Bone & Joint Research最新文献

{"title":"Unravelling lumbar disc herniation severity beyond MRI : integrated transcriptomic and metabolomic analyses highlight glycerophospholipid metabolism and inform a machine-learning diagnostic model: a pilot study.","authors":"Qiaosong Deng, Shiqi Ren, Nan Zhang, Guanshen Li, Ziwei Yu, Xiaojun Li, Hengyan Cui, Yimin Zhang, Yafeng Zhang, Jianfeng Chen","doi":"10.1302/2046-3758.145.BJR-2024-0071.R1","DOIUrl":"https://doi.org/10.1302/2046-3758.145.BJR-2024-0071.R1","url":null,"abstract":"<p><strong>Aims: </strong>While MRI serves as a tool for assessing the severity of lumbar disc herniation (LDH), it has been observed that imaging diagnoses do not always align with clinical symptoms in nearly half of patients. The absence of dependable prognostic biomarkers impedes the early and accurate diagnosis of LDH, which is critical for the development of further treatment approaches. Thus, the aim of this study was to elucidate the molecular mechanisms that determine pain and LDH severity.</p><p><strong>Methods: </strong>We conducted a pilot study with 55 patients, employing transcriptomic and metabolomic analyses on blood samples to identify potential biomarkers. A gene-metabolite interaction approach helped in identifying the pivotal pathway linked to disease severity. Moreover, a machine-learning model was designed to differentiate between patients based on the intensity of pain.</p><p><strong>Results: </strong>Cholinergic-related glycerophospholipid metabolism emerged as the predominant enriched pathway in the severe symptom group via gene-metabolite interaction network analysis. Among various models, the gradient boosting machines (GBM) model stood out, achieving a commendable area under the curve (AUC) of 0.875 in distinguishing between the severe and mild symptom groups using combined RNA and metabolomics data.</p><p><strong>Conclusion: </strong>Integrated molecular profiling of blood biomarkers has highlighted a novel determining pathway for LDH severity. This machine-learning approach can serve as a valuable predictive tool when MRI findings are inconclusive. Future research will focus on validating these biomarkers and exploring their potential for personalized medicine approaches.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"14 5","pages":"434-447"},"PeriodicalIF":4.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12066174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of palmitoylation modifications in the regulation of bone cell function, bone homeostasis, and osteoporosis.","authors":"Ximeng Wang, Yuxuan Zhang, Zhidi Lin, Hongli Wang, Guangyu Xu, Xiaosheng Ma","doi":"10.1302/2046-3758.145.BJR-2024-0259.R2","DOIUrl":"https://doi.org/10.1302/2046-3758.145.BJR-2024-0259.R2","url":null,"abstract":"<p><p>Osteoporosis a is a metabolic bone disease caused by an imbalance in bone homeostasis, which is regulated by osteoblasts and osteoclasts. Protein palmitoylation modification is a post-translational modification that affects protein function, localization, and targeting by attaching palmitoyl groups to specific amino acid residues of proteins. Recent studies have shown that protein palmitoylation is involved in the regulation of osteoclast overproduction, osteoblast migration, osteogenic differentiation, dysfunctional autophagy, and endocrine hormone membrane receptors in osteoporosis. Exactly to what extent palmitoylation modifications can regulate osteoporosis, and whether palmitoylation inhibition can delay osteoporosis, is a key question that needs to be investigated urgently. In this review, we observed that palmitoylation modifications act mainly through two target cells - osteoblasts and osteoclasts - and that the targets of palmitoylation modifications are focused on plasma membrane proteins or cytosolic proteins of the target cells, which tend to assume the role of receiving extracellular signals. We also noted that different palmitoyl transferases acting on different substrate proteins exert conflicting regulation of osteoblast function. We concluded that the regulation of osteocyte function, bone homeostasis, and osteoporosis by palmitoylation modifications is multidimensional, diverse, and interconnected. Perfecting the palmitoylation modification network can enhance our ability to utilize post-translational modifications to resist osteoporosis and lay the foundation for targeting palmitoyl transferases to treat osteoporosis in the future.