United Nations Population Division

Patients with vertebral, hip, distal radius, and proximal humerus fractures are most common among the osteoporosis-related fractures. The incidences of these fractures increase with age, however, the increase patterns differ between the fracture sites. The prevalence of vertebral fracture for Japanese is similar or slightly higher and the incidences of osteoporosis-related limb fractures are lower than those for Caucacians. A decrease in prevalence of vertebral fractures and an increase in the incidence of limb fractures are the secular trend in Japan. Previous fractures are significant risk factor for both vertebral and hip fractures. Greater physical activity increases the risk of distal radius fractures, and decreases the risk of proximal humerus fractures.

Epidemiology of osteoporotic fractures

Due to the increasing life expectancy, orthopaedic surgeons are more and more often confronted with fragility fractures of the pelvis (FFPs). These kinds of fractures are the result of a low-energy impact or they may even occur spontaneously in patients with severe osteoporosis. Due to some distinct differences, the established classifications for pelvic ring lesions in younger adults do not fully reflect the clinical and morphological criteria of FFPs. Most FFPs are minimally displaced and do not require surgical therapy. However, in some patients, an insidious progress of bone damage leads to increasing displacement, nonunion and persisting instability. Therefore, new concepts for surgical treatment have to be developed to address the functional needs of the elderly patients. Based on an analysis of 245 consecutive patients with FFPs, we propose a novel classification system for this condition. This classification is based on morphological criteria and it corresponds with the degree of instability. Also in the elderly, these criteria are the most important for the decision on the type of treatment as well as type and extent of surgery. The estimation of the degree of instability is based on radiological and clinical findings. The classification gives also hints for treatment strategies, which may vary between minimally invasive techniques and complex surgical reconstructions.

Comprehensive classification of fragility fractures of the pelvic ring: Recommendations for surgical treatment.

This review will define the role of collagen and within-bone heterogeneity and elaborate the importance of trabecular and cortical architecture with regard to their effect on the mechanical strength of bone. For each of these factors, the changes seen with osteoporosis and ageing will be described and how they can compromise strength and eventually lead to bone fragility.

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Bone mechanical properties and changes with osteoporosis.

Abbreviated Injury Scale

The overexpression of the enzymes involved in the degradation of procollagen lysine is correlated with various tumor entities. Procollagen-lysine, 2-oxoglutarate 5-dioxygenase 3 (PLOD3) expression was found to be correlated to the progression and migration of cancer cells in gastric, lung and prostate cancer. Here, we analyzed the gene expression, protein expression, and the clinical parameters of survival across 33 cancers based on the Clinical Proteomic Tumor Analysis Consortium (CPTAC), function annotation of the mammalian genome 5 (FANTOM5), Gene Expression Omnibus (GEO), Genotype-Tissue Expression (GTEx), Human Protein Atlas (HPA) and The Cancer Genome Atlas (TCGA) databases. Genetic alteration, immune infiltration and relevant cellular pathways were analyzed in detail. PLOD3 expression negatively correlated with survival periods and the infiltration level of CD8+ T cells, but positively correlated to the infiltration of cancer associated fibroblasts in diverse cancers. Immunohistochemistry in colon carcinomas, glioblastomas, and soft tissue sarcomas further confirm PLOD 3 expression in human cancer tissue. Moreover, amplification and mutation accounted for the largest proportion in esophageal adenocarcinoma and uterine corpus endometrial carcinoma, respectively; the copy number alteration of PLOD3 appeared in all cancers from TCGA; and molecular mechanisms further proved the effect of PLOD3 on tumorigenesis. In particular, PLOD3 expression appears to have a tumor immunological effect, and is related to multiple immune cells. Furthermore, it is also associated with tumor mutation burden and microsatellite instability in various tumors. PLOD3 acts as an inducer of various cancers, and it could be a potential biomarker for prognosis and targeted treatment.

A Human Pan-Cancer System Analysis of Procollagen-Lysine, 2-Oxoglutarate 5-Dioxygenase 3 (PLOD3).

To compare the mechanical strength of antegrade versus retrograde lag screw fixation of anterior column acetabular fractures. Standardised anterior column fractures were created in synthetic pelvis models and stabilised by either antegrade (ANTE, n = 4) or retrograde (RETRO, n = 4) anterior column screw fixation. In a validated setup, a cyclic loading protocol was applied with increasing axial force (750 cycles, 250–750 N) followed by load to failure. Construct survival, energy absorbed, construct stiffness, and load to failure were assessed. Descriptive and opto-metric methods were used to describe the mode of failure. All constructs failed with loads below 1500 N. With regard to energy absorbed until failure, the ANTE group resisted to 3.763 × 105 N*cycles (range 3.760 × 105–3.763 × 105) and the RETRO group to 3.762 × 105 N*cycles (range 3.761 × 105–3.765 × 105; p = 1.0). The load to failure was 1254 N (range 977–1299) in the ANTE group and 1234 N (range 1087–1456) in the RETRO group (p = 1.0). Construct stiffness with 250 N was not different between the two groups (ANTE 192 N/mm vs. RETRO 215 N/mm, p = 0.486). In all samples, the mode of failure was a transiliac fracture with screw breakout due to rotation of the pubic fragment around the axis of the screw with a range of rotational motion [ROM] during cyclic testing of 0.96° in one ANTE sample and 0.82° in one RETRO sample for 750 N, and ROM at failure of 2.53° in one ANTE sample and 2.23° in one RETRO sample. There was some plastic deformation of the screws in all cases but no breakage. In this in vitro mechanical study, antegrade screw fixation of an anterior column acetabular fracture was not different in construct survival, load to failure, stiffness, and mode of failure when compared to retrograde screw fixation.

