Osteoid osteoma of the calcaneus: an unusual cause of hindfoot pain in an adolescent athlete

Osteoid osteomas are distinctive, benign tumors of bone that cause localized pain. This problem, although rare in athletes, must be resolved before pain-free competition can resume. We present a case of a 14-year-old white, male football player who complained of heel pain. He was treated conservatively with ice, stretching, and a nonsteroidal anti-inflammatory drug (Advil). Postseason, his symptoms worsened and he was referred for orthopedic consultation. Radiography displayed a possible osteoid osteoma; a CT evaluation confirmed the diagnosis. The athlete was treated surgically for the condition, and following a 2-week immobilization and a 3-week rehabilitation program, the pain completely resolved.     

Revision of total hip arthroplasty: clinical outcome of extended trochanteric osteotomy and intraoperative femoral fracture

In femoral revision arthroplasty the orthopaedic surgeon frequently has to decide between performing an extended trochanteric osteotomy or trying to remove the femoral stem without an osteotomy and taking the risk of an intraoperative fracture. As this decision is often hard to make this study compared intraoperative femoral fractures during stem removal with extended trochanteric osteotomies in femoral revision arthroplasties. Twenty-eight femoral revision arthroplasties with an extended trochanteric osteotomy were compared with forty-five intraoperative fractures during revision hip arthroplasty. Preoperatively and after a follow-up of 2.8 years the patients were examined clinically and radiologically. We found no osteosynthesis related complication in the extended trochanteric osteotomy group, but six in the fracture group. Furthermore fewer re-revisions were observed in the osteotomy group. Additionally, a significant better clinical and radiological outcome can be found in the extended trochanteric osteotomy group compared to the fracture group. The results of this study suggest that a well conducted extended femoral osteotomy should be discussed in special cases to prevent femoral fractures during stem and cement removal which would probably lead to a poor postoperative outcome.     

强化螺钉治疗老年人重度骨质疏松Evans Ⅱ型股骨转子间骨折最佳骨水泥量的有限元分析

目的 探讨强化螺钉治疗老年人重度骨质疏松EvansⅡ型股骨转子间骨折的最佳骨水泥量。方法 选取2020年10月5日新疆医科大学第一附属医院1例73岁女性左股骨粗隆间骨折患者的双侧髋部及股骨CT资料,导入Mimics 20和 Geomagic Wrap 2017软件构建右侧股骨三维模型。使用Solidworks 2017软件建立强化螺钉模型,并将右侧股骨三维模型与强化螺钉模型按照常规标准手术技术进行装配、组合;使用Geomagic Wrap 2017软件在组合后的模型上模拟EvansⅡ型骨折,在股骨转子间骨折不同骨水泥量强化螺钉固定模型与EvansⅡ型骨折模型组装完成后,施加载荷。截取强化螺钉近端周围部分松质骨重新定义为骨水泥部件,按包裹水泥量的不同分别建立A模型（2 mL）、B模型（3 mL）、C模型（4 mL）、D模型（5 mL）、E模型（6 mL）5个模型组,设置材料参数、边界条件、施加载荷后储存为K文件,分别导入Ansys 2019软件中进行有限元分析。观察对比不同骨水泥量强化螺钉固定模型中骨水泥表面对股骨头近端松质骨的切割情况,股骨颈内翻、内旋角度,强化螺钉应力分布情况,以及股骨近端位移情况。结果 A、B、C、D模型组骨水泥表面对股骨头近端松质骨切割最轻微,E模型组切割程度最严重。A、B、C、D、E模型组中股骨颈内翻角度分别为5.2°、6.0°、4.5°、5.1°、2.6°,股骨颈内旋角度分别为1.1°、1.4°、0.9°、1.0°、0.4°,其中E模型组股骨颈内翻角、内旋角均最小。A、B模型组骨水泥量模型应力主要集中在螺钉和主钉连接处; C、D模型组骨水泥量模型应力大部分集中于螺钉和主钉连接处,应力有向主钉分散的趋势;E模型组骨水泥量模型应力主要分布在强化螺钉的尾端,6 mL骨水泥量强化螺钉模型载入股骨转子间骨折模型后,在股骨大粗隆处出现新的骨折。A、B、C、D、E模型组中,股骨近端位移分别为7.7、8.4、8.2、8.1、13.7 mm;其中E模型组股骨近端位移最大,出现了骨水泥漏,且在强化螺钉模型载入股骨转子间骨折模型后,在股骨大粗隆处出现新的骨折。结论 强化螺钉治疗老年人重度骨质疏松EvansⅡ型股骨转子间骨折,使用2~4 mL骨水泥量,具有较好的生物力学效应。     

