Injectable double-crosslinked bone cement with enhanced bone adhesion and improved osteoporotic pathophysiological microenvironment for osteoregeneration in osteoporosis.

The osteoporotic bone defect caused by excessive activity of osteoclasts has posed a challenge for public healthcare. However, most existing bioinert bone cement fails to effectively regulate the pathological bone microenvironment and reconstruct bone homeostasis in the presence of osteoclast overactivity and osteoblast suppression. Herein, inspired by natural bone tissue, an in-situ modulation system for osteoporotic bone regeneration is developed by fabricating an injectable double-crosslinked PEGylated poly(glycerol sebacate) (PEGS)/calcium phosphate cement (CPC) loaded with sodium alendronate (ALN) (PEGS/CPC@ALN) adhesive bone cement. By incorporating ALN, the organic-inorganic interconnection within PEGS/CPC@ALN results in a 100 % increase in compression modulus and energy dissipation efficiency. Additionally, PEGS/CPC@ALN effectively adheres to the bone by bonding with amine and calcium ions present on the bone surface. Moreover, this in-situ regulation system comprehensively mitigates excessive bone resorption through the buffering effect of CPC to improve the acidic microenvironment of osteoporotic bone and the release of ALN to inhibit hyperactive osteoclasts, and facilitates stem cell proliferation and differentiation into osteoblasts through calcium ion release. Overall, the PEGS/CPC@ALN effectively regulates the pathological microenvironment of osteoporosis while promoting bone regeneration through synergistic effects of drugs and materials, thereby improving bone homeostasis and enabling minimally invasive treatment for osteoporotic defects.

Subchondral curettage cement packing in the distal radius causes wrist joint degeneration: long-term evaluation of distal radius giant-cell bone tumour.

INTRODUCTION: This study investigated wrist joint degeneration after curettage and PMMA treatment for giant cell bone tumours (GCBT) at the distal radius. METHODS: We performed a retrospective single-centre study, which included 23 patients with GCBT at distal radius treated with curettage and PMMA between 2001 and 2021. The progression of wrist joint degeneration was assessed through radiographic evidence, comparing the postoperative grade with both the preoperative grade and the grade of the contralateral wrist at the latest follow-up. We also analyzed the influence of age, sex, tumour distance of the joint, subchondral bone involvement, tumour size and body mass index. RESULTS: The study included 23 patients with a mean age of 32.1 ± 13.3 years. The average duration of follow-up was 96.4 ± 69 months (range, 24-265 months). The mean tumour-cartilage distance was 1.79 ± 2.4 mm (range, 0-10 mm) and the mean BMI was 23.5 ± 3.8 kg/m2. Degeneration of the wrist joint was evident in 16 patients (69.6%) at the final assessment, however, 10 patients (43.4%) were identified as having a progression of joint degeneration secondary to the surgical procedure among the 16 patients with wrist joint degeneration at the final control view. Age, gender, dominance, tumour-cartilage distance, subchondral bone involvement, tumour size, patient height, weight, and BMI were not associated with secondary joint degeneration. CONCLUSIONS: Ten of 23 patients developed wrist joint degeneration over an average follow-up period of 8 years, and no particular factors associated with the degeneration were identified.

Evaluation of Antibiotic-Loaded Bone Cement in Treatment of Infected Diabetic Foot: Systematic Review and Meta-Analysis.

