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Segmental bone defects, stemming from trauma, infection, and tumors, pose formidable clinical challenges. Traditional bone repair materials, such as autologous and allogeneic bone grafts, grapple with limitations including source scarcity and immune rejection risks. The advent of nucleic acid nanotechnology, particularly the use of DNA hydrogels in tissue engineering, presents a promising solution, attributed to their biocompatibility, biodegradability, and programmability. However, these hydrogels, typically hindered by high gelation temperatures (∼46 °C) and high construction costs, limit cell encapsulation and broader application. Our research introduces a novel polymer-modified DNA hydrogel, developed using nucleic acid nanotechnology, which gels at a more biocompatible temperature of 37 °C and is cost-effective. This hydrogel then incorporates tetrahedral Framework Nucleic Acid (tFNA) to enhance osteogenic mineralization. Furthermore, considering the modifiability of tFNA, we modified its chains with Aptamer02 (Apt02), an aptamer known to foster angiogenesis. This dual approach significantly accelerates osteogenic differentiation in bone marrow stromal cells (BMSCs) and angiogenesis in human umbilical vein endothelial cells (HUVECs), with cell sequencing confirming their targeting efficacy, respectively. In vivo experiments in rats with critical-size cranial bone defects demonstrate their effectiveness in enhancing new bone formation. This innovation not only offers a viable solution for repairing segmental bone defects but also opens avenues for future advancements in bone organoids construction, marking a significant advancement in tissue engineering and regenerative medicine. Construction of DNA Hydrogel Composite Material. [Display omitted] •Innovative DNA Hydrogel for Bone Repair: Introduces a novel polymer-modified DNA hydrogel, using nucleic acid nanotechnology, that gels at a biocompatible temperature (37 °C), overcoming limitations of traditional DNA hydrogel synthesized in high-temperature.•Enhanced Osteogenesis and Angiogenesis Capacity: Incorporates tetrahedral Framework Nucleic Acid and Aptamer02 in DNA hydrogel, boosting osteogenic mineralization and angiogenesis, respectively.•Cost-Effectiveand Biocompatible: Presents a cost-effective solution with improved biocompatibility, addressing the challenges of high construction costs in existing DNA hydrogels.

Objective The aim of this study was to analyse the efficacy of three-dimensional (3D)-printed screw guide-assisted percutaneous metatarsal transverse osteotomy (PMTO) for the treatment of mild-to-moderate hallux valgus (HV). Methods A retrospective case analysis was used to collect the clinical data of 21 patients with mild-to-moderate HV admitted to Shanghai Jiao Tong University School of Medicine Affiliated Sixth People’s Hospital between June 2022 and April 2023, all of whom were treated with 3D-printed screw guide-assisted PMTO, and to compare the pre- and postoperative hallux valgus angle (HVA) and the 1st-2nd intermetatarsal angle (IMA). The duration of surgery and the shortening of the first metatarsal were recorded. The efficacy and function of the patients were assessed via the American Orthopedic Foot and Ankle Surgery Society (AOFAS) forefoot score and visual analogue score (VAS) preoperatively and at the last follow-up. Statistical analysis included normality assessment and internal comparisons (t tests for normally distributed quantitative data and the Mann‒Whitney U test for nonnormally distributed data). Results All patients underwent successful surgery with a mean follow-up of 24.1 ± 2.2 months without complications. The mean HVA and IMA were corrected to 11.2 ± 2.6° and 8.1 ± 1.4° from the preoperative values of 32.2 ± 5.0° and 12.6 ± 1.6°, respectively ( P  < 0.05). The mean shortening of the first metatarsal was 3.2 ± 1.0 mm. The average operative duration was 41.0 ± 2.3 min. The AOFAS forefoot and VAS scores improved from 59.7 ± 3.6 and 6.1 ± 1.3 preoperatively to 89.8 ± 4.3 and 0.7 ± 0.6 at the last follow-up, respectively ( P  < 0.05). Conclusion The use of 3D-printed screw guides, improving the safety and effectiveness of PMTO and shortening the operation time, is an effective, efficient and secure way to correct HV deformities. Level of evidence Level IV, retrospective cohort study.

