The influence of foehn winds on the incidence of severe injuries in southern Bavaria – an analysis of the TraumaRegister DGU®BMC Musculoskeletal Disorders - Tập 21 - Trang 1-9 - 2020
Frederik Greve, Karl-Georg Kanz, Michael Zyskowski, Francesca von Matthey, Peter Biberthaler, Stefan Muthers, Andreas Matzarakis, Rolf Lefering, Stefan Huber-Wagner
Foehn describes a wind which occurs in areas with close proximity to mountains. The presence of foehn wind is associated with worsening health conditions. This study analyzes the correlation between a foehn typical circulation and the incidence for suffering a severe trauma. This is a retrospective, multicentre observational register study. The years from 2013 to 2016 were analyzed for the presence of foehn winds. A logistic regression analysis with the number of daily admitted trauma patients as the primary target value was performed in dependence of foehn winds. Southern Bavaria is a typical foehn wind region. Individuals were treated in 37 hospitals of Southern Bavaria which participate in the TraumaRegister DGU®, an international register that includes all severe trauma patients, mainly in Germany. We analyzed patients with an Injury Severity Score (ISS) of at least nine with admission to intensive care units or prior death in the emergency room. 6215 patients were enrolled in this study. A foehn-typical circulation was present on 65 days (4.5%). 301 patients (5%) suffered a trauma with an ISS ≥ 9 on a foehn day. The mean ISS was 20.2 (9–75). On average, 4.3 patients (0–15 patients) were admitted on a daily basis due to a severe trauma. The multivariate regression analysis revealed a daily increase of 0.87 individuals (p = 0.004; 95% CI 0.23–1.47) on foehn days. During spring 1.07 patients (p = < 0.001; 95% CI 0.72–1.42), in summer 1.98 patients (p = < 0.001; 95% CI 1.63–2.32), in fall 0.63 (p = < 0.001; 95% CI 0.28–0.97) and on Saturdays, 0.59 patients (p = < 0.001; 95% CI 0.24–0.93) were additionally admitted due to severe trauma. Foehn winds are significantly associated with severe trauma in trauma centers of the TraumaNetzwerk DGU®.
Efficacy of the “Eiffel tower” double titanium elastic nailing in combined management of congenital pseudarthrosis of the tibia: preliminary outcomes of 17 cases with review of literatureBMC Musculoskeletal Disorders - - 2021
Xiaoyu Wang, Li Shi, Rui Zhang, Wenbo Wang, Feng Wang, Mengwei Wang, Ze Xu, Rongtai Zuo, Jia Xu, Qinglin Kang
Abstract
Background
Difficulty in obtaining union, recurrent fractures, and residual deformities remain the problems challenging the management of congenital pseudarthrosis of the tibia (CPT). We applied the “Eiffel Tower” double titanium elastic nails (TENs) in the existing combined approach, which takes advantages of TEN’s mechanical stability with the protection against refracture, Ilizarov’s high fusion rate with alignment control and the biologic environment provided by bone grafting for bony union. The results of this procedure are presented and discussed.
Methods
Seventeen patients with CPT treated by combined surgery including pseudarthrosis resection, the “Eiffel Tower” double TENs technique, autogenous iliac bone grafting, and Ilizarov fixation between 2013 and 2019 were retrospectively investigated. Signs of bone union, limb length discrepancy (LLD), rate of refracture, and degree of residual deformities were reviewed. The AOFAS Ankle Hindfoot scale and measurement of ankle motion were used to evaluate ankle function. The mean follow-up time was 40.5 (11 to 91) months.
Results
The mean age at index surgery was 6.2 (2.5 to 15) years. Union of the pseudarthrosis was achieved in 100% of cases. Among them, 15 (88.2%) patients obtained union of the pseudarthrosis on the first attempt (primary union). The average time to primary union was 3.8 (2 to 6) months. The rest 2 cases achieved union after additional surgeries (secondary union). In terms of complications, refracture occurred in 2 patients (11.8%) and 4 patients (23.5%) developed pin infection. The mean limb length discrepancy at the final follow up was 33.4 (6–141) mm. The average AOFAS score improved from 38.2 (27 to 51) pre-operatively to 77 (63 to 87) post-operatively (p < 0.01).