BACKGROUND: Diabetic foot ulcer (DFU) is a common and complex complication in patients with diabetes mellitus. The study of antibiotic-loaded bone cement for the treatment of infected diabetic foot is limited. We aimed to assess the efficacy of antibiotic-loaded bone cement for the treatment of infected diabetic foot. METHODS: The MEDLINE, Embase, BIOSIS, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Knowledge databases were systematically searched up to May 2023 with no language restrictions. We assessed eligible studies for the efficacy of antibiotic-loaded bone cement for the treatment of infected diabetic foot. The standard mean differences (SMDs) or the risk ratios (RRs) were calculated for continuous or dichotomous data, respectively. Data were analysed using the Cochrane Collaboration's RevMan 5.0 software. RESULTS: Nine articles with 565 patients were analysed in our meta-analysis. The wound healing time in ABC group was significantly shorter than that in the control group (SMD = -1.64, 95% CI -2.27 to -1.02 p < 0.00001, I2 = 88%). The ABC group had a significantly decreased number of debridements (SMD = -2.47, 95% CI -4.24 to -0.70, p < 0.00001, I2 = 95%). The pooled data showed no significant difference (RR = 0.41, 95% CI 0.12 to 1.39, p = 0.84, I2 = 0%). CONCLUSION: This is the first meta-analysis comparing the efficacy of antibiotic-loaded bone cement for the treatment of infected diabetic foot. Antibiotic-loaded bone cement treatment significantly shortened the wound healing time and reduced the number of debridements without increasing the incidence of complications. TRIAL REGISTRATION: PROSPERO CRD42023406017.

Application of low temperature ice saline bone cement in percutaneous vertebroplasty.

OBJECTIVE: Percutaneous vertebroplasty uses the traditional method of bone cement filler to inject bone cement, which is easy to solidify, we have found a new method to delay the solidification of bone cement: low temperature ice saline bone cement, which compares the advantages of the new method and the traditional method of injecting bone cement. METHODS: 82 cases of osteoporotic vertebral compresion fracture(OVCF) were divided into two groups by retrospective study method, 40 patients in group A were treated with the traditional method, 42 patients in group B were treated with the new method.The leakage rate of bone cement, postoperative VAS score, amount of bone cement in each vertebral body, operation time of bone cement, and number of bone cement fillers used were compared between the two groups. RESULTS: There was no significant difference in the bone cement leakage rate, postoperative VAS score, the amount of bone cement in each vertebral body and the number of bone cement fillers used between the two groups; the operation time of bone cement in two groups was statistically significant, and the operation time in group B was significantly longer than that in group A. CONCLUSION: Low temperature ice saline water bone cement has significant advantages in multiple vertebral fractures, relatively large amount of bone cement injected into each vertebral body and long operation time, which is more suitable for beginners.

Effect of pH and hydroxyapatite-like layer formation on the antibacterial properties of borophosphate bioactive glass incorporated poly(methyl methacrylate) bone cement.

Infection is a leading cause of total joint arthroplasty failure. Current preventative measures incorporate antibiotics into the poly (methyl methacrylate) (PMMA) bone cement that anchors the implant into the natural bone. With bacterial resistance to antibiotics on the rise, the development of alternative antibacterial materials is crucial to mitigate infection. Borate bioactive glass, 13-93-B3, has been studied previously for use in orthopedic applications due to its ability to be incorporated into bone cements and other scaffolds, convert into hydroxyapatite (HA)-like layer, and enhance the osseointegration and antibacterial properties of the material. The purpose of this study is to better understand how glass composition and change in surrounding pH effects the composite's antibacterial characteristics by comparing the incorporation of 30% wt/wt 13-93-B3 glass and pH neutral borophosphate bioactive glass into PMMA bone cement. We also aim to elucidate how HA-like layer formation on the cement's surface may affect bacterial adhesion. These studies showed that 13-93-B3 incorporated cements had significant reduction of bacterial growth surrounding the composite beyond 24 h of exposure when compared to a neutral borate bioactive glass incorporated cement (p < 0.01) and cement only (p < 0.0001). Additionally, through soaking cement composites in simulated body fluid and then exposing them to a bioluminescent strand of staphylococcus aureus, we found that the presence of a HA-like layer on the 13-93-B3 or pH neutral glass incorporated cement disks resulted in an increase in bacterial attachment on the composite cement's surface, where p < 0.001, and p < 0.05 respectively. Overall, our studies demonstrated that borate bioactive glass incorporated PMMA bone cement has innate antimicrobial properties that make it a promising material to prevent infection in total joint arthroplasties.

Endovascular treatment of a large bone cement pulmonary embolism: Case report.

