Complete talar extrusion is rare and usually associated with a high-energy mechanism of injury causing complete dissociation of the talus from the surrounding bony and soft-tissue structures with enough force to expel the talus out of the body. Treatment can be complicated by infection, osteonecrosis, posttraumatic osteoarthritis, and leg length discrepancy, which may require multiple subsequent surgeries for improved outcome and quality of life. Reimplantation of the native talus affords maintenance of joint height and favorable outcomes have been reported. Failed reimplantations have been successfully managed with arthrodesis with or without a bone allograft. We report a case of talar extrusion initially treated with a talus-shaped impregnated antibiotic spacer, followed by femoral head allograft and tibiocalcaneal fusion. This treatment resulted in radiographic evidence of bony fusion at 12 weeks without subsequent infection and good clinical outcome at 2-year follow-up.

Angiogenic effects of epidermal growth factor (EGF), a potent mitogen, have been demonstrated previously. Moreover, different in vitro studies showed that EGF affects processes associated with bone healing, such as osteoblast differentiation and bone resorption. The aim of this study was to investigate the effect of combined core decompression (CD) and recombinant human EGF (rhEGF) treatment on early-stage osteonecrosis of the femoral head (ONFH) surgically induced in rats. ONFH was induced by dissecting the cervical periosteum and placing a ligature tightly around the femoral neck. Thirty rats were assigned to one of the following groups (n = 10 each group): sham-operated control, CD, and CD+rhEGF group. rhEGF was injected intraosseously into infarcted areas 2 weeks after the surgery. Preservation of femoral head architecture was assessed at 8 weeks post treatment by radiographic and histomorphological analyses. Osteopontin (OPN) and cluster of differentiation 31 (CD31) were detected by immunochemistry, as indicators of bone remodeling and vascular density, respectively. Inter- and intra-group (non-operated left and operated right femur) differences in radiographic and histomorphological results were analyzed. The femoral head area and sphericity were more preserved in CD+rhEGF compared to CD and sham-control group. CD31 levels were significantly different between the three groups, and were higher in CD+rhEGF compared to CD group. OPN levels were increased in CD and CD+rhEGF groups compared to sham control, but with no significant difference between CD and CD+rhEGF groups. Overall, our results indicate that EGF promotes bone formation and microvascularization in ONFH and thus positively affects the preservation of femoral head during healing.

The effect of implanting a β-TCP bioceramic rod system (BRS) can be observed with using the 3-dimensional (3D) finite-element method on the biomechanics of early-stage osteonecrosis of the femoral head (ONFH), to provide a theoretical basis for the biomechanics of applying the β-TCP BRS in the treatment of ONFH.A healthy 172 cm tall male adult volunteer (age: 40 years, weight: 70 kg, and femoral diameter: 50 mm) was selected for this study. The volunteer had no history of diseases in the hip, lower back, and lower limbs. He also had no history of trauma and surgery and had no lesions in the femoral head.A finite-element model of the normal proximal femur was constructed, and on this basis, 4 ONFH finite-element models were constructed, which had 15% and 30% necrotic areas in the superolateral area and 2 and 4 mm collapse in the weight-bearing area of the femoral head, respectively.This process was followed by simulated implantation of the β-TCP BRS in the finite-element models of the femoral head. Changes in the stress and displacement of the femoral head were observed before and after treatment with the β-TCP BRS, and the risk of femoral-head collapse was assessed.Under an applied walking load, the stress concentration on the femoral head was alleviated after treatment. Moreover, the stress and collapse values of the weight-bearing area decreased compared with those before treatment, and the differences were statistically significant (P < .05); the risk of collapse was also lower than that before treatment. As the area of the necrosis increased, the collapse value also increased, and the risk of collapse increased. More severe preoperative collapse implied that a greater risk of postoperative recollapse exists.This case report was written for 4 purposes: Implantation of the β-TCP BRS could effectively improve the internal mechanical properties of ONFH, enhance the support capacity of bones in the weight-bearing area in ONFH, reduce the compressive stress on the necrotic bone, and lower the risk of collapse in ONFH.

Epidermal growth factor-like domain-containing protein 7 (EGFL7), a member of the epidermal growth factor (EGF)-like protein family, is a potent angiogenic factor expressed in many different cell types. EGFL7 plays a vital role in controlling vascular angiogenesis during embryogenesis, organogenesis, and maintaining skeletal homeostasis. It regulates cellular functions by mediating the main signaling pathways (Notch, integrin) and EGF receptor cascades. Accumulating evidence suggests that Egfl7 plays a crucial role in cancer biology by modulating tumor angiogenesis, metastasis, and invasion. Dysregulation of Egfl7 has been frequently found in several types of cancers, such as malignant glioma, colorectal carcinoma, oral and oesophageal cancers, gastric cancer, hepatocellular carcinoma, pancreatic cancer, breast cancer, lung cancer, osteosarcoma, and acute myeloid leukemia. In addition, altered expression of miR-126, a microRNA associated with Egfl7, was found to play an important role in oncogenesis. More recently, our study has shown that EGFL7 is expressed in both the osteoclast and osteoblast lineages and promotes endothelial cell activities via extracellular signal-regulated kinase (ERK), signal transducer and activator of transcription 3 (STAT3), and integrin signaling cascades, indicative of its angiogenic regulation in the bone microenvironment. Thus, understanding the role of EGFL7 may provide novel insights into the development of improved diagnostics and therapeutic treatment for cancers and skeletal pathological disorders, such as ischemic osteonecrosis and bone fracture healing.

The authors examined a 55-year-old female who had received eight intravenous infusions of a potent bisphosphonate (BP) for metastatic bone disease. A mandibular extraction was subsequently performed. At presentation, infection with suppuration and sequestrum formation were observed in the area of extraction. Both the oncologist and dental practitioner must be made aware that when BPs are going to be administered, dental care should be performed in a timely fashion. Prophylactic measures must be taken by the dentist if dental surgery is required for a patient who has received BP.