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"14 5","pages":"420-433"},"PeriodicalIF":4.7,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cyclooxygenase-2 negatively regulates osteogenic differentiation in murine bone marrow mesenchymal stem cells via the FOXO3a/p27kip1 pathway.","authors":"Shu-Chun Chuang, Ya-Shuan Chou, Yi-Shan Lin, Je-Ken Chang, Chung-Hwan Chen, Mei-Ling Ho","doi":"10.1302/2046-3758.145.BJR-2024-0262.R2","DOIUrl":"https://doi.org/10.1302/2046-3758.145.BJR-2024-0262.R2","url":null,"abstract":"<p><strong>Aims: </strong>Cyclooxygenase-2 (COX-2) is an enzyme that synthesizes prostaglandins from arachidonic acid. Previous reports have indicated that COX-2 is constitutively expressed in osteogenic cells instead of being expressed only after pathogenic induction, and that it facilitates osteoblast proliferation via PTEN/Akt/p27^kip1 signalling. However, the role of COX-2 in osteogenic differentiation of murine bone marrow mesenchymal stromal cells (BMSCs) remains controversial. In this study, we investigated the function of COX-2 in the osteogenic differentiation of BMSCs.</p><p><strong>Methods: </strong>COX-2 inhibitor, COX-2 overexpression vector, and p27^kip1 small interfering RNA (siRNA) were used to evaluate the role of COX-2 in osteogenic differentiation and related signalling pathways in BMSCs.</p><p><strong>Results: </strong>We found that the messenger RNA (mRNA) and protein levels of COX-2 decreased gradually during osteogenic differentiation. Inhibition of COX-2 activity promoted FOXO3a and p27^kip1 expression and simultaneously enhanced osteogenesis, as indicated by increased osteogenic gene expression and mineralization in BMSCs. Furthermore, when p27^kip1 was silenced, the suppressive effects of COX-2 on osteogenesis were reversed. It demonstrated that the negative regulatory effect of COX-2 on osteogenesis was mediated by p27^kip1. In addition, our results showed that overexpression of COX-2 reduced the mRNA and protein levels of FOXO3a and p27^kip1, and thus attenuated osteogenic gene expression. These results indicate that COX-2 negatively regulates osteogenic differentiation by reducing the expression of osteogenic genes via the FOXO3a/p27^kip1 signalling pathway.</p><p><strong>Conclusion: </strong>Together with the findings from previous and current studies, these results indicate that COX-2 has a different role in proliferation versus differentiation during osteogenesis via FOXO3a/p27^kip1 signalling in osteoblasts or BMSCs.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"14 5","pages":"407-419"},"PeriodicalIF":4.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The full radiostereometric analysis migration pattern of tibial components is associated with aseptic loosening : introducing MTPMemax (MTPM estimated maximum).","authors":"Bart G Pijls, Elise K Laende","doi":"10.1302/2046-3758.145.BJR-2024-0554","DOIUrl":"https://doi.org/10.1302/2046-3758.145.BJR-2024-0554","url":null,"abstract":"<p><strong>Aims: </strong>Thresholds for acceptable amounts of migration tibial components measured with radiostereometric analysis (RSA) are limited to specific follow-up moments and do not use the full migration pattern. The Michaelis-Menten (MM) model, a non-linear model from biochemistry, could potentially be used to model the entire migration pattern. The purpose of this study was therefore to determine if MM models can be fitted to RSA migration data of tibial components, and if these fitted model parameters can be used for early detection of tibial components at high risk for aseptic loosening.</p><p><strong>Methods: </strong>Migration patterns of tibial component maximum total point motion (MTPM) over six months, one year, and two years, as well as revision rates for aseptic loosening from previously published systematic reviews, were used. Fitted MM models gave the estimated maximal MTPM (MTPMemax) and a constant (K), which is the time in months at which half the MTPMemax is reached for tibial component designs. To assess model fit, intraclass correlation coefficients (ICCs) were calculated for the modelled MTPMemax and reported five-year MTPM values. The estimated MTPMemax and K-values were plotted against their corresponding five-year revision rate for aseptic loosening.