes after surgery for pediatric proximal tibial OS; (2) the complications associated with this endoprosthesis; and (3) the extent to which the growth potential of the adjacent open physis can be preserved. Methods: Seven skeletally immature patients (mean age, 11.1 years; range, 9–13 years) with proximal tibial OS were included between November 2020 and December 2022. All underwent tumor resection and reconstruction by this custom endoprosthesis. Postoperative limb function was evaluated by the Musculoskeletal Tumor Society (MSTS) score system and complications were recorded. Overall leg length and femoral length were measured radiographically to determine the growth rate. Results: The mean follow-up time was 34.7 months (standard deviation (SD), 8.9 months). One patient presented with local recurrence 12 months after surgery, and another patient had pulmonary metastasis 3 months postoperatively. The range of flexion of the knee after rehabilitation was between 90° and 125°, with an average of 103.6° (SD, 12.5°). The average MSTS score of the patients after surgery was 27.4 (SD, 1.5). Wound dehiscence took place in three patients after chemotherapy. At the last follow-up, the overall limb length discrepancy was 2.1 cm (SD, 2.4 cm). Growth at the distal femoral physis after surgery was observed in all patients during follow-up, with an average of 81.4% (range, 57.78–100%) of growth of the contralateral distal femoral physis. Conclusions: This custom hinged endoprosthesis can preserve the growth potential of the adjacent distal femur and provide satisfying functional outcomes with lower postoperative complication rate. It could serve as an alternative for proximal tibial OS in skeletally immature children. Full article

Background and Objectives: Our study aimed to retrospectively examine the routine radiographs on the first postoperative day of osteosynthesis applications performed in the supine position with the help of a traction table, in the lateral decubitus position, and in the supine position in patients with intertrochanteric fractures of the femur who had a proximal femoral nail applied. It also aimed to compare them in terms of radiology. This study investigated the effects of three different patient positions on fracture reduction, a topic rarely encountered in the literature. Materials and Methods: Patients who underwent proximal femoral nailing in three different positions—the supine, traction table, and lateral decubitus positions—due to femoral intertrochanteric fractures in two different centers were analyzed. A total of 157 patients with complete early radiographs were included in this study to evaluate the quality of postoperative reduction and fixation. Results: There was a significant difference between the traction table-assisted supine position group (mean: 25.31 mm) and both the lateral decubitus position (mean: 31.91 mm) and supine position (mean: 31.79 mm) groups in terms of the TAD (p = 0.000). Regarding the collodiaphyseal angle, the traction table-assisted supine position (mean: 130.720°) and lateral decubitus position (mean: 130.290°) groups showed significantly higher values than the supine position group (mean: 124.190°) (p = 0.000). The average lengths of the lag and compression screws were lower in the lateral decubitus position group compared with the other groups (p = 0.000). Patients in the supine position group had smaller nail diameters and lengths (p = 0.000). When examining the Cleveland–Bosworth lag screw placements, the most frequent position was center–center, including 22 patients (31%) in the traction table-assisted supine position group, 15 patients (30.6%) in the lateral decubitus position group, and 9 patients (24.3%) in the supine position group, though the difference was not statistically significant (p = 0.203). Among the reduction criteria we investigated, the TAD on the traction table was statistically significantly closer to the targeted measurement, with an average of 25.31 mm, compared with the other two positions (p = 0.000). The collodiaphyseal angle was significantly within the target range in the traction table-assisted supine group, averaging 130.720°, compared with the supine position (p = 0.000). In the traction table group, according to the modified Baumgaertner classification, 59.2% achieved a good reduction; according to the Ikuta classification, subtype N accounted for 69.4%; and according to the Cleveland–Bosworth classification, a center–center placement was present in 31% of patients. Conclusions: All three types of operation can be preferred according to the habits of the surgeon operating and the variables during the operation (the fracture type, history of orthopedic surgery, and the material components of the application phase). Accompanied by these data, we recommend the traction table operation as a priority and the lateral decubitus position operation as a second preference in compliance with the technical requirements. Full article

Background and Clinical Significance: Proximal femoral focal deficiency (PFFD), also referred to as congenital femoral deficiency, is a longitudinal limb deficiency and birth defect that affects the lower extremity including the hip and femur, resulting in a deformed and shortened limb. It can be diagnosed and classified using a combination of imaging modalities, including radiographs, ultrasonography, magnetic resonance imaging and computerized tomography. It is crucial to characterize this birth defect in the prenatal period to appropriately prepare parents through counseling. Postnatal imaging should be performed to confirm the diagnosis, prognosticate and predict the patient’s course for treatment and management. Close follow-up and family/patient-centered care contribute to optimized patient outcomes. Case Presentation: Here, we present a series of three cases of varying PFFD severity and presentation, detailing the evaluation process, the limitations and value of imaging, and the treatment outcomes of these patients. Each case has a different PFFD classification and treatment strategy that we utilized according to the data that we attained through continuous patient care and discussion. Conclusions: We highlight the difficulties in identifying and classifying PFFD in the prenatal period while demonstrating how postnatal imaging clarified the diagnosis and informed appropriate counseling and treatment. Close follow-up and the length of patient continuity allowed us to maximize patient outcomes despite the variety in PFFD presentation and severity. Full article