Recurrent metatarsal stress fractures in a college football lineman

Stress fractures are common overuse injuries of bone attributed to repetitive trauma, training errors, and/or structural abnormalities. A 21-year-old, 252-lb football lineman participating in spring conditioning drills complained of right foot pain following a plantar flexion, inversion injury that occurred while cutting. Pain was concentrated over the dorsum of the foot in both weight bearing and at rest. X-ray evaluation indicated an acute stress fracture of the fourth metatarsal and two nonunions of the second and third metatarsals. Additionally, x-rays revealed metatarsus adductus, a congenital anatomic deformity. The athlete demonstrated compensatory hyperpronation in the right hind foot during a follow-up biomechanical evaluation. He was removed from weightbearing activities, treated symptomatically for pain and swelling, and placed in a rigid orthotic. He has returned to full activity without further incident. This case report emphasizes the important role that biomechanical factors may have in osseous stress injuries.     

股骨近端锁定钢板治疗老年陈旧性粗隆间骨折9例

目的探讨老年陈旧性粗隆间骨折股骨近端锁定板的手术治疗。方法自2006年2月～2011年3月对9例老年陈旧性粗隆间骨折实行切开复位股骨近端锁定板固定术,手术在骨科牵引床上进行,同时使用C型臂x光机检查复位固定情况。结果所有患者均满意复位固定,经随访12～36个月（平均22个月）,按Harris标准评分7例为优,2例为差。结论老年陈旧性粗隆问骨折股骨近端锁定板术为一简单有效的手术方法。     

股骨颈骨折患者并发股骨头坏死的预后相关影响因素

创伤引发的股骨颈骨折是临床上常见的骨科疾病之一,而其后续发生的以股骨头缺血坏死为代表的并发症是导致患者出现下肢运动功能障碍的主要原因之一。目前对于创伤后股骨颈骨折具体的损伤及修复机制仍不甚明了,因此研究股骨颈骨折后患者身体的各项指标及临床上针对的治疗措施对预后产生的影响,可为预测股骨颈骨折患者未来的预后打好基础,并为采取相应的干预手段提供思路。目前主要认为创伤后股骨颈血供不足和相关炎性重建反应是创伤性股骨头坏死的主要作用机制,而作用于相关机制的因素则被认为是其可能的危险因素。本文整理了近年来对于股骨颈骨折后续发生坏死相关影响因素的报道。学界主要认为受伤原因、Garden分型等骨折分型方式、内固定方式及复位质量等因素被认为是导致预后不良的可能危险因素。     

三枚中空螺纹加压钉+髂骨块植骨治疗股骨颈骨折的生物力学研究与临床应用

目的：对作者设计的三枚中空螺纹加压钉＋髂骨块植骨（ＨＳＩ）治疗股骨颈（头下型）骨折,进行生物力学分析。为临床应用提供科学依据。方法：利用新鲜尸股骨标本进行实验应力分析。比较三枚中空螺纹加压钉＋髂骨块植骨与单纯应用三枚中空螺纹加压钉固定（ＨＳ）比较,观察两者在内固定上的生物力学性能指标变化。结果;实验结果表明采用螺纹钉＋髂骨植骨固定（ＨＳＩ）与单纯采用螺纹钉固定（ＨＳ）治疗股骨颈（头下型）骨折,其生物力学性能无显著性差异。临床１３例实践证明。采用螺纹钉＋髂骨植骨术式符合生物力学模型。是治疗股骨颈（头下型）骨折一种有效的新方法。     