</p><p><strong>Results: </strong>For six-month, one-year, and two-year migration patterns, the ICC was 0.81, 0.83, and 0.91, respectively, suggesting excellent agreement between calculated MTPMemax values and the known five-year MTPM values. MTPMemax up to 1.3 mm was considered to be safe based on association with aseptic loosening revision rate, while MTPMemax of more than 1.3 mm was unsafe. The K-value could not be used as a predictor for safe versus unsafe implants.</p><p><strong>Conclusion: </strong>MTPMemax values may be used for early detection of tibial components at high risk for aseptic loosening, possibly offering improvements over the older threshold system.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"14 5","pages":"398-406"},"PeriodicalIF":4.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Growth differentiation factor 15 as a potential diagnostic biomarker for rheumatoid arthritis : a systematic review.","authors":"Xu Liu, Anko E Essien, Wenhao Lu, Hongfu Jin, Linyuan Pan, Yusheng Li, Wenfeng Xiao","doi":"10.1302/2046-3758.145.BJR-2024-0230.R2","DOIUrl":"https://doi.org/10.1302/2046-3758.145.BJR-2024-0230.R2","url":null,"abstract":"<p><strong>Aims: </strong>This systematic review aimed to investigate the association between growth differentiation factor 15 (GDF-15) and rheumatoid arthritis (RA) disease activity, explore the differences at the genetic level, and evaluate the value of GDF-15 in diagnosing RA.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted using PubMed, Web of Science, Cochrane Library, and Embase on 23 August 2023. Methodological quality was independently assessed by using the Agency for Healthcare Research and Quality scale. The primary parameters analyzed were the serum GDF-15 concentration, disease activity, and diagnostic sensitivity and specificity.</p><p><strong>Results: </strong>A total of 469 documents were retrieved, and five clinical studies were ultimately included. In the included studies, GDF-15 serum levels were found to be notably greater in RA patients than in healthy individuals, and these levels exhibited a positive correlation with disease severity. Furthermore, increased GDF-15 serum levels were associated with specific gene variations in RA patients, but varied according to ethnicity. In two included studies, GDF-15 showed high diagnostic sensitivity and specificity for highly active RA, demonstrating its utility as a diagnostic biomarker of RA.</p><p><strong>Conclusion: </strong>GDF-15 expression is increased in RA patients and is associated with disease activity; thus, GDF-15 is potentially an effective diagnostic biomarker for RA. However, additional high-quality studies, especially randomized controlled trials and cohort studies with follow-up data, are needed to assess the role of GDF-15 in RA.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"14 5","pages":"389-397"},"PeriodicalIF":4.7,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulsed Nd:YAG laser therapy accelerates fracture healing in a rat femoral osteotomy model.","authors":"Po-Yen Ko, Che-Chia Hsu, Shih-Yao Chen, Chieh-Hsiang Hsu, Chia-Lung Li, I-Ming Jou, Po-Ting Wu","doi":"10.1302/2046-3758.145.BJR-2024-0285.R2","DOIUrl":"https://doi.org/10.1302/2046-3758.145.BJR-2024-0285.R2","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to evaluate the effects of Nd:YAG laser treatment on fracture healing in a rat model. We hypothesized that laser therapy would accelerate healing by stimulating early neovascularization and osteoblast recruitment.</p><p><strong>Methods: </strong>A total of 54 male Sprague-Dawley rats received intramedullary Kirschner wire (K-wire) osteosynthesis following femoral osteotomy, and were randomly divided into two groups (n = 27 each): the control group, and the laser group that received daily pulsed Nd:YAG laser for ten days immediately after osteotomy. Fracture sites were assessed using micro-CT (μCT; n = 8 at each timepoint), histology (n = 4), and three-point bending tests (n = 4) at week 2, week 4<i>,</i> and week 6, respectively. At week 2, an additional three rats per group were selected for the western blot tests.</p><p><strong>Results: </strong>Compared to controls, the laser group showed higher vascular endothelial growth factor (VEGF), CD31, and Runx2 protein expression, and significantly higher neovascular area density and osteoblast density (p = 0.025 and p = 0.008, respectively) at week 2. At week 4, the laser treatment led to higher histological fracture healing scale and flexural modulus, and less strain (p = 0.001, p = 0.020, and p = 0.004, respectively). Macroscopically, the laser group showed higher mature bone volume fraction and radiological union score at weeks 4 and 6 (volume fraction: p = 0.017 and p = 0.001; union score: p = 0.001 and p = 0.024, respectively).