Given the progressive ageing of Western populations, the fragility fractures market has a growing socioeconomic impact. Fragility fractures are common in the elderly, negatively impacting their quality of life, limiting autonomy, increasing disability, and decreasing life expectancy. Different causes contribute to the development of a fractures in frail individuals. Among all, targeting fragile patients before the development of a fracture may represent the greatest challenge, and current diagnostic tools suffer from limitations. This study summarizes the current evidence on the management of fragility fractures, discussing risk factors, prevention, diagnosis, and actual limitations of the clinical therapeutic options, putting forward new ideas for further scientific investigation.
Articular cartilage (AC) sheathes joint surfaces and minimizes friction in diarthrosis. The resident cell population, chondrocytes, are surrounded by an extracellular matrix and a multitude of proteins, which bestow their unique characteristics. AC is characterized by a zonal composition (superficial (tangential) zone, middle (transitional) zone, deep zone, calcified zone) with different mechanical properties. An overview is given about different testing (load tests) methods as well as different modeling approaches. The widely accepted biomechanical test methods, e.g., the indentation analysis, are summarized and discussed. A description of the biphasic theory is also shown. This is required to understand how interstitial water contributes toward the viscoelastic behavior of AC. Furthermore, a short introduction to a more complex model is given.
Introduction: Corticosteroid-induced osteoporosis (CIO) is the most common type of secondary osteoporosis, leading to fractures, and increased morbidity and mortality. Source of data: Pubmed, EMBASE, Scopus and Google Scholar databases. Areas of agreement: Prolonged glucocorticoids administration leads to secondary osteoporosis. Areas of controversy: The optimal management for CIO is controversial. Growing points: The present study compared bone mineral density, fractures and adverse events in patients undergoing treatment with risedronate, alendronate, zoledronate, denosumab or etidronate for CIO. Areas timely for developing research: For selected patients with CIO, alendronate performed better overall. These results must be interpreted within the limitations of the present study. Level of evidence: I, Bayesian network meta-analysis of randomized clinical trials.
The wrist is by far the most differentiated section of the musculoskeletal system. The spectrum of wrist injuries ranges from minor injuries to complex traumas with simultaneous loss of functions, resulting in enormous economic costs. A proper understanding of the anatomy and biomechanics is essential for effective treatment, whether conservative or surgical; this applies to the wrist no less than to other parts of the human body. Here; information on the wrist anatomy; kinematics; and biomechanical behavior is presented, commencing with a brief explanation of the structure of its hard and soft tissues. Eight carpal bones in combination with two forearm bones (radius and ulna) construct the wrist joint. The motion of the wrist joint is initiated by the muscles of the forearm, and strong and short ligaments ensure the stability of the wrist. All of these components are essential to bringing functions to the wrist joint because these structures allow wrist mobility and sustainability. In addition, the kinematics of the wrist joint is presented and different biomechanical model approaches. The therapeutic (surgical) restoration of the balance between the load–bearing capacity and the actual stress on a joint is the prerequisite for a lifelong and trouble-free function of a joint. Regarding the complex clinical problems, however, a valid biomechanical wrist joint model would be necessary as assistance, to improve the success of systematized therapies based on computer–aided model–based planning and intervention.