Antegrade versus retrograde screw fixation of anterior column acetabular fractures: a biomechanical in vitro study

Die Versorgung der osteoporotischen, dislozierten proximalen Humerusfraktur stellt – auch nach Entwicklung neuer Implantate – weiterhin eine technische und chirurgische Herausforderung dar. Die winkelstabile Plattenosteosynthese hat sich dabei als ein Standardverfahren durchgesetzt. Dennoch sind die Komplikationsraten unbefriedigend, insbesondere hinsichtlich Varusdislokation und Penetration der proximalen Schrauben durch die Kopfkalotte. In der aktuellen Literatur wird die Wiederherstellung der medialen Abstutzung als wichtigstes Ziel der operativen Versorgung genannt. Der vorliegende Artikel demonstriert anhand eines Fallbeispiels die Alternative einer intramedullaren Augmentation und erlautert das Konzept der medialen Abstutzung bei der winkelstabilen Plattenosteosynthese proximaler Humerusfrakturen. Es werden diesbezuglich Moglichkeiten, Ergebnisse und Empfehlungenunterschiedlicher Verfahren vorgestellt. Diskutiert werden die Bedeutung einer korrekten Reposition der medialen Kortizes, die Verwendung von Kalkarschrauben, die Doppelplattenosteosynthese sowie das vorgestellte Verfahren der intramedullaren Augmentation.

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Mediale Abstützung mit kortikalem intramedullärem Interponat bei winkelstabiler Plattenosteosynthese der proximalen Humerusfraktur

Exact knowledge of the sacral anatomy is crucial for the percutaneous insertion of iliosacral screws. However, dysplastic anatomical patterns are common. In addition to a preoperative computed tomography (CT) analysis, conventional radiographic measures may help to identify upper sacral dysplasia and to avoid damage to surrounding structures. Aiming to further increase safety in percutaneous iliosacral screw placement in the presence of sacral dysmorphism, this study examined the prevalence of previously established radiographic signs and, in addition, defined the “critical SI angle” as a new radiographic criterion. Pelvic CT scans of 98 consecutive trauma patients were analysed. Next to assessment of established signs indicating upper sacral dysplasia, the critical sacroiliac (SI) angle was defined in standardized pelvic outlet views. The critical SI angle significantly correlates with the presence of mammillary bodies and an intraarticular vacuum phenomenon. With a cut-off value of − 14.2°, the critical SI angle detects the feasibility of a safe iliosacral screw insertion in pelvic outlet views with a sensitivity of 85.9% and a specificity of 85.7%. The critical SI angle can support the decision-making when planning iliosacral screw fixation. The clinical value of the established signs of upper sacral dysplasia remains uncertain.

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Feasibility of iliosacral screw placement in patients with upper sacral dysplasia.

Soft tissue sarcomas (STS), a group of rare malignant tumours with high tissue heterogeneity, still lack effective clinical stratification and prognostic models. Therefore, we conducted this study to establish a reliable prognostic gene signature. Using 189 STS patients' data from The Cancer Genome Atlas database, a four-gene signature including DHRS3, JRK, TARDBP and TTC3 was established. A risk score based on this gene signature was able to divide STS patients into a low-risk and a high-risk group. The latter had significantly worse overall survival (OS) and relapse free survival (RFS), and Cox regression analyses showed that the risk score is an independent prognostic factor. Nomograms containing the four-gene signature have also been established and have been verified through calibration curves. In addition, the predictive ability of this four-gene signature for STS metastasis free survival was verified in an independent cohort (309 STS patients from the Gene Expression Omnibus database). Finally, Gene Set Enrichment Analysis indicated that the four-gene signature may be related to some pathways associated with tumorigenesis, growth, and metastasis. In conclusion, our study establishes a novel four-gene signature and clinically feasible nomograms to predict the OS and RFS. This can help personalized treatment decisions, long-term patient management, and possible future development of targeted therapy.

Georg Osterhoff

Papers

A Human Pan-Cancer System Analysis of Procollagen-Lysine, 2-Oxoglutarate 5-Dioxygenase 3 (PLOD3).

Antegrade versus retrograde screw fixation of anterior column acetabular fractures: a biomechanical in vitro study

Mediale Abstützung mit kortikalem intramedullärem Interponat bei winkelstabiler Plattenosteosynthese der proximalen Humerusfraktur

Feasibility of iliosacral screw placement in patients with upper sacral dysplasia.

A Novel Four-Gene Prognostic Signature for Prediction of Survival in Patients with Soft Tissue Sarcoma