Category: Hindfoot; Trauma Introduction/Purpose: Calcaneal Sanders type II or III fractures are highly disabling with significant burden. Surgical treatment modalities include open reduction and internal fixation (ORIF) techniques and a variety of minimally invasive surgical (MIS) approaches. ORIF techniques are associated with complications and traditional MIS techniques need extensive intraoperative fluoroscopic procedures. The present study aims to investigate the effects of three different minimally invasive internal fixation (MIIF) techniques used to treat Sanders type II intra-articular calcaneal fractures using finite element analyses. Methods: A 64-row spiral computed tomography scan was used to observe the calcaneus of a healthy adult. The scanning data were imported into Mimics in a DICOM format. Using a new model of a Sanders type II-B intra-articular calcaneal fracture, three minimally invasive techniques were simulated. Technique A involved fixation using an isolated minimally invasive locking plate; Technique B used a minimally invasive locking plate with one medial support screw; and Technique C simulated a screw fixation technique using four 4.0-mm screws. After simulating a 640-N load on the subtalar facet, the maximum displacement and von Mises stress of fragments and implants were recorded to evaluate the biomechanical stability of different fixation techniques using finite element analyses. Results: After stress loading, the maximum displacements of the fragments and implants were located at the sustentaculum tali and the tip of sustentaculum tali screw, respectively, in the three techniques; however, among the three techniques, Technique B had better results for displacement of both. The maximum von Mises stress on the fragments was < 56 Mpa, and stress on the implants using the three techniques was less than the yield strength, with Technique C having the least stress. Conclusion: All three techniques were successful in providing a stable fixation for Sanders type II intra-articular calcaneal fractures, while the minimally invasive calcaneal locking plate with medial support screw fixation approach exhibited greater stability, leading to improved enhancement for the facet fragment; however, screw fixation dispersed the stress more effectively than the other two techniques.

Background Rheumatoid arthritis (RA) affects ankle joints in up to one half of patients with established disease, causing inflammation and damage. Arthroscopic synovectomy removes inflamed tissue to improve joint function, but long-term outcomes and the potential role of adjunctive therapies are limited. Materials and methods A total of 176 patients who had a preoperative diagnosis of RA according to the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria, radiographic Larsen grade ≤ 3, and who underwent arthroscopic synovectomy from May 2013 to May 2019 were prospectively enrolled. Weight-bearing anteroposterior and lateral plain radiographs of the ankle were performed annually after initial surgery. The Larsen grade was used to evaluate the progression of ankle joint damage in RA, and patient-reported outcomes (American Orthopaedic Foot and Ankle Society [AOFAS] Ankle–Hindfoot Scale and the Foot and Ankle Outcome Score [FAOS]) were collected annually. The primary outcome measure was 5-year AOFAS score. Baseline characteristics, including age, body mass index (BMI), duration of symptoms before surgery, Larsen grade before surgery, and other potentially related factors, including number of platelet-rich plasma (PRP) injections and change in BMI from baseline, were recorded. Results There were 138 patients included, all with minimum 5-year follow-up data. The overall reoperation rate was 13% (95% confidence interval [CI] 6.8–18.9%; 18 of 138). According to multivariable analysis, 5-year AOFAS scores were associated with number of PRP injections (correlation coefficient = 2.09 [95% CI 1.47–2.71]; P  < 0.001), duration of symptoms before surgery (correlation coefficient = 0.42 [95% CI 0.14–0.70]; P  = 0.01), Larsen grade before surgery (correlation coefficient = 0.28 [95% CI 0.06–0.49]; P  = 0.034), and mean BMI change from baseline (correlation coefficient = −1.23 [95% CI −1.57 to −0.89]; P  < 0.001). When comparing the number of PRP injections (0, 1–2, or ≥ 3), patients who had serial PRP injections (≥ 3) had diminished functional and radiographic deterioration over time. Conclusions Arthroscopic synovectomy improves symptoms for ankle RA and appears to slow—but not halt—radiographic deterioration over 5 years. Serial PRP injections and reduction in BMI from baseline could be associated with better clinical outcomes and slower joint degeneration, which needs to be verified by randomized controlled trials. Level of evidence Level II, prospective cohort study. Trial registration Research Registry, researchregistry10878. Registered 24 November 2024—retrospectively registered, http://researchregistry.knack.com/researchregistry10878

