Scholar - SciOpen

The risk of internal fixation failure remains relatively high in stable femoral neck fracture (FNF) (Garden Ⅰ or Ⅱ). Preoperative sagittal displacement of the femoral head has been proposed as a potential influencing factor. This study aimed to evaluate the impact of sagittal displacement on the outcomes of cannulated screw internal fixation (CSIF) in patients with stable FNF (Garden Ⅰ or Ⅱ) by reconstructing the axial sagittal oblique plane of the fracture using preoperative computed tomography (CT) imaging.

Methods

This study included 167 patients with FNF who underwent CSIF. The sagittal tilt angle of the femoral head (STAFH) was evaluated using three‐dimensional CT (3D‐CT). The distribution of preoperative STAFH was analyzed, and its independent association with treatment failure was assessed. Treatment failure was defined as the need for revision surgery within 2 years postoperatively due to avascular necrosis, nonunion, or internal fixation failure.

Results

Among the 167 patients, 9 (5.4%) exhibited anterior tilt (AT) of the femoral head, 158 (94.60%) presented with posterior tilt (PT). A total of 50 patients (29.9%) demonstrated excessive sagittal displacement (AT ≥ 10° or PT ≥ 20°). In the failure group, 80.0% of patients had excessive sagittal displacement compared to 28.1% in the healed group. Excessive sagittal displacement was significantly associated with an increased risk of surgical failure (odds ratio: 11.953, 95% CI: 3.656–39.083, p < 0.05).

Conclusions

In patients with Garden Ⅰ or Ⅱ FNF, greater preoperative sagittal displacement of the femoral head was correlated with a higher likelihood of CSIF failure. AT ≥ 10° or PT ≥ 20° were identified as independent predictors of CSIF failure in FNF patients. Nevertheless, these findings still require confirmation through prospective, multi‐center clinical trials with large sample sizes.

Research Article Issue

Biophysical-driven piezoelectric and aligned nanofibrous scaffold promotes bone regeneration by re-establishing physiological electrical microenvironment

Aoao Wang, Xinbo Ma, Yafeng Yang, Guoliang Shi, Liwei Han, Xiantong Hu, Rui Shi, Jun Yan, Quanyi Guo, Yantao Zhao

Nano Research 2024, 17(8): 7376-7393

Published: 07 May 2024

Abstract

PDF (71.9 MB) Collect Collected

Downloads：480

The initial healing stages of bone fracture is a complex physiological process involving a series of spatially and temporally overlapping events, including pathogen clearance, immunological modulation, and osteogenesis. In this study, we have developed a piezoelectric and aligned nanofibrous scaffold composed of ZnO@PCL/PVDF with multiple antibacterial, immunomodulatory, and osteogenic effects using electrospinning technology. This scaffold’s piezoelectric signal output under ultrasound (US) control can be similar to the physiological electrical signals of healthy bone tissue, creating a truly biomimetic electrical microenvironment in the bone defect. In vitro studies have shown that ZnO@PCL/PVDF scaffold significantly enhances the proliferation, migration, and osteogenic differentiation of MC3T3-E1 cells under piezoelectric drive provided by ultrasound. Furthermore, the scaffold exhibits inhibitory effects on the growth of E. coli and S. aureus, as well as the ability to induce M2 macrophage polarization, indicating potent antibacterial and immunomodulatory properties. In vivo experiments demonstrated that the ZnO@PCL/PVDF scaffold can accelerate the repair of mandibular defects in rats, effectively inhibit bacterial colonization, and reduce inflammatory responses. Altogether, this study confirms that the newly developed ZnO@PCL/PVDF scaffold effectively promotes bone repair by truly mimicking the endogenous electrical microenvironment and precisely regulating the temporospatial disorders of initial bone healing, thus providing a simple and effective solution for bone defects.

Total 2