Background: Failure to accurately estimate gestational age remains an important dilemma for optimal evidence-based antenatal care. Currently, when the last menstrual period (LMP) is unknown, ultrasonography measurement is the best method for estimating gestational age (GA). This study aims to assess the feasibility and accuracy of ultrasonography measurement of the transverse cerebellar diameter (TCD) to deduce fetal GA after 13 weeks of gestation. Methods: A prospective study was conducted on 384 normal singleton pregnancies. Demographic information and biometric measurements, including TCD, were collected using a data sheet. The data were then analyzed using SPSS version 27, DATAtab, and the R program. Results: The study found a strong significant association between GA based on TCD and the LMP, GA based on femur length (FL), GA based on biparietal diameter (BPD), GA based on abdominal circumference (AC), and GA based on the average gestational age (AVG) (r = 0.976, 0.970, 0.966, 0.968, and 0.984, respectively, p < 0.001). Furthermore, there was perfect agreement between GA estimated using TCD and GA based on LMP, with a mean difference of 0.41 weeks and upper and lower limits of agreement of −1.43 to 2.26 weeks. Conclusions: Ultrasonography measurements of the TCD accurately predict gestational age with excellent concordance with GA based on the LMP, FL, AC, and BPD. TCD can be used as a reliable estimator of GA in the second and third trimesters of pregnancy with the benefit of its brain-sparing effect in fetuses of fetal intrauterine growth restriction pregnancies. Combining TCD with FL, BPD, and AC provides the most accurate method of GA prediction. Full article

Background: The Gollop–Wolfgang complex is a rare congenital limb deformity characterized by a bifid femur, tibial hemimelia, and ectrodactyly of the hand. First described in 1980, fewer than 200 cases have been reported globally, with an estimated incidence of 1:1,000,000 live births. Case Presentation: We report a 2-month-old female infant with classic features of the Gollop–Wolfgang complex, including a left bifid femur, complete absence of the left tibia, and contralateral tetradactyly. A clinical examination revealed significant limb length discrepancy, knee instability, equinovarus foot deformity, and skeletal abnormalities confirmed by imaging studies. Extensive investigations, including echocardiography and genetic testing, excluded systemic anomalies and identified non-pathogenic variants in the Collagen Type XI Alpha 2 (COL11A2) and EVC2 genes. A surgical resection of the bifid femur was performed. Results: This case highlights the importance of early diagnosis and a multidisciplinary approach in managing the Gollop–Wolfgang complex. While our case presented with typical features, subtle variations highlight the phenotypic spectrum of the condition. The combination of tibial hemimelia and bifid femur frequently necessitates knee disarticulation due to the absence of a viable tibial anlage, while limb salvage techniques remain challenging. A genetic evaluation identified variants of uncertain significance in the COL11A2 and EVC2 genes, indicating that the genetic basis of the condition is not fully understood. Conclusions: These findings emphasize the need for continued genetic research to clarify the etiology of the Gollop–Wolfgang complex and to improve treatment strategies, particularly in refining surgical approaches and exploring new therapeutic options. Full article

Background/Objectives: Post-traumatic stress disorder (PTSD) has been associated with negative effects on bone health, potentially leading to reduced bone mass, altered geometry, and impaired mechanical strength. However, the extent of these changes and possible pharmacological interventions remains unclear. This study aimed to assess the impact of PTSD on bone properties and evaluate the therapeutic potential of CE-123 in mitigating PTSD-induced skeletal deterioration. Additionally, we examined the effects of CE-123 on healthy bone to determine its broader influence on skeletal integrity and growth. Methods: We conducted an experiment using female Wistar rats divided into four groups: Control, PTSD, Control+CE-123, and PTSD+CE-123. PTSD was induced using a validated stress paradigm, and CE-123 was administered to evaluate its effects on bone properties. Morphometric, densitometric, and mechanical parameters of the tibia and femur were analyzed, along with growth plate measurements to assess potential effects on skeletal development. Results: PTSD led to significant reductions in bone mineral density, bone mass, and mechanical properties, particularly in cortical thickness and relative bone weight, suggesting increased bone fragility. CE-123 treatment in PTSD-exposed rats prevented some of these adverse effects but did not fully restore bone integrity. In healthy rats, CE-123 increased bone length and growth plate size, particularly in the proliferative and resting zones, indicating a stimulatory effect on bone growth. Conclusions: PTSD negatively affects bone structure and mechanical strength, while CE-123 shows a potential to mitigate these effects. However, its influence on healthy bones raises questions about its long-term impact on skeletal development. Further studies are needed to evaluate CE-123’s clinical applicability and safety, particularly in younger populations. Full article