Conclusions
The “Eiffel Tower” double TENs technique is an ideal intramedullary fixation method in the surgical treatment of CPT. The combination of TENs technique with bone grafting and Ilizarov fixation has the advantages of early bone union, less injury on metaphysis, and early functional recovery.
Level of evidence
Level IV.
Reproducibility of improvements in patient-reported functional ability following functional capacity evaluationBMC Musculoskeletal Disorders - Tập 23 - Trang 1-9 - 2022
Martin Schindl, Harald Zipko, Matthias Bethge
Performance of functional capacity evaluation (FCE) may affect patients, self-efficacy to complete physical activity tasks. First evidence from a diagnostic before-after study indicates a significant increase of patient-reported functional ability. Our study set out to test the reproducibility of these results. Patients with musculoskeletal trauma and an unclear return to work prognosis were recruited in a trauma rehabilitation center in Lower Austria. We included patient cohorts of three consecutive years (2016: n = 161, 2017: n = 140; 2018: n = 151). Our primary outcome was patient-reported functional ability, measured using the Spinal Function Sort (SFS). SFS scores were assessed before and after performing an FCE to describe the change in patient-reported functional ability (cohort study). We investigated whether the change in SFS scores observed after performing an FCE in our first cohort could be replicated in subsequent cohorts. Demographic data (gender, age and time after trauma) did not differ significantly between the three patient cohorts. Correlation analysis showed highly associated before and after SFS scores in each cohort (2016: rs = 0.84, 95% CI: 0.79 to 0.89; 2017: rs = 0.85, 95% CI: 0.81 to 0.91; 2018: rs = 0.86, 95% CI: 0.82 to 0.91). Improvements in SFS scores were consistent across the cohorts, with overlapping 95% confidence intervals (2016: 14.8, 95% CI: 11.3 to 18.2; 2017: 14.8, 95% CI: 11.5 to 18.0; 2018: 15.2, 95% CI: 12.0 to 18.4). Similarity in SFS scores and SFS differences were also supported by non-significant Kruskal–Wallis H tests (before FCE: p = 0.517; after FCE: p = 0.531; SFS differences: p = 0.931). A significant increase in patient-reported functional ability after FCE was found in the original study and the results could be reproduced in two subsequent cohorts.
Criterion validation of two submaximal aerobic fitness tests, the self-monitoring Fox-walk test and the Åstrand cycle test in people with rheumatoid arthritisBMC Musculoskeletal Disorders - Tập 15 - Trang 1-11 - 2014
Birgitta Nordgren, Cecilia Fridén, Eva Jansson, Ted Österlund, Wilhelmus Johannes Grooten, Christina H Opava, Anette Rickenlund
Aerobic capacity tests are important to evaluate exercise programs and to encourage individuals to have a physically active lifestyle. Submaximal tests, if proven valid and reliable could be used for estimation of maximal oxygen uptake (VO2max). The purpose of the study was to examine the criterion-validity of the submaximal self-monitoring Fox-walk test and the submaximal Åstrand cycle test against a maximal cycle test in people with rheumatoid arthritis (RA). A secondary aim was to study the influence of different formulas for age predicted maximal heart rate when estimating VO2max by the Åstrand test. Twenty seven subjects (81% female), mean (SD) age 62 (8.1) years, diagnosed with RA since 17.9 (11.7) years, participated in the study. They performed the Fox-walk test (775 meters), the Åstrand test and the maximal cycle test (measured VO2max test). Pearson’s correlation coefficients were calculated to determine the direction and strength of the association between the tests, and paired t-tests were used to test potential differences between the tests. Bland and Altman methods were used to assess whether there was any systematic disagreement between the submaximal tests and the maximal test. The correlation between the estimated and measured VO2max values were strong and ranged between r = 0.52 and r = 0.82 including the use of different formulas for age predicted maximal heart rate, when estimating VO2max by the Åstrand test. VO2max was overestimated by 30% by the Fox-walk test and underestimated by 10% by the Åstrand test corrected for age. When the different formulas for age predicted maximal heart rate were used, the results showed that two formulas better predicted maximal heart rate and consequently a more precise estimation of VO2max. Despite the fact that the Fox-walk test overestimated VO2max substantially, the test is a promising method for self-monitoring VO2max and further development of the test is encouraged. The Åstrand test should be considered as highly valid and feasible and the two newly developed formulas for predicting maximal heart rate according to age are preferable to use when estimating VO2max by the Åstrand test.