Fracture of titanium nitride-coated femoral component after total knee arthroplasty

We report a case of fracture of a titanium nitride-coated femoral component 3 years after primary total knee arthroplasty (TKA). The fracture was at the medial condylar area just posterior to the medial peg of the femoral component. The backside of the broken medial condylar portion of the femoral component was devoid of cement. Debonding of the component is a possible cause of the stress fracture. To our knowledge, this is the first case report of the fracture of the femoral component manufactured from titanium alloy.Level of evidenceIV     

强化螺钉骨水泥髓内钉固定治疗重度骨质疏松性股骨转子间Evans Ⅱ型骨折的生物力学有限元分析

目的 通过有限元分析探讨强化螺钉骨水泥髓内钉固定治疗重度骨质疏松性股骨转子间Evans Ⅱ型骨折的生物力学效果。方法 选取新疆医科大学第一附属医院骨科中心2020年10月5日收治的1例重度骨质疏松性Evans Ⅱ型左股骨转子间骨折患者的CT资料。患者女,73岁,身高160 cm,体质量56 kg。将患者髋部及股骨的CT数据在Mimics 20软件和 Geomagic Wrap 2017软件中进行提取、优化,得到右侧股骨三维模型;运用Solidworks 2017软件画出内固定模型并参考标准的手术技术进行股骨模型装配。将装配好的模型在3-Matic软件中进行截骨得到Evans Ⅱ型股骨转子间骨折模型,截取螺钉近端周围的部分松质骨设置为骨水泥部件,分别构建A模型[普通股骨近端防旋髓内钉（PFNA）内固定模型]、B模型（钉道强化PFNA内固定模型）及C模型（强化螺钉内固定模型）。按照患者CT数据及内固定的材质标准赋予相应的参数、条件,以及人体力学在股骨的受力及患者的体质量赋予载荷值分别储存,并利用ansys 2019软件中的Explicit Dynamics模块进行分析。观察指标：对比3种模型螺钉在股骨近端的切割程度、股骨颈向内翻角度、股骨颈内旋角度、应力在股骨的分布情况,以及股骨头近端移位情况。结果 3种模型螺钉在股骨近端骨水泥表面均由螺旋刀片四周向远端发生切割、形变、沉陷,程度由轻到重依次为C、B、A模型。股骨颈骨块内翻角度和股骨颈旋转角度,A、B模型均分别为0.37°和0.16°,C模型稍占优势分别为0.32°和0.15°。A模型应力主要集中在螺旋刀片和主钉交接处,B、C模型相较于A模型发生了应力转移,分散向骨水泥部位;C模型股骨骨折部分发生最大移位的距离为5.8 mm,相较于A、B模型（均为6.7 mm）减小。结论 强化螺钉内固定治疗重度骨质疏松性股骨转子间Evans Ⅱ型骨折较普通股骨PFNA及钉道强化PFNA具有更好的生物力学效果。     

Fracture toughness is dependent on bone location--a study of the femoral neck, femoral shaft, and the tibial shaft

The fracture toughness of the right femoral neck, femoral shaft, and tibial shaft of matched cadaveric bones, ages 50 to 90 years, was compared. Results of this study indicate that tensile (G(Ic)) and shear (G(IIc)) fracture toughness vary depending on bone location. The femoral neck has the greatest resistance to crack initiation for both tension and shear loading while the femoral shaft has the least. The relationship between age and the fracture toughness of the femoral neck and shaft was investigated. G(c) of the femoral shaft significantly decreased with age for mode I and was nearly significant for mode II. Fracture toughness of the femoral neck did not change with age for the later decades of life. Implications of these findings are discussed.     