In addition to various physiological parameters that affect athletes’ performance and outcomes, anthropometric variables are also related to athletic performance. In particular, the length of the lower limbs is closely associated with human mobility and stride length, making it a crucial factor in various movement-based sports. Furthermore, favorable body proportions may vary depending on the sport, and a better understanding of how body proportions affect physical performance across different levels of athletes is needed. Therefore, the purpose of this study is to investigate the relationship between leg length and physical performance by measuring body dimensions (tibia and femur length) for athletes categorized by sports characteristics and performance levels. The study involved 312 athletes from 23 sports, divided into three activity levels. Anthropometric measurements of tibia and femur length were taken, and physical performance tests, including strength, muscular endurance, cardiovascular endurance, agility, explosiveness, flexibility, and anaerobic power, were conducted in the laboratory. The relationships between variables (leg length × physical performance) were analyzed using Pearson’s correlation coefficients. Leg length via activity levels was verified through one-way analysis of variance (ANOVA) testing, including normality and homoscedasticity. Post hoc analysis (Tukey’s HSD test) was used to compare specific differences when significance was found. Statistical significance was accepted at the 0.05 level. As a result, an increase in lower limb length was found to have a relationship with physical performance components, including power (r = 0.302, p = 0.001), agility (r = −0.289, p = 0.001), endurance capacity (r = 0.168, p = 0.005), and anaerobic peak power (r = 0.265, p = 0.001). However, in the LD group, which consisted of athletes in static sports, no significant relationship was observed between lower limb length and physical performance components. However, in the LD group, which included static sports, no significant relationship was found between lower limb length and physical performance components. These findings may serve as foundational data for athlete talent identification and performance prediction. Full article

Background: Curettage represents a reliable therapeutic option for large-sized benign and locally aggressive bone tumors. In cases of impending fractures, internal fixation with plates and screws can be necessary to stabilize the treated bone after curettage. Metal plates have been the only fixation devices available on the market for decades, but Carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) now represents an alternative in orthopedic oncology. Methods: We reviewed our patients with benign or locally aggressive bone tumors treated with curettage and fixation with CFR-PEEK plates. Plate length and curettage technique were chosen considering the characteristics of each lesion. We recorded the size and location of the lesions, adjuvant treatments and fillers used after curettage, complications, and local recurrences. Postoperative functionality was assessed using the MSTS score. Results: Forty cases were included in our study. The tumors were located in the distal femur (19 cases), femur shaft (1), humerus (17), or proximal tibia (3). Local adjuvants were used in 20 cases. Cavities were filled with bone allografts in 30 cases and cement in 10 cases. Only four cases suffered postoperative complications, and two developed local recurrences. The mean postoperative follow-up was 29.2 months. The mean postoperative upper and lower limb MSTS was 28.0 and 26.7, respectively. Conclusions: After an accurate curettage and an adequate filling of the resulting bone gap, CFR-PEEK plates can provide good mechanical resistance, and their radio-transparency can ease the early diagnosis of local recurrences. CFR-PEEK plates should be considered in selected cases, in a personalized surgical approach. Full article

Background and Objectives: Intertrochanteric fractures of the femur are common in the elderly due to the increase in longer life expectancy. However, unstable intertrochanteric fractures in the elderly population were still a significant concern for the postsurgical period after total hip arthroplasty (THA). This study aimed to compare the demographics, operative time, dislocation rate, and length of stay of the novel interfragmentary technique (IFT) and the conventional posterolateral approach (CPA) for unstable intertrochanteric femoral fractures treated with THA in the elderly. Materials and Methods: This retrospective study investigated community-dwelling elderly patients with type III, IV, and V unstable femoral intertrochanteric fractures according to the Evans–Jensen classification, treated with THA by a well-experienced single surgeon. The patients were separated into IFT (n = 74) and CPA (n = 67) groups. Patient demographics (age, gender, and body mass index), total surgical duration, dislocation rates, length of stay and follow-up, and complication rates were recorded. Results: The mean age was 80.37 years in the IFT and 80.14 in the CPA groups (p = 0.838). Body mass index, gender, complication, and revision rates did not differ between groups (p > 0.05). The mean follow-up of the IFT group was 4.15 years, and 10.25 years in the CPA group (p = 0.001). Total surgical duration was comparable, with 69.98 min in the IFT group and 69.55 min in the CPA group (p = 0.697). The dislocation rate was 2.7% (n = 2) in the IFT group and 9% (n = 6) in the CPA group (p = 0.109). The mean length of stay was 66.97 h in the IFT group and 67.83 h in the CPA group (p = 0.729). Conclusions: The interfragmentary surgical technique, a novel technique for unstable intertrochanteric fracture surgery, shows promising clinical outcomes. Preserving the short rotator muscles and posterior capsule utilizing the novel IFT can be advantageous for the risk of dislocation without increasing surgical duration. It can be concluded that performing THA using IFT emerges as a practical and viable procedure for treating unstable intertrochanteric fractures in elderly patients. Full article