We report a case of endovascular treatment of bone cement embolism after percutaneous vertebroplasty. The patient underwent percutaneous vertebroplasty for acute L1 compression fracture. Two weeks later, the patient developed symptoms of pulmonary embolism. Computed tomography pulmonary angiogram confirmed the presence of a bone cement foreign body in the pulmonary artery. Endovascular treatment was performed, and the cement embolism was caught, pulled to the level of the iliac vein, and fixed with stents. At the 1-year follow-up, the patient did not have any complaints, postoperative computed tomography pulmonary angiogram showed no obvious manifestations of pulmonary embolism, and angiography showed that the bone cement was fixed in place and that the iliac veins were normal.

Analyzing the Bioactivity of a Novel Bone Cement: An In Vitro Study.

AIM: To analyze the effect of bioactive bone cement (BBC) placed in a phosphate buffer saline solution in comparison to mineral trioxide aggregate (MTA). METHODOLOGY: Ten samples each of BBC (group 1) and MTA (group 2) were prepared and stored in a phosphate buffer saline solution. After three days of storage, white precipitates were formed on the surface of the samples. The solution with precipitates from each sample was analyzed for the presence of calcium and phosphate ions with coupled plasma atomic spectroscopy. RESULTS: BBC showed a significant amount of calcium and phosphate release after a seven-day storage period in phosphate buffer saline solution. Calcium release was significantly higher in group 1 (MTA) (p < 0.001) compared to that in group 2 (BBC), while group 2 (BBC) (p < 0.001) exhibited greater phosphate release compared to group 1 (MTA). CONCLUSION: BBC (group 2) retains its bioactivity when it comes into contact with a stimulated oral environment (STF). This demonstrates that BBC is bioactive in a simulated oral environment. Moreover, it retained good handling properties and could be easily manipulated into a dough form. Clinically, in cases of apical surgery, internal resorption or perforation repair where material placement poses difficulty, BBC will prove to be beneficial.

A Case of Severe Acute Kidney Injury Due to an Antibiotic-Loaded Cement Spacer for Infected Knee Arthroplasty.

The treatment for periprosthetic joint infection frequently involves the placement of a high-dose antibiotic-loaded bone cement spacer (ALCS) into the debrided joint. Typical antibiotics in the spacer include aminoglycosides and vancomycin. It has been believed that systemic absorption of intraarticular antibiotics would be low and early experience suggested that the risk of acute kidney injury (AKI) from ALCS was minimal. However, recent case reports and case series have suggested a risk of acute kidney injury due to antibiotic absorption, though confounding factors are common. We report a case of severe AKI requiring hemodialysis with extremely high systemic tobramycin levels after the placement of an ALCS with increased dosing of antibiotics after previous failure to resolve a periprosthetic joint infection with a prior ALCS. There was no concomitant use of intravenous nephrotoxic antibiotics nor other confounding factors. Despite dialysis, the patient needed urgent removal of the ALCS to control tobramycin levels with subsequent resolution of the AKI. This case highlights the potentially serious nephrotoxicity of ALCS's, the importance of antibiotic type and dosing, and the value of close monitoring after ALCS placement, especially in a patient with chronic kidney disease.

Deep learning-based multimodal image analysis predicts bone cement leakage during percutaneous kyphoplasty: protocol for model development, and validation by prospective and external datasets.

Background: Bone cement leakage (BCL) is one of the most prevalent complications of percutaneous kyphoplasty (PKP) for treating osteoporotic vertebral compression fracture (OVCF), which may result in severe secondary complications and poor outcomes. Previous studies employed several traditional machine learning (ML) models to predict BCL preoperatively, but effective and intelligent methods to bridge the distance between current models and real-life clinical applications remain lacking. Methods: We will develop a deep learning (DL)-based prediction model that directly analyzes preoperative computed tomography (CT) and magnetic resonance imaging (MRI) of patients with OVCF to accurately predict BCL occurrence and classification during PKP. This retrospective study includes a retrospective internal dataset for DL model training and validation, a prospective internal dataset, and a cross-center external dataset for model testing. We will evaluate not only model's predictive performance, but also its reliability by calculating its consistency with reference standards and comparing it with that of clinician prediction. Discussion: The model holds an imperative clinical significance. Clinicians can formulate more targeted treatment strategies to minimize the incidence of BCL, thereby improving clinical outcomes by preoperatively identifying patients at high risk for each BCL subtype. In particular, the model holds great potential to be extended and applied in remote areas where medical resources are relatively scarce so that more patients can benefit from quality perioperative evaluation and management strategies. Moreover, the model will efficiently promote information sharing and decision-making between clinicians and patients, thereby increasing the overall quality of healthcare services.