Shoulder muscle changes in patients with type 2 diabetes mellitus who have a painful shoulder: a quantitative muscle ultrasound studyBMC Musculoskeletal Disorders - Tập 23 - Trang 1-12 - 2022
Login Ahmed S. Alabdali, Bjorn Winkens, Geert-Jan Dinant, Nens van Alfen, Ramon P. G. Ottenheijm
It is assumed that in patients with diabetic neuropathy, muscle denervation can result in shoulder disorders. Muscle denervation will lead to changes in muscle architecture, which can be assessed by quantitative muscle ultrasound (QMUS). The aim was to investigate whether increased muscle echogenicity, as a sign of neuropathy, is more often present in patients with shoulder pain who have type 2 diabetes mellitus (T2DM) than in those without. Sixty-six patients with T2DM and 23 patients without diabetes mellitus (DM) having shoulder pain were included. Quantitative muscle ultrasound images were obtained bilaterally from the biceps brachii, deltoid, and supra- and infraspinatus muscles. The mean echogenicity (muscle ultrasound grey value) was transformed into z-scores and compared to reference values obtained from 50 healthy participants. Associations between muscle echogenicity and clinical variables were explored. In painful shoulders of both patients with T2DM and patients without DM, mean echogenicity z-scores of all muscles were significantly increased compared to healthy controls. No significant differences in echogenicity between patients with T2DM and those without DM were found. In patients with T2DM, a distal symmetric polyneuropathy was significantly associated with increased echogenicity of all muscles except the infraspinatus muscle. These findings indicate that patients with painful shoulders, irrespective of having T2DM, seem to have abnormal shoulder muscles. Future studies are needed to elucidate whether neuropathy or other conditions lead to these muscle changes.
SNHG14 induces osteogenic differentiation of human stromal (mesenchymal) stem cells in vitro by downregulating miR-2861BMC Musculoskeletal Disorders - Tập 21 - Trang 1-9 - 2020
Mingchang Du, Bo Wu, Shiwen Fan, Ye Liu, Xu Ma, Xun Fu
The differentiation of human stromal (mesenchymal) stem cells (hMSCs) is a critical procedure for the development of osteoblast. SNHG14 is a newly discovered lncRNA that has been barely studied. Our preliminary experiments showed that SNHG14 may be dysregulated in the differentiation of hMSCs. In this study, we focused on elucidating the relationships among SNGH14, miR-2861, and osteoblastic differentiation of hMSCs. To investigate the roles of SNHG14 and miR2861 in hMSCs differentiation, qRT-PCR, luciferase activity, cell transfections, the detections of ALP activity, and Alizarin Red staining were performed. We found that the expression of SNHG14 was enhanced, while the expression of miR-2861 was suppressed in serum and hMSCs from patients with osteoporosis. SNHG14 could target miR-2861, and shSNHG14 suppressed osteoblast differentiation of hMSC. MiR-2861 suppressed osteoblast differentiation of hMSC. In addition, the effects of SNHG14 on osteoblast differentiation of hMSC were attenuated by miR-2861. In conclusion, our experimental data showed that the induction effects of SNHG14 on osteoblast differentiation of hMSC were attenuated by miR-2861. SNHG14 could induce osteogenic differentiation of hMSC in vitro by targeting miR-2861.