</p><p><strong>Conclusion: </strong>Pulsed Nd:YAG laser therapy accelerates multiple quantitative indicators of fracture healing within six weeks in a rat femoral osteotomy model, which was associated with enhanced angiogenesis and osteogenesis during the early healing phase.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"14 5","pages":"376-388"},"PeriodicalIF":4.7,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreased femoral fracture load after cephalomedullary nail removal : a biomechanical ex vivo study.","authors":"Gilbert M Schwarz, Alexander Synek, Stephanie Huber, Jochen G Hofstaetter, Dieter Pahr, Andreas Reisinger, Sylvia Nürnberger, Lena Hirtler","doi":"10.1302/2046-3758.145.BJR-2024-0278.R2","DOIUrl":"https://doi.org/10.1302/2046-3758.145.BJR-2024-0278.R2","url":null,"abstract":"<p><strong>Aims: </strong>Spontaneous neck fractures are feared complications of cephalomedullary nail removal after successful healing of per- and subtrochanteric fractures. To date, the initial postoperative stability as well as the correct weightbearing regimen remain unclear. The aim of this biomechanical ex vivo study was to evaluate the initial postoperative failure load after hardware removal of specimens, which received cephalomedullary nails during their lifetime.</p><p><strong>Methods: </strong>A total of 20 specimens of voluntary body donors were included in this study. Group 1 (n = 10) consisted of specimens that received cephalomedullary nails during their lifetime due to per- or subtrochanteric fractures. Each individual was matched for age, sex, femur size, and neck-shaft angle (Group 2 = control, n = 10). Biomechanical testing was performed in a single-leg stance setting, and volumetric bone mineral density (vBMD) was measured proximally at the femoral neck and distally at the epicondyles.</p><p><strong>Results: </strong>Groups 1 and 2 differed significantly in terms of failure loads (p = 0.002), fracture types, and ratios of proximal and distal vBMD (p = 0.035). Femora after nail removal were significantly weaker (1,835.0 N vs 4,523.0 N) and showed lower ratios of proximal to distal vBMD (0.74 vs 1.18), which indicated altered stress distributions at the femoral neck in presence of femoral neck screws. They were further characterized by predominantly subcapital buckle-type fractures, while the control Group 2 showed predominantly transcervical fractures.</p><p><strong>Conclusion: </strong>Altered stress distribution in presence of femoral neck screws leads to changes in biomechanical properties of the proximal femur, resulting in potentially unstable situations after nail removal in clinical settings. Elective removal of cephalomedullary nails should be undertaken with caution in view of the potentially increased fracture risk.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"14 5","pages":"368-375"},"PeriodicalIF":4.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and advances in the management of heterotopic ossification in total hip arthroplasty.","authors":"Babar Kayani, Warran Wignadasan, Andreas Fontalis, Fares S Haddad","doi":"10.1302/2046-3758.144.BJR-2024-0323.R1","DOIUrl":"https://doi.org/10.1302/2046-3758.144.BJR-2024-0323.R1","url":null,"abstract":"","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"14 4","pages":"351-355"},"PeriodicalIF":4.7,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carpaine ameliorates synovial inflammation by promoting p65 degradation and inhibiting the NF-κB signalling pathway.","authors":"Hongbo Zhang, Ziyang Li, Zhicheng Zhang, Haobin Li, Zihao Yao, Haiyan Zhang, Chang Zhao, Xiaochun Bai, Chenglong Pan, Daozhang Cai, Chun Zeng","doi":"10.1302/2046-3758.144.BJR-2024-0327.R1","DOIUrl":"https://doi.org/10.1302/2046-3758.144.BJR-2024-0327.R1","url":null,"abstract":"<p><strong>Aims: </strong>Osteoarthritis (OA) is a chronic and debilitating joint disease. Despite its prevalence, especially in ageing and obese populations, effective treatments targeting the molecular mechanisms of OA are limited. This study aimed to investigate the role of carpaine (CP), a major alkaloid from the Carica papaya leaf, in inhibiting articular cartilage destruction and synovitis during OA progression, and to elucidate the underlying molecular mechanisms.