Percutaneous functional spinal unit cementoplasty versus percutaneous kyphoplasty for severe osteoporotic vertebral compression fracture complicated with endplate-disc complex injury: A retrospective case-control study.

BACKGROUND: Severe osteoporotic vertebral compression fracture (SOVCF) is frequently complicated by endplatedisc complex (EDC) injury. While percutaneous kyphoplasty (PKP) can offer rapid analgesia and facilitate early activity, it does not restore vertebral height and may result in intervertebral leakage and untreated EDC injury. OBJECTIVE: This study aimed to evaluate the clinical outcomes of percutaneous functional spinal unit cementoplasty (PFSUP) for SOVCF complicated by EDC injury and compare its clinical and imaging outcomes with PKP. METHODS: This was a retrospective case-control study. Patients with SOVCF complicated with EDC injury between January 1, 2018, and December 31, 2019, were recruited and assigned to the PKP group and PFSUP group based on their treatment procedures Back pain was evaluated using the visual analog scale (VAS) and daily life activities were assessed using the Oswestry disability index (ODI). X-rays were employed to observe the presence and location of cement leakage, as well as to measure the sagittal vertical axis (SVA) and local kyphosis angle (LKA). Loss of correction was calculated by subtracting the LKA after surgery from that at the final follow-up visit Subsequent vertebral fracture (SVF) was confirmed using the Genant semi-quantitative method and/or MRI. RESULTS: A total of 64 patients were included in this study. Among them 41 cases were assigned to the PKP group (28 females, 74.8 years on average), while the remaining 23 cases were assigned to the PFSUP group (15 females, 76.3 years on average). All surgical interventions were successfully completed without major complications. Compared to the PKP group, the PFSUP group had longer operation time (70.28 ± 11.44 vs 44.5 ± 10.12, P< 0.001) higher frequencies of radiation exposure (97.6 ± 19.85 vs 38.6 ± 9.53, P< 0.001), and a lower cement leakage rate (26.1% vs. 41.5%, P< 0.001). One day after surgery and at the final follow-up the PFSUP group had lower VAS and ODI scores, as well as lower LKA and Sva values compared with the PKP group (all P< .001). At the final follow-up visit, the PFSUP group demonstrated a lower loss of correction (4.38 ± 2.71 vs. 10.19 ± 3.41 P< 0.001) and a lower SVF rate compared to the PKP group (21.7% vs. 31.7%, P< 0.001). CONCLUSION: PFSUP outperformed PKP in alleviating pain restoring and maintaining sagittal balance, and lowering the incidence of cement leakage and SVF for SOVCF with EDC injury However, PFSUP was associated with longer operation time and high radiation exposure frequencies.

Effect of prophylactic infusion of norepinephrine on the prevention of hypotension during vertebroplasty: a randomized clinical trial.