Cardiovascular disease prevalence in patients with inflammatory arthritis, diabetes mellitus and osteoarthritis: a cross-sectional study in primary careBMC Musculoskeletal Disorders - Tập 13 Số 1 - Trang 1-5 - 2012
Nielen, Markus MJ, van Sijl, Alper M, Peters, Mike JL, Verheij, Robert A, Schellevis, François G, Nurmohamed, Michael T
There is accumulating evidence for an increased cardiovascular burden in inflammatory arthritis, but the true magnitude of this cardiovascular burden is still debated. We sought to determine the prevalence rate of non-fatal cardiovascular disease (CVD) in inflammatory arthritis, diabetes mellitus and osteoarthritis (non-systemic inflammatory comparator) compared to controls, in primary care. Data on CVD morbidity (ICPC codes K75 (myocardial infarction), K89 (transient ischemic attack), and/or K90 (stroke/cerebrovascular accident)) from patients with inflammatory arthritis (n = 1,518), diabetes mellitus (n = 11,959), osteoarthritis (n = 4,040) and controls (n = 158,439) were used from the Netherlands Information Network of General Practice (LINH), a large nationally representative primary care based cohort. Data were analyzed using multi-level logistic regression analyses and corrected for age, gender, hypercholesterolemia and hypertension. CVD prevalence rates were significantly higher in inflammatory arthritis, diabetes mellitus and osteoarthritis compared with controls. These results attenuated - especially in diabetes mellitus - but remained statistically significant after adjustment for age, gender, hypertension and hypercholesterolemia for inflammatory arthritis (OR = 1.5 (1.2-1.9)) and diabetes mellitus (OR = 1.3 (1.2-1.4)). The association between osteoarthritis and CVD reversed after adjustment (OR = 0.8 (0.7-1.0)). These results confirm an increased prevalence rate of CVD in inflammatory arthritis to levels resembling diabetes mellitus. By contrast, lack of excess CVD in osteoarthritis further suggests that the systemic inflammatory load is critical to the CVD burden in inflammatory arthritis.
Could extended laminectomy effectively prevent spinal cord injury due to spinal shortening after 3-column osteotomy?BMC Musculoskeletal Disorders -
Yuyue Chen, Huanjie Yang, Ningling Xie, Shuang Zhang, Xiaobao Zou, Chenfu Deng, Binbin Wang, Hengrui Li, Xiangyang Ma
Abstract
Objective
To explore whether the laminectomy extension can effectively prevent spinal cord injury (SCI) due to spinal shortening after 3-column osteotomy in goat models.
Methods
A total of twenty healthy goats were included and done with 3-column osteotomy of T13 and L1 under the somatosensory evoked potential (SSEP) monitoring. The samples were divided into two groups. The first group underwent regular laminectomy while the second group underwent an extended laminectomy with an extra 10 mm-lamina cranial to L2. The SSEP measured after 3-column osteotomy was set as the baseline, and the SSEP decreased by 50% from the baseline amplitude and/or delayed by 10% relative to the baseline peak latency was set as positive results, which indicated spinal cord injury. The vertebral column was gradually shortened until the SSEP monitoring just did not show a positive result. The height of the initial osteotomy gap (the distance from the lower endplate of T12 to the upper endplate of L2), the shortened distance (△H), the number of spinal cord angulated and the changed angle of the spinal cord (△α) were measured and recorded in each group. Neurological function was evaluated by the Tarlov scores on day 2 postoperatively.
Results
All the goats except one of the first group due to changes in the SSEP during the osteotomy were included and analyzed. In the first group, the height of the initial osteotomy segment and the safe shortening distances were 61.6 ± 2.6 mm and 35.2 ± 2.6 mm, respectively; the spinal cord of 5 goats was angulated (46.4 ± 6.6°), the other four goats were kinked and not angulated. In the second group, the height of the initial osteotomy segment and the safe shortening distances were 59.8 ± 1.5 mm and 43.3 ± 1.2 mm, respectively, and the spinal cord of ten goats were angulated (97.6 ± 7.2°). There was no significant difference in the height of the initial osteotomy segment between the two groups by using Independent-Samples T-Test, P = 0.095 (P > 0.05); there were significant difference in the safe shortening distance and the changed angle of the spinal cord between the two groups by using Independent-Samples T-Test (both $$\Delta$$H and $$\Delta$$α of P < 0.001), the difference between their mean were 8.1 mm and 51.2°. Significant difference was found in the number of spinal cord angulation between the two groups through Fisher’s exact test (5/9 vs. 10/10, P = 0.033).
Conclusions
An additional resection of 10 mm-lamina cranial to L2 showed the satisfactory effect in alleviating SCI after 3-column osteotomy. Timely and appropriate extend laminectomy could be a promising therapeutic strategy for SCI attributable to facilitating spinal cord angulation rather than spinal cord kinking and increasing the safe shortening distance.