外固定方法制作的大鼠股骨骨折模型

背景：外固定器抗旋转能力强,不影响局部血运,不固定关节,动物可以自由活动,适合用于骨折模型的制作。 目的：创立一种新型的股骨骨折动物模型。 方法：SD大鼠24只于大鼠右侧股骨截骨,以自行研究设计的微型单边外固定器为固定装置,制成骨折模型,术后通过大体观察、影像学观察及组织学方法观察股骨对位情况和截骨端的愈合情况。 结果与结论：术后外固定器保持正常位置,未见螺纹钉拔出,针孔松动,骨折等现象,大鼠股骨保持正常生理位置。固定后第2周骨断端已经有模糊的原始骨痂形成。第4周时已有连续性骨痂通过,但骨断端仍较清晰。第8周时,骨断端已经愈合,髓腔再通,出现骨性愈合。证实微型单边外固定器可以为股骨骨折模型大鼠提供可靠的固定,并且右侧股骨截骨骨折模型大鼠制作合理。     

Delbet Ⅱ型儿童股骨颈骨折不同内固定方式的有限元分析

背景：儿童DelbetⅡ型股骨颈骨折后股骨头坏死率较高,有限元法已广泛应用于研究成人股骨颈骨折内固定后的稳定性,但儿童股骨颈骨折的相关分析较少。目的：研究3种不同内固定方式治疗DelbetⅡ型儿童股骨颈骨折的生物力学性能。方法：选择1例8岁儿童健康志愿者为研究对象。CT扫描患儿股骨近端影像数据导入Mimics 17.0,在Geomagic 14.0,Cero 3.0,Hyper Works13.0中建立3种内固定方式治疗DelbetⅡ型儿童股骨颈骨折的有限元模型,分别为空心钉模型（CS模型）、空心钉联合克氏针模型（CS+K模型）、锁定钢板模型（LP模型）,观察3种模型的内固定应力、骨骺应力及骨折断端相对位移。结果与结论：（1）CS+K模型骨折端和股骨头内的应力显著大于CS模型、LP模型（P <0.001）;LP模型的股骨侧应力显著大于CS+K模型、CS模型（P<0.001）;（2）CS模型的相对位移量显著大于CS+K模型和LP模型（P<0.001）;（3）LP模型的骺板平均应力显著大于CS+K模型、CS模型（P<0.001）;（4）结果表明,空心钉联合克氏针固定...     

Bilateral stress fracture of the femoral shaft after total knee arthroplasty: A case report

The authors present a case of bilateral stress fracture of the femoral shaft 15 years after total knee arthroplasty. Considerable femoral bowing deformity and varus malposition of the femoral and tibial components after total knee arthroplasty may produce abnormal stresses and lead to stress fracture of the distal femur in the region of greatest curvature.     

3D Finite Element Analysis of a Man Hip Joint Femur under Impact Loads

Objective： The biomechanical characters of the bone fracture of the man femoral hip joint under impact loads are explored. Methods ：A biosystem model of the man femoral hip joint by using the GE （ General Electric） lightspeed multi-lay spiral CT is conducted. A 3D finite element model is established by employing the finite element software ANSYS. The FE analysis mainly concentrates on the effects of the impact directions arising from intense movements and the parenchyma on the femoral hip joint on the stress distributions of the proximal femur. Results：The parenchyma on the hip joint has relatively large relaxation effect on the impact loads. Conclusion：Effects of the angle δ of the impact load to the anterior direction and the angle γ of the impact load to the femur shaft on the bone fracture are given;δ has larger effect on the stress and strain distributions than the angle γ,which mainly represents the fracture of the upper femur including the femoral neck fracture when the posterolateral femur is impacted, consistent with the clinical resuits.     