Background Flatfoot is a common foot disorder involving progressive foot deformity of the three‐dimensional structures of the forefoot, midfoot, and hindfoot. Currently, Chinese surgeons and patients favor subtalar arthroereisis (SA) due to its minimally invasive and low‐damage characteristics. HyProCure device is widely used. However, there is limited analysis of large sample sizes. This study utilized statistical evaluation with a large sample size to analyze clinical characteristics trends of SA for flatfoot, including baseline indicators, selection of HyProCure size and surgical strategy, complications, and implant removal. This study will enhance the understanding of SA in China. Methods A retrospective analysis of 732 patients (1008 ft) who underwent SA from June 2015 to June 2023, with 509 pediatric and adolescent patients (772 ft) and 223 adult patients (236 ft). Based on the patient's age, patients aged ≤ 18 were included in the children and adolescent group, while adult acquired flatfoot deformity (AAFD) patients aged > 18 were included in the adult group. General data was collected, including patient sex, age, side, body mass index (BMI), surgery date, HyproCure size, and surgical data, and trends were analyzed. Postoperative complications and HyProCure removal were collected as outcome measures during follow‐up. Results The age of patients treated with SA was gradually getting younger, with male patients predominating, mainly concentrated in the 11–14 age group. HyProCure 7 has the highest usage rate. In the children and adolescent group, 288 ft (37.31%) only underwent SA. In the adult group, 18 ft (7.63%) only underwent SA. Complications include sinus tarsi pain, peroneal spasms, achilles tendon tension, and muscle strength decline. The complication rate in the children and adolescent group was 5.05%, while in the adult group it was 28.81%. Overall, it was 10.62%. The removal rate of HyProCure in the children and adolescent group is 1.04%, in the adult group is 15.25%, and overall is 4.37%. Conclusions The trend in flatfoot treated with SA was towards children and adolescent male patients, and sinus tarsi pain was the most common complication after SA. The complication rate and removal rate in the children and adolescent group were lower than those in the adult group. HyProCure can be removed without additional adverse effects. We intend to conduct a retrospective analysis of patients with subtalar arthroereisis (SA) to explore the distribution trend of clinical features. First, patient collection began in 2015, and inclusion criteria and exclusion criteria were established. Since the best indication of SA is flatfoot patients aged 10–12 years, we decided to compare the two populations of children and adolescents with adults, and to explore the differences between male and female patients. Data collection included general data and surgical data. After data collection, all data is analyzed.

Objectives To analyze the feasibility, effectiveness and safety of autologous costochondral transplantation (ACT) in patients with Hepple V osteochondral lesion of talus (OLT), and to analyze the short-to-intermediate-term efficacy. Methods Clinical data of 27 patients (27 ankles) with Hepple V OLT admitted in Shanghai Jiao Tong University School of Medicine Affiliated Sixth People’s Hospital between February 2020 and February 2022 were retrospectively analyzed, of which were treated with ACT. The general information, operation time, and hospitalization days of the patients were recorded. According to the foot and ankle ability measurement (FAAM)–activities of daily living subscale (FAAM–ADL) and sports subscale (FAAM-Sp), the EuroQol-Visual Analogue Scale (EQ VAS) and the Magnetic Resonance Observation of Cartilage Repair Tissue 2.0 ankle score (MOCART 2.0), surgical efficacy and of the patients’ function were evaluated, to verify the clinical satisfaction of ACT. The related complications that occurred during the follow-up of the patients in the group were also recorded. Statistical analysis included normality assessment, intra-group comparisons (one-way analysis of variance (ANOVA) and LSD method for normal quantitative data, Mann–Whitney U for non-normal data, and chi-square for categorical variables). P  < 0.05 was considered a statistically significant difference. Results All patients were operated successfully. The general information, operation time, and hospitalization days of the patients were fully recorded. At the final follow-up, scores of FAAM–ADL, FAAM-Sp and EQ VAS were improved to 87.7 ± 6.8 (P < 0.001), 87.2 ± 7.4 (P < 0.001), 90.7 ± 3.3 ( P  < 0.001) from preoperative ones, respectively. MOCART 2.0 scores improved from 85(80, 90) 12 months postoperatively to 85(85, 90) at final follow-up ( P  = 0.025). Three patients (11.1%) voluntarily removed the internal fixation of the internal ankle osteotomy. There were no complications, such as neurovascular injury, nonunion or delayed union, and post-traumatic arthritis in both groups. Conclusion This study preliminarily validated that ACT could restore the defective talar articular cartilage shorten the operation time and hospitalization days, reduce the amount of intraoperative blood loss, achieve excellent outcomes and help patients return to work and recreational activities more quickly.