BACKGROUND: Transient hypotension is a common occurrence during the implantation of bone cement. This placebo-controlled randomized clinical trial study investigated the effect of prophylactic infusion of norepinephrine on the incidence of hypotension in senior patients who underwent vertebroplasty. METHODS: The trial recruited patients who were greater than or equal to 65 years of age, had an American Society of Anesthesiologist physical status classification of I to III, and underwent vertebroplasty from August 2020 to August 2021 at the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine in China. The patients were randomly grouped according to whether they received either a norepinephrine infusion of 0.05 µg/kg/min or an equivalent volume of saline 10 min before implantation of bone cement. Intraoperative hemodynamics were monitored continuously by the MostCare system at the following 7 time points: 10 min before implantation of bone cement and immediately, 30 s, 1, 3, 5, and 10 min after implantation of bone cement. We also recorded the number of hypotensive episodes and the total number of vasopressors after implantation of bone cement. Multivariable logistic regression was used to assess the risk factors associated with hypotension after implantation of bone cement. RESULTS: A total of 63 patients were randomized to the control group (n = 31; median [IQR] age, 74 [69-79] years) and the norepinephrine group (n = 32; median [IQR] age, 75 [71-79] years). The incidence of hypotension in the norepinephrine group was significantly lower than that in the control group after implantation of bone cement (12.5% vs. 45.2%; relative risk [RR], 3.61 [95% CI, 1.13-15.07]; P = 0.005). Moreover, the median (IQR) number of hypotensive episodes (0 [0-0] vs. 0 [0-2]; P = 0.005) and the total number of vasopressors (0 [0-0] vs. 0 [0-1]; P = 0.004) in the norepinephrine group were significantly lower than those in the control group. Furthermore, compared with the baseline, the MAP significantly decreased at 1 min (P = 0.007) and 3 min (P < 0.001) after bone cement implantation in the control group. However, the MAP at 3 min in the norepinephrine group was significantly higher than that in the control group (P < 0.001). The incidence of complications was not different between the groups. In multivariable logistic regression, the FRAIL score (OR, 2.29; 95% CI, 1.21-4.31) was identified as a risk factor associated with hypotension. CONCLUSION: Prophylactic infusion of norepinephrine before bone cement implantation can stabilize hemodynamics and reduce the incidence of hypotension after implantation of bone cement.

Influence of Screw Length and Cement Position Within the Injured Vertebra on Fixation Strength in Short-Segment Fixation of Osteoporotic Thoracolumbar Burst Fractures.

OBJECTIVE: The prevalence of osteoporotic vertebral fractures has increased with aging populations, necessitating effective treatments such as percutaneous kyphoplasty combined with posterior screw fixation. However, biomechanical research on the effects of using short screws on fixation stability and bone stress or on the impact of bone cement bonding to screws on structural strength is lacking. This study aimed to optimize short-segment fixation strategies for osteoporotic thoracolumbar burst fractures by analyzing the biomechanical effects of pedicle screw length and bone-cement augmentation. METHODS: Four models of the thoracolumbar spine were established using computed tomography data of a female volunteer: 1) short screws in the injured vertebra without contact with the bone cement, 2) long screws without contact with the bone cement, 3) long screws in contact with the bone cement, and 4) long screws without the bone cement. The 4 fixation models were simulated under physiological loads. The range of motion, implant stress, and segmental stability were assessed. RESULTS: The 3 groups containing the bone cement exhibited similar performances in terms of stability and stress distribution, whereas the group without the bone cement exhibited a poorer biomechanical performance. Incorporation of the bone cement enhanced the biomechanical properties of the structure, and short screws in the injured vertebra without contact with the bone cement did not significantly compromise the biomechanical performance. CONCLUSIONS: Short screws in injured vertebrae without contact with the bone cement can achieve satisfactory stability and stress distribution. It is feasible to implant short screws in the injured vertebrae, reduce the number of bilaterally injured vertebrae, and inject bone cement through the non-pedicle approach during the surgical procedure, which simplifies the surgical process.

Intraosseous Lipoma of Calcaneus An Uncommon Cause of Heel Pain: A Case Report.

ABSTRACT: Intraosseous lipoma of calcaneum is a rare cause of heel pain. Calcaneum is a typical site of involvement of IOL. There are only a few published articles regarding calcaneal intraosseous lipoma and one has been reported from Nepal. We report a case of 35 years female who presented with left heel pain for 1 year. The pain was gradually increasing in intensity and was severe enough to refrain her from activities of daily living. She was surgically operated with curettage and filling the defect with bone cement. There is no residual pain at 2.5 years follow up. We briefly review the postulated pathogenesis, clinical manifestations, diagnosis and various modalities of treatment of intraosseous lipoma. An orthopedic surgeon should have high degree of suspicion regarding the uncommon cause of heel pain and its possible management. When conservative methods do not relieve symptoms, surgical excision and filling the defect with bone cement provides long term relief.