Osteonecrosis

In orthopedic pathology, the pathologist is most commonly faced with the study of resected femoral heads for osteonecrosis. Such a study necessitates a knowledge of clinical findings, of physiopathology and chiefly of radiological findings. Osteonecrosis of the femoral head following fracture has been reported with four morphological stages which are very precisely described. In the same way, idiopathic, non traumatic, or primary osteonecrosis is covered, stressing the putative etiological factors and the most important findings of imaging. The review includes also the skeletal manifestations of decompression sickness as well as bone infarctions not associated with caisson disease, and spontaneous osteonecrosis of the knee. From the recruitment of the Hospital for Special Surgery, NY, it has been recently reported that a significant number of patients regarded as cases of osteonecrosis, either in the femoral head or in the knee, are actually cases of subchondral insufficiency fractures.     

股骨转子间骨折不同外侧壁分型髓内钉治疗的有限元分析

背景：目前针对外侧壁破损型股骨转子间骨折的手术内固定方式存在争议,以股骨近端防旋髓内钉固定为主流方案,不同外侧壁分型的股骨转子间骨折髓内固定的生物力学研究较少。目的：通过有限元分析比较股骨近端防旋髓内钉治疗不同外侧壁分型股骨转子间骨折的生物力学特点,探讨外侧壁对股骨转子间骨折内固定的影响。方法：选择1例健康老年女性患者,根据股骨近端CT扫描数据,应用Mimics 21.0,Geomagic Wrap,Creo 6.0,Abaqus 2020软件建立股骨近端和股骨近端防旋髓内钉的三维有限元模型,模拟外侧壁稳定型、危险型及破裂型股骨转子间骨折,建立股骨近端防旋髓内钉内固定装配模型。观察在静止及行走2种状况下赋予同等载荷时3种骨折内固定模型的等效应力及位移分布云图。结果与结论：(1)A3.3型股骨转子间骨折在动态载荷时最大等效应力及位移均最大,最大等效应力约为A2.3型的2倍,A1.3型的2.7倍,最大等效位移约为A2.3型的1.5倍,A1.3型的3倍,静态时各型差别不明显;(2)动静态载荷时股骨颈、骨折端及主钉处等效应力A3.3型较A1.3和A2.3型增大,以主钉处明显;(3)动态载荷时股...     

多功能股骨板(MFFP)对股骨髁上髁间骨折的生物力学实验研究及临床应用

目的：对股骨髁上,髁间骨折应用多功能股骨板（ＭＦＦＰ）内固定进行生物力学评价。比较不同内固定器械的优劣。为临床提供科学依据。方法：用１２具新鲜股骨髁进行电测实验应力分析。对多功能股骨板（ＭＦＦＰ）及其它不同内固定器械对照比较其生物力学性能。结果：证明我功能股骨板（ＭＦＦＰ）的生物力学性能优于加压滑动髁螺钉（ＤＣＳ）、Ｌ形钢板等其它内固定方式,其强度和刚度存在显著性差异（Ｐ〈０．０１）。实验和理论分析结果得到髁间突上应力较大,股骨上应力趋于平缓。髁间分离位移较小。结论：多功能股骨板（ＭＦＦＰ）比其它内固定方式占有结构合理、生物性能好、防旋性能强、操作简便的优势。临床应用ＭＦＦＰ治疗股骨髁间骨折１２例,优良率达９６．８％。均愈合、无并发症,表明ＭＦＦＰ是治疗股骨髁上髁间骨折较好的内固定方法。值得推广应用。     

股骨粗隆间骨折应用多功能股骨板(MFFP)内固定的生物力学分析

目的：对我院设计的多功能股骨板（Ｍｕｌｔｉ Ｆｕｎｃｔｉｏｎ Ｆｅｍｏｒａｌ Ｐｌａｔｅ,ＭＦＦＰ）应用于股骨粗隆间不稳定骨折进行生物力学分析,为临床应用提供科学依据。方法：按生物力学原理,在１２具新鲜尸体标本股骨上端内、外侧由有４枚应变片进行强刚度等分析。结果：实验研究表明：①多功能股骨板（ＭＦＦＰ）系统能降低股骨距上载荷并增加骨折断端的稳定必②加压滑动髁螺钉及ＤＨＳ却增加了载荷并降低了骨折的稳     