Background Scarf osteotomy is a well-established procedure for hallux valgus, yet recurrence rates range from 3.6% to 10%. Pes planus, which often coexisting with hallux valgus, is a risk factor for recurrence. This study aimed to evaluate the effectiveness of simultaneous correction of hallux valgus and flexible pes planus. Methods A total of 85 feet with hallux valgus associated with adult flexible pes planus were retrospectively reviewed. All patients were treated with scarf osteotomy (SO). Subtalar arthroereisis using a HyProCure implant (SOH) was performed to correct hindfoot valgus based on shared decision-making. We collected and compared pre- and at least 2 year postoperative clinical outcomes (American Orthopaedic Foot & Ankle Society (AOFAS) forefoot, hindfoot score, Visual Analog Scale (VAS) pain intensity) and radiographic outcomes (hallux valgus angle (HVA), intermetatarsal angle (IMA), Meary’s angle, talonavicular coverage angle (TNCA), and calcaneal pitch (CP) angle in both groups. Results Of the cases reviewed, 51 feet were allocated to SO group, and 34 feet were in SOH group. Recurrence frequency was 5 feet (9.8%) in the SO group, while no recurrences were reported in the SOH group. There was no significant difference in AOFAS forefoot and VAS scores between the groups, However, the SOH group demonstrated significant improvement in AOFAS hindfoot scores and CP angle, as well as a greater reduction in Meary’s angle and TNCA, compared to the SO group. Changes in HVA and IMA did not differ significantly between the groups. Three feet in the SOH group experienced sinus tarsi pain, which resolved after removal of the HyProCure implant. Conclusions Subtalar arthroereisis with a HyProCure implant is an effective treatment option for adult flexible pes planus associated with scarf osteotomy for hallux valgus, leading to a steady improvement in the patients forefoot deformity and increased patient satisfaction at least 2 years postoperatively.

Background and objective Calcaneal Sanders type II or III fractures are highly disabling with significant burden. Surgical treatment modalities include open reduction and internal fixation (ORIF) techniques and a variety of minimally invasive surgical (MIS) approaches. ORIF techniques are associated with complications and traditional MIS techniques need extensive intraoperative fluoroscopic procedures. The present study aims to investigate the effects of three different minimally invasive internal fixation (MIIF) techniques used to treat Sanders type II intra-articular calcaneal fractures using finite element analyses. Methods A 64-row spiral computed tomography scan was used to observe the calcaneus of a healthy adult. The scanning data were imported into Mimics in a DICOM format. Using a new model of a Sanders type II-B intra-articular calcaneal fracture, three minimally invasive techniques were simulated. Technique A involved fixation using an isolated minimally invasive locking plate; Technique B used a minimally invasive locking plate with one medial support screw; and Technique C simulated a screw fixation technique using four 4.0-mm screws. After simulating a 640-N load on the subtalar facet, the maximum displacement and von Mises stress of fragments and implants were recorded to evaluate the biomechanical stability of different fixation techniques using finite element analyses. Results After stress loading, the maximum displacements of the fragments and implants were located at the sustentaculum tali and the tip of sustentaculum tali screw, respectively, in the three techniques; however, among the three techniques, Technique B had better results for displacement of both. The maximum von Mises stress on the fragments was < 56 Mpa, and stress on the implants using the three techniques was less than the yield strength , with Technique C having the least stress. Conclusion All three techniques were successful in providing a stable fixation for Sanders type II intra-articular calcaneal fractures, while the minimally invasive calcaneal locking plate with medial support screw fixation approach exhibited greater stability, leading to improved enhancement for the facet fragment; however, screw fixation dispersed the stress more effectively than the other two techniques.