Combination therapy of negative pressure wound therapy and antibiotic-loaded bone cement for accelerating diabetic foot ulcer healing: A prospective randomised controlled trial.

Negative pressure wound therapy (NPWT) and antibiotic-loaded bone cement (ALBC) are commonly used treatments for diabetic foot ulcers (DFUs). However, the combined efficacy of these two modalities remains unclear. This clinical study aimed to assess the effectiveness and underlying mechanisms of NPWT&ALBC in the management of DFUs. A total of 28 patients were recruited, 16 of whom served as controls and received only NPWT, whilst 12 received NPWT&ALBC. Both groups underwent wound repair surgery following the treatments. Blood samples were obtained to detect infections and inflammation. Wound tissue samples were also collected before and after the intervention to observe changes in inflammation, vascular structure and collagen through tissue staining. Compared with the NPWT group, the NPWT&ALBC group exhibited a superior wound bed, which was characterised by reduced inflammation infiltration and enhanced collagen expression. Immunostaining revealed a decrease in IL-6 levels and an increase in α-SMA, CD68, CD206 and collagen I expression. Western blot analysis demonstrated that NPWT&ALBC led to a decrease in inflammation levels and an increase in vascularization and collagen content. NPWT&ALBC therapy tends to form a wound bed with increased vascularization and M2 macrophage polarisation, which may contribute to DFUs wound healing.

Acetabular Bone Cement Extension Leading to Bladder Obstruction: An Orthopedic Surgical Complication.

Polymethyl methacrylate, commonly known as bone cement, is widely used for implant fixation in orthopedic and trauma surgery due to its excellent adhesive properties and biocompatibility. However, complications such as bone cement extrusion, although rare, can lead to significant morbidity. We present the case of an 86-year-old Hispanic female who presented to the emergency department (ED) with tachycardia, hypertension, and respiratory distress. Her medical history included Parkinson's disease, hiatal hernia, osteoarthritis, colon cancer, and a complex post-hip fracture surgical history. Despite being bedridden, she had been previously in stable health. A computed tomography (CT) scan revealed a significant hiatal hernia, minimal remaining left lung tissue, a right lung nodule, hydronephrosis, and a large radiopaque mass in the right pelvis extending from the acetabular area. This radiopaque mass was later determined to be bone cement, with a portion extruding into the bladder. The patient was diagnosed with sepsis secondary to a urinary tract infection and hyponatremia; a urology consultation recommended a conservative approach to avoid potential antibiotic resistance. This case report highlights a rare complication of total hip arthroplasty involving bone cement extrusion into the bladder, which led to hydronephrosis and a urinary tract infection (UTI). Although such complications can be asymptomatic, they should be considered in patients with a history of arthroplasty.

Femoral Head Fracture Fixation Using Femoral Head Cement Templating for Iliac Bone Graft and Biodegradable Screws via Ganz Surgical Dislocation of the Hip: A Case Report.

A 22-year-old Malaysian male presented with a closed posterior dislocation of the right hip with femoral head fracture (Pipkin II) after an alleged motor vehicle accident (MVA). This type of injury may pose future complications, such as avascular necrosis, post-traumatic osteoarthritis, or heterotopic ossification to the hip joint, and later affect joint function. After an immediate closed reduction of the hip, the patient underwent Ganz Surgical dislocation of the hip - a surgical method used to aid the reconstruction of the bony defect of the femoral head. Using bone cement templating, right iliac bone graft was harvested to support the bony defect of the femoral head, and biodegradable screws were inserted to reconstruct the femoral head. The use of absorbable screws eliminated the need for a second surgery to remove hardware, reducing complications. At eight months post-operatively, the patient was able to ambulate without walking aid and fully bear weight on his right hip without pain. Imaging confirmed proper alignment and healing, with no indication for further surgery. This favorable outcome highlighted the efficacy of biodegradable screws in maintaining femoral head integrity while minimizing future surgical intervention. One year later, the patient regained excellent functional capacity, achieving a Lower Extremity Functional Scale (LEFS) score of 96.3%, indicating near-complete recovery with minimal limitations. This case report illustrates the success of using cement-templated iliac bone graft combined with biodegradable screws in femoral head fixation. The approach not only achieved structural stability but also led to a high functional outcome without the need for additional procedures. These findings support the use of absorbable fixation in complex orthopedic cases such as hip dislocations with femoral head involvement.