骨质疏松影响股骨近端防旋髓内钉治疗股骨转子间骨折的有限元仿真

文题释义：骨质疏松：是骨量减少导致骨微结构破坏、进而易发生骨折的全身性疾病,它不仅是导致髋部骨折的重要原因之一,也是导致股骨近端防旋髓内钉内固定失效的重要原因之一。 股骨转子间骨折：在老年人中较为常见,现主要是手术治疗,股骨近端防旋髓内钉被广泛应用于临床。股骨转子间骨折内固定术后失效时有发生,其原因可能与骨质疏松、骨折类型、尖顶距值、复位质量等密切相关。 背景：股骨近端防旋髓内钉治疗股骨转子间骨折在临床应用广泛,但仍有部分术后内固定失效病例,股骨近端骨质疏松被认为是一个重要原因。Singh指数是评价股骨近端骨质疏松严重程度的一个重要指标,基于Singh指数探讨不同骨质疏松程度对股骨近端防旋髓内钉治疗转子间骨折疗效的影响,对减少内固定失效概率,增加手术成功率具有重要意义。 目的：探讨不同骨质疏松程度对股骨近端防旋髓内钉治疗转子间骨折疗效的影响,为临床治疗转子间骨折提供新思路和实验基础。 方法：选取1例左侧股骨转子间骨折患者的CT资料,导入Mimics 19.0和Geomagic studio 2017软件中进行提取、优化得到右侧股骨三维模型。运用Solidworks 2017软件画出内固定模型并与股骨模型按照标准手术技术装配,以STEP格式导入Hypermesh 14.0软件中截骨得到AO 2.1型股骨转子间骨折模型,参照Singh指数1-6划分应力骨小梁得到A-F模型,设置材料属性参数、边界条件、施加载荷,分别储存为K文件导入LS-DYNA软件求解。 结果与结论：①当股骨头受力时,Singh 6-Singh 1股骨头颈骨块中螺旋刀片产生切割,普通骨小梁消失,包裹螺旋刀片的应力骨小梁不但没有消失,且承载和分散了部分应力,使得螺旋刀片仍具有较大的接触面积和把持力,维持着骨折的复位,减少了股骨头颈骨块的内翻和旋转;②从Singh 6-Singh 1,随着应力骨小梁的消失,骨质疏松越严重,股骨近端防旋髓内钉治疗股骨转子间骨折就越容易失效;③股骨近端海绵状的丰厚骨小梁,特别是应力骨小梁,通过抵抗、缓冲弯曲应变而在维持股骨的弹性稳定起着重要作用,是股骨近端弹性稳定的重要结构。 ORCID: 0000-0002-4097-2790(黄培镇) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

移动式C型臂X射线机图像拼接在骨科手术中的应用

背景：在脊柱和长骨骨折等骨科手术治疗中,获取骨折部位的完整骨结构图像对于监控和评价骨科术中效果具有十分重要的临床意义。 目的：探讨移动式C型臂X射线机图像拼接技术在临床骨科手术中的应用效果。 方法：对骨科手术部位的脊柱和长骨进行C型臂X射线机透视并采集2-4幅图像,经过图像拼接软件将图像多区域重叠,进行图像拼接技术处理后得到脊柱和长骨骨折内固定手术部位的1张全景图像。 结果与结论：移动式C型臂X射线机图像拼接技术处理后能在1张照片上获得脊柱和长骨骨折内固定手术部位全景图像,能较清晰、完整地显示脊柱和长骨的全景,并有助于术者在术中及时地了解和评估骨折部位的对位、对线情况,且能进行长度和角度测量,为进一步提高手术质量提供强有力的支持。