Purpose To investigate the treatment outcomes of subtalar arthroereisis (SA) in progressive collapsing foot deformity (PCFD) patients, to assess the clinical efficacy in PCFD patients after HyProCure removal, and to evaluate safety and effectiveness of SA. Methods In this retrospective study, 202 cases (213 feet) of PCFD patients treated with SA from June 2015 to December 2022 were selected. General data and surgical information were recorded, and clinical efficacy was evaluated through imaging and clinical indicators. Furthermore, for 36 patients (36 feet) who underwent secondary surgery to remove HyProCure, imaging and clinical evaluation indicators at 1-year post-removal were recorded. Complications were also documented. Results The main complications were sinus tarsi pain (91.37%), with partial relief or disappearance of symptoms in some patients after conservative treatment. The imaging indicators improved significantly after SA ( P  < 0.01), and AOFAS score and VAS were significantly improved ( P  < 0.01), with a 100% excellent rate in patients one year after SA. For patients who removed HyProCure, the imaging indicators exhibited a significant improvement at preoperation and post-SA ( P  < 0.01), and no statistical difference was observed between post-SA and post-removal ( P  > 0.05). Regarding clinical indicators, AOFAS score at post-SA was difference compared with preoperation and post-removal separately ( P  < 0.01). However, the difference in VAS between preoperation and post-SA was not statistically significant ( P  > 0.05). Notably, there was a significant improvement at post-removal compared with post-SA ( P  < 0.01). Conclusion PCFD patients showed significant improvement in imaging and clinical evaluations after SA, with no significant flatfoot recurrence in patients who had HyProCure removed. Therefore, the application of HyProCure in SA can be considered a safe and effective surgical treatment for PCFD patients.

Posttraumatic osteoarthritis (PTOA) patients are often diagnosed by X-ray imaging at a middle-late stage when drug interventions are less effective. Early PTOA is characterized by overexpressed matrix metalloprotease 13 (MMP13). Herein, we constructed an integrated diagnosis and treatment micelle modified with MMP13 enzyme-detachable, cyanine 5 (Cy5)-containing PEG, black hole quencher-3 (BHQ3), and cRGD ligands and loaded with siRNA silencing MMP13 (siM13), namely ERMs@siM13. ERMs@siM13 could be cleaved by MMP13 in the diseased cartilage tissues to detach the PEG shell, causing cRGD exposure. Accordingly, the ligand exposure promoted micelle uptake by the diseased chondrocytes by binding to cell surface αvβ3 integrin, increasing intracellular siM13 delivery for on-demand MMP13 downregulation. Meanwhile, the Cy5 fluorescence was restored by detaching from the BHQ3-containing micelle, precisely reflecting the diseased cartilage state. In particular, the intensity of Cy5 fluorescence generated by ERMs@siM13 that hinged on the MMP13 levels could reflect the PTOA severity, enabling the physicians to adjust the therapeutic regimen. Finally, in the murine PTOA model, ERMs@siM13 could diagnose the early-stage PTOA, perform timely interventions, and monitor the OA progression level during treatment through a real-time detection of MMP13. Therefore, ERMs@siM13 represents an appealing approach for early-stage PTOA theranostics. [Display omitted] •ERMs@siM13 is activated by MMP13 overexpressed in diseased cartilage area, restoring Cy5 fluorescence and exposing cRGD.•ERMs@siM13 showed increased uptake by diseased chondrocytes and thus downregulated MMP13 levels, retarding OA progression.•ERMs@siM13 can detect PTOA progression via fluorescence imaging by responding to dynamically changed MMP13 levels.