</p><p><strong>Methods: </strong>CP (purity > 98%) was dissolved in dimethyl sulfoxide (DMSO). Various antibodies and reagents were sourced from Sigma-Aldrich, Abcam, and other suppliers. Peritoneal macrophages (pMACs) were cultured in Dulbecco's Modified Eagle Medium (DMEM) and treated with CP to assess its effects on inflammatory cytokine production and nuclear factor-kappa B (NF-κB) signalling. A total of 40 ten-week-old male C57/BL6 mice underwent destabilization of the medial meniscus (DMM) surgery to induce OA. Post-surgery, mice were treated with CP (0.5 or 3 mg/kg) or vehicle via intra-articular injections for up to ten weeks. Cartilage degradation and synovitis were evaluated using Safranin O, Fast Green staining, haematoxylin and eosin (H&E) staining, immunohistochemistry, and quantitative polymerase chain reaction (PCR).</p><p><strong>Results: </strong>CP treatment significantly reduced cartilage degeneration and maintained hyaline cartilage thickness compared to the vehicle group. Indicators of cartilage degeneration, such as collagen X (Col X) and matrix metallopeptidase 13 (MMP13), were markedly decreased in the CP-treated group. CP-treated mice exhibited significantly lower synovitis scores at both five and ten weeks post-DMM surgery. CP prominently decreased the production of proinflammatory cytokines (interleukin (IL)-1β, IL-6) in M1 polarized macrophages both in vitro and in vivo. CP impeded NF-κB signalling by promoting p65 degradation through the E3 ubiquitin ligase LRSAM1. The defensive effect of CP was reversed by <i>Lrsam1</i> small interfering RNA (siRNA), confirming the role of LRSAM1 in CP-mediated NF-κB inhibition.</p><p><strong>Conclusion: </strong>CP acts as a 'physiological brake' on NF-κB activation, thereby mitigating synovial inflammation and cartilage destruction in OA. These findings suggest that targeting synovitis via CP could be a promising therapeutic strategy for OA.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"14 4","pages":"356-367"},"PeriodicalIF":4.7,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct and indirect costs of long bone fracture nonunions of the lower limb : the economic burden on the German healthcare system.","authors":"Tanja C Maisenbacher, Mika F Rollmann, Maximilian M Menger, Niklas R Braun, Benedikt J Braun, Steven C Herath, Fabian Stuby, Andreas K Nuessler, Tina Histing, Marie K Reumann","doi":"10.1302/2046-3758.144.BJR-2024-0150.R2","DOIUrl":"10.1302/2046-3758.144.BJR-2024-0150.R2","url":null,"abstract":"<p><strong>Aims: </strong>Fracture nonunion represents a major complication in orthopaedic surgery, occurring in 5% to 10% of fracture patients. Fracture nonunions are associated with pain and loss of function, and lead to a substantial socioeconomic burden. The present retrospective cohort study analyzed direct and indirect costs and length of hospital stay, number of surgical procedures, and hospital (re-)admissions of nonunion patients.</p><p><strong>Methods: </strong>Data from 18- to 65-year-old patients surgically treated for lower limb fractures and nonunions in a German level I trauma centre between 2012 and 2018 were analyzed. A total of 193 patients with nonunion were included, and 2,511 patients with fractures served as the control group. Direct costs were calculated using reimbursement according to the diagnosis-related group (DRG). Indirect costs were calculated including daily sickness allowance and productivity loss.</p><p><strong>Results: </strong>The median healing time of nonunion patients was 45 weeks. Treatment expenses showed a 2.6-fold increase in direct costs, a 3.3-fold increase in indirect costs, and a 3.3-fold increase in total costs for nonunion patients compared to the control group. As every patient with a nonunion suffered from a fracture prior to nonunion treatment, costs were calculated by adding the median direct costs of €10,487 (IQR 9,173 to 15,262), median daily sickness allowance of €23,046 (IQR 14,892 to 36,264), median productivity loss of €85,714 (IQR 60,949 to 126,650), and median total socioeconomic burden of €123,334 (IQR 88,630 to 176,329).</p><p><strong>Conclusion: </strong>Nonunions not only pose a significant burden on the injured individual and on healthcare systems, but also have a substantial socioeconomic impact. High direct and indirect costs illustrate that healing complications need to be detected and addressed as early as possible.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"14 4","pages":"341-350"},"PeriodicalIF":4.7,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}