Five or more gender- and size-diverse customizations of distal femur prostheses are needed to improve fit for Chinese knees.

PURPOSE: Mismatch between partial imported prostheses and Chinese anatomy affects the clinical outcome of the procedure. The purpose of this study was to measure the anatomical dimensions of Chinese distal femurs to provide guidance for the design of more compatible distal femoral prostheses. METHODS: A total of 406 healthy distal femurs were reconstructed and measured. Consistency of these measurements and differences in sides, gender, and populations were examined. Parameter correlations were analyzed, and pairs with strong correlations underwent linear regression analysis. The design of distal femoral prostheses was referenced from the results of K-means and hierarchical clustering analysis. RESULTS: Ten parameters were measured, including the trans-epicondylar axis, width of the distal femur (ML), anteroposterior diameter of the distal femur (AP), etc. The intra-class correlation coefficient ranged from 0.795 to 0.999 for intra-observer consistency, and from 0.796 to 0.998 for inter-observer consistency. Males exhibited significantly larger parameters than females, except for the posterior condylar angle (all P values < 0.05). Compared to other populations, substantial differences were observed for most parameters, such as ML, AP, width of lateral femoral condyle, etc. (all P values < 0.05). Clustering analysis suggested that distal femoral prostheses should include at least five sizes to adequately accommodate the sampled population. ML sizes for males were 68, 70, 83, 73, and 89 mm, and for females 64, 65, 71, 67, and 77 mm. AP sizes for males were 56, 60, 60, 64, and 64 mm, and for females 48, 52, 54, 57, and 58 mm. CONCLUSIONS: Chinese distal femur morphology, as analyzed using 3D techniques, varies significantly between genders and when compared with international data. For improved patient fit, the creation of five or more distal femur prostheses, diversified by gender and size and informed by the associated morphological parameters, is recommended. LEVEL OF EVIDENCE: IV.

Three-dimensional computed tomography mapping techniques in the morphometric analysis of AO/OTA 33A and 33C distal femoral fractures: a retrospective single-center study.

Purpose: Complex distal femoral fractures involve a challenging set of considerations that must be known to provide optimal management. This study aimed to determine the location and frequency of fracture lines and comminution zones in AO/OTA types 33A and 33C distal femoral fractures using three-dimensional computed tomography mapping. Methods: Seventy-four consecutive eligible patients were included. Fracture fragments for each patient were reconstructed, virtually reduced, and adjusted to match the distal femoral template. Then, all fracture lines and comminuted areas were extracted in transparent mode, and corresponding heat maps were constructed. Finally, these maps, along with the quantitative analysis findings of the counts and volumes of each fragment, were used to summarize the characteristics of the fractures. Results: Thirty-four females and 40 males [average age, 58 years (range, 18-92 years)] presented with a distal femoral fracture. There were 53 AO/OTA type 33A fractures, and 21 AO/OTA type 33C fractures. These two patterns differed significantly on fracture fragment count, comminuted zone fracture fragment count, and mean comminuted zone fracture fragment volume (p < 0.05). Most of the fracture line heat zones were in the femoral epiphysis, intercondylar notch of the femur, and patellofemoral joint. The comminuted area heat regions were mostly found on the lateral, anterior, and posterior femoral diaphysis, with less involvement on the medial side. Conclusion: Our findings may serve as a guide for the surgical approach selection of complex distal femur fractures, the placement strategy of the internal fixation, and the optimization of the osteotomy plan for biomechanical studies.

The comparison of Nice knots and traditional methods as an auxiliary reduction-fixation technique in pre-contoured locking plate fixation for comminuted Robinson type 2B clavicle fracture: A retrospective study.

ABSTRACT: Open reduction and pre-contoured locking plate fixation is a popular treatment option for displaced midshaft clavicle fracture. Lag screw and cerclage are 2 main intraoperative techniques to reduce and fix fragments. However, both lag screw and metallic cerclage have disadvantages. The doubled-suture Nice knot has been reported in many areas of orthopedic surgery for its effectiveness. This study aims to compare the outcomes of comminuted mid-shaft clavicle fractures reduced by Nice knots vs traditional techniques (lag screw or/and metallic cerclage) when bridged with pre-contoured locking plates.We retrospectively reviewed 101 patients (65 females and 36 males) diagnosed with midshaft clavicle fractures with at least one wedge fragment reduced by either Nice knots or traditional methods and bridged with pre-contoured locking plates between December 2016 and April 2019. Operation time, functional outcomes, pain, patient satisfaction, fracture healing, and complications were assessed at a follow-up of 12 to 40 months.The mean age of all the patients was 50.8 years. There were 52 and 49 patients in the Nice knot group and traditional group respectively, and no differences between 2 groups were found in general patient characteristics, fracture type, follow up and injury-to-surgery duration. The Nice knot group had significant less operation time (P < .01) than the traditional group (mean and standard deviation [SD], 78.6 ±â€Š19.0 compared with 94.4 ±â€Š29.9 minutes, respectively). For healing time, functional score, pain, satisfaction and complications, there were no significant differences between groups, despite the Nice knot group had slightly better results.Both Nice knots and traditional methods treated for comminuted Robinson type 2B clavicle fractures were effective and safe. And the Nice knots seemed to be superior with significant less operation time.

A Network Pharmacology-Based Study on the Anti-Lung Cancer Effect of Dipsaci Radix.

OBJECTIVE: Dipsaci Radix (DR) has been used to treat fracture and osteoporosis. Recent reports have shown that myeloid cells from bone marrow can promote the proliferation of lung cancer. However, the action and mechanism of DR has not been well defined in lung cancer. The aim of the present study was to define molecular mechanisms of DR as a potential therapeutic approach to treat lung cancer. METHODS: Active compounds of DR with oral bioavailability ≥30% and drug-likeness index ≥0.18 were obtained from the traditional Chinese medicine systems pharmacology database and analysis platform. The potential target genes of the active compounds and bone were identified by PharmMapper and GeneCards, respectively. The compound-target network and protein-protein interaction network were built by Cytoscape software and Search Tool for the Retrieval of Interacting Genes webserver, respectively. GO analysis and pathway enrichment analysis were performed using R software. RESULTS: Our study demonstrated that DR had 6 active compounds, including gentisin, sitosterol, Sylvestroside III, 3,5-Di-O-caffeoylquinic acid, cauloside A, and japonine. There were 254 target genes related to these active compounds as well as to bone. SRC, AKT1, and GRB2 were the top 3 hub genes. Metabolisms and signaling pathways associated with these hub genes were significantly enriched. CONCLUSIONS: This study indicated that DR could exhibit the anti-lung cancer effect by affecting multiple targets and multiple pathways. It reflects the traditional Chinese medicine characterized by multicomponents and multitargets. DR could be considered as a candidate for clinical anticancer therapy by regulating bone physiological functions.