Differential diagnoses and therapeutic features of giant cell tumor of the bone in an elderly patient: A case report.

INTRODUCTION: Giant cells tumor (GCT) of the bone is usually seen in young adults between the ages of 20 and 40. When occurring in older patients, diagnosis and therapeutic specific feature are to be considered. We underline those aspects through this case report. CASE PRESENTATION: We report the case of a 73-year-old man presenting with a painful swelling knee. The diagnosis of GCT of proximal tibia was retained and the patient underwent extensive curettage, subchondral bone grafting and cementation of the residual cavity. The long-term results show a good functional outcome and no recurrence. DISCUSSION: In this age group, other lesions have similar clinical and radiological presentations as GCT of bone. The diagnosis of a metastatic carcinoma is to be carefully ruled-out in this situation. While the option of large resection with joint arthroplasty is better accepted in ageing patients as a treatment of GCT of bone, this case suggests that jointpreserving methods should also be considered especially when there are no signs of osteoarthritis. While polymethylmethacrylate cementation is an efficient adjuvant in order to reduce recurrences, it may cause secondary osteoarthritis. Subchondral grafting seems to be a good alternative to prevent this complication. CONCLUSION: Malignancies should be ruled-out before retaining the diagnosis of GCT of the bone after the age of 50. Conservative surgical treatment is always an option in this age group.

Enhanced bone cement distribution in percutaneous vertebroplasty using a curved guide wire: a propensity score matching analysis.

BACKGROUND: Osteoporotic vertebral compression fractures (OVCF) severely affect the quality of life in the aged population. Percutaneous vertebroplasty (PVP) alleviates pain and stabilizes vertebrae, but suboptimal bone cement distribution can cause complications. Hence, this study aimed to clarify whether a new technique for PVP, using a curved guide wire, enhances the distribution of bone cement and improves clinical outcomes in patients with OVCF. METHODS: Patients with single-segment OVCF underwent PVP or curved guide wire percutaneous vertebroplasty (C-PVP). Propensity score matching (PSM) was employed to balanced the baseline characteristics. The primary outcomes were the visual analog scale (VAS) and Oswestry disability index (ODI) scores. The secondary outcomes included assessments of bone cement distribution, bone cement injection volume, radiological parameters, and general clinical results. Additionally, Complications and adverse events were documented. RESULTS: After PSM analysis, each group comprised 54 patients, which significantly reduced baseline differences. The C-PVP group showed better clinical outcomes compared to the traditional PVP group. One month after surgery, the C-PVP group had significantly lower VAS and ODI scores (p < 0.001). These improvements persisted at six months and the final follow-up. Additionally, bone cement distribution scores were better (p < 0.001), injection volume was higher (p = 0.03), leakage was less frequent (p = 0.02), and adjacent vertebral fractures occurred less frequently (p = 0.04) in the C-PVP group. Radiological parameters and overall clinical outcomes revealed no significant differences between the two groups. CONCLUSION: The use of curved guide wire in PVP significantly improves bone cement distribution and injection volume, resulting in better clinical efficacy in patients with OVCF.

Pulmonary embolism and intracardiac foreign bodies caused by bone cement leakage: a case report and literature review.

Percutaneous vertebroplasty (PVP) is a surgical procedure that involves injecting polymethylmethacrylate (PMMA) bone cement into the diseased vertebrae to rapidly relieve pain and strengthen the vertebrae. We reported a 73-year-old patient who underwent percutaneous vertebroplasty (PVP) surgery for thoracolumbar vertebral compression fracture. After the surgery, the patient experienced symptoms such as chest tightness and dyspnea. Further examination revealed multiple high-density foreign bodies in the blood vessels/heart and concomitant multi-organ dysfunction. It was considered that the multi-organ embolism was caused by bone cement leakage. The patient improved after undergoing surgical treatment and anticoagulant therapy.