Hip and fragility fracture prediction by 4-item clinical risk score and mobile heel BMD: a women cohort studyBMC Musculoskeletal Disorders - Tập 11 - Trang 1-11 - 2010
Daniel Albertsson, Dan Mellström, Christer Petersson, Hans Thulesius, Robert Eggertsen
One in four Swedish women suffers a hip fracture yielding high morbidity and mortality. We wanted to revalidate a 4-item clinical risk score and evaluate a portable heel bone mineral density (BMD) technique regarding hip and fragility fracture risk among elderly women. In a population-based prospective cohort study we used clinical risk factors from a baseline questionnaire and heel BMD to predict a two-year hip and fragility fracture outcome for women, in a fracture preventive program. Calcaneal heel BMD was measured by portable dual X-ray laser absorptiometry (DXL) and compared to hip BMD, measured with stationary dual X-ray absorptiometry (DXA) technique. Seven women suffered hip fracture and 14 women fragility fracture/s (at hip, radius, humerus and pelvis) among 285 women; 60% having heel BMD ≤ -2.5 SD. The 4-item FRAMO (Fracture and Mortality) Index combined the clinical risk factors age ≥80 years, weight <60 kg, prior fragility fracture, and impaired rise-up ability. Women having 2-4 risk factors showed odds ratio (OR) for hip fracture of 5.9 and fragility fracture of 4.4. High risk group hip fracture risk was 2.8% annually compared to 0.5% for the low risk majority (69%). Heel BMD showed hip fracture OR of 3.1 and fragility fracture OR of 2.6 per SD decrease. For 30 DXA assessed participants mean hip BMD at -2.5 SD level corresponded to a lower BMD at the heel. Five of seven hip fractures occurred within a small risk group of 32 women, identified by high FRAMO Index + prior fragility fracture + heel T-score ≤-3.5 SD. In a follow-up study we identified high risk groups for hip and fragility fracture with our plain 4-item risk model. Increased fracture risk was also related to decreasing heel BMD in calcaneal bone, measured with a mobile DXL technique. A combination of high FRAMO Index, prior fragility fracture, and very low BMD restricted the high risk group to 11%, among whom most hip fractures occurred (71%). These practical screening methods could eventually reduce hip fracture incidence by concentrating preventive resources to high fracture risk women.
Development of a new pre-vascularized tissue-engineered construct using pre-differentiated rADSCs, arteriovenous vascular bundle and porous nano-hydroxyapatide-polyamide 66 scaffoldBMC Musculoskeletal Disorders - Tập 14 - Trang 1-14 - 2013
Pei Yang, Xin Huang, Jacson Shen, Chunsheng Wang, Xiaoqian Dang, Henry Mankin, Zhenfeng Duan, Kunzheng Wang
Development of a pre-vascularized tissue-engineered construct with intrinsic vascular system for cell growth and tissue formation still faces many difficulties due to the complexity of the vascular network of natural bone tissue. The present study was to design and form a new vascularized tissue-engineered construct using pre-differentiated rADSCs, arteriovenous vascular bundle and porous nHA-PA 66 scaffold. rADSCs were pre-differentiated to endothelial cells (rADSCs-Endo) and then incorporated in nHA-PA 66 scaffolds in vitro. Subsequently, in vivo experiments were carried out according to the following groups: Group A (rADSCs-Endo/nHA-PA 66 scaffold with arteriovenous vascular bundle), Group B (rADSCs/nHA-PA 66 scaffold with arteriovenous vascular bundle); Group C (nHA-PA66 scaffold with arteriovenous vascular bundle), Group D (nHA-PA 66 scaffold only). The vessel density and vessel diameter were measured based on histological and immunohistochemical evaluation, furthermore, the VEGF-C, FGF-2 and BMP-2 protein expressions were also evaluated by western blot analysis. The results of in vivo experiments showed that the vessel density and vessel diameter in group A were significantly higher than the other three groups. Between Group B and C, no statistical difference was observed at each time point. In accordance with the results, there were dramatically higher expressions of VEGF-C and FGF-2 protein in Group A than that of Group B, C and D at 2 or 4 weeks. Statistical differences were not observed in VEGF-C and FGF-2 expression between Group B and C. BMP-2 was not expressed in any group at each time point. Compared with muscular wrapping method, arteriovenous vascular bundle implantation could promote vascularization of the scaffold; and the angiogenesis of the scaffold was significantly accelerated when pre-differentiated rADSCs (endothelial differentiation) were added. These positive results implicate the combination of pre-differentiated rADSCs (endothelial differentiation) and arteriovenous vascular bundle may achieve rapidly angiogenesis of biomaterial scaffold.
