{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:10:10Z","timestamp":1760130610543,"version":"build-2065373602"},"reference-count":33,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2023,9,18]],"date-time":"2023-09-18T00:00:00Z","timestamp":1694995200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Male patients often experience increased bone and muscle loss after traumatic fractures. This study aims to compare the treatment outcomes of male and female patients with large bone defects. A total of 345 trauma patients underwent surgery, with participants divided into two groups: one receiving bone substitute material (BSM) for augmented defects (n = 192) and the other without augmentation (empty defects = ED, n = 153). Outcome parameters were assessed among female (n = 184) and male (n = 161) patients. Descriptive statistics revealed no significant differences between male and female patients. Approximately one-half of the fractures resulted from high-energy trauma (n = 187). The BSM group experienced fewer complications (p = 0.004), including pseudarthrosis (BSM: n = 1, ED: n = 7; p = 0.02). Among female patients over 65, the incidence of pseudarthrosis was lower in the BSM group (p = 0.01), while younger females showed no significant differences (p = 0.4). Radiologically, we observed premature bone healing with subsequent harmonization. Post hoc power analysis demonstrated a power of 0.99. Augmenting bone defects, especially with bone substitute material, may reduce complications, including pseudarthrosis, in female patients. Additionally, this material accelerates bone healing. Further prospective studies are necessary for confirmation.<\/jats:p>","DOI":"10.3390\/ijms241814232","type":"journal-article","created":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T02:26:17Z","timestamp":1695090377000},"page":"14232","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Retrospective Analysis of Bone Substitute Material for Traumatic Long Bone Fractures: Sex-Specific Outcomes"],"prefix":"10.3390","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1971-1561","authenticated-orcid":false,"given":"Jonas","family":"Pawelke","sequence":"first","affiliation":[{"name":"Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University, 35392 Giessen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vithusha","family":"Vinayahalingam","sequence":"additional","affiliation":[{"name":"Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University, 35392 Giessen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Heiss","sequence":"additional","affiliation":[{"name":"Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University, 35392 Giessen, Germany"},{"name":"Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, Justus Liebig University, Rudolf-Buchheim-Stra\u00dfe 8, 35392 Giessen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1187-8578","authenticated-orcid":false,"given":"Thaqif El","family":"Khassawna","sequence":"additional","affiliation":[{"name":"Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University, 35392 Giessen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9864-547X","authenticated-orcid":false,"given":"Gero","family":"Knapp","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, Justus Liebig University, Rudolf-Buchheim-Stra\u00dfe 8, 35392 Giessen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1002\/jor.25116","article-title":"Sex differences in systemic bone and muscle loss following femur fracture in mice","volume":"40","author":"Osipov","year":"2022","journal-title":"J. Orthop. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"4605","DOI":"10.1007\/s00784-023-05087-y","article-title":"Influence of age and gender on alveolar bone healing post tooth extraction in 129 Sv mice: A microtomographic, histological, and biochemical characterization","volume":"27","author":"Biguetti","year":"2023","journal-title":"Clin. Oral Investig."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3102","DOI":"10.1007\/s11999-011-1914-y","article-title":"Influence of Gender and Fixation Stability on Bone Defect Healing in Middle-aged Rats: A Pilot Study","volume":"469","author":"Mehta","year":"2011","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"712494","DOI":"10.3389\/fphys.2021.712494","article-title":"Differences in Fracture Healing Between Female and Male C57BL\/6J Mice","volume":"12","author":"Fischer","year":"2021","journal-title":"Front. Physiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1152\/physrev.00033.2015","article-title":"Estrogens and Androgens in Skeletal Physiology and Pathophysiology","volume":"97","author":"Almeida","year":"2017","journal-title":"Physiol. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1016\/j.bone.2009.08.005","article-title":"Sex-specific compromised bone healing in female rats might be associated with a decrease in mesenchymal stem cell quantity","volume":"45","author":"Strube","year":"2009","journal-title":"Bone"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Vescini, F., Chiodini, I., Falchetti, A., Palermo, A., Salcuni, A.S., Bonadonna, S., De Geronimo, V., Cesareo, R., Giovanelli, L., and Brigo, M. (2021). Management of Osteoporosis in Men: A Narrative Review. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms222413640"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"119091","DOI":"10.1016\/j.lfs.2021.119091","article-title":"Estrogens as regulator of hematopoietic stem cell, immune cells and bone biology","volume":"269","author":"Kumar","year":"2021","journal-title":"Life Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1001\/archsurg.134.9.935","article-title":"Male Gender Is a Risk Factor for Major Infections After Surgery","volume":"134","author":"Offner","year":"1999","journal-title":"Arch. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1093\/infdis\/132.3.316","article-title":"Bacteremia at Boston City Hospital: Occurrence and Mortality during 12 Selected Years (1935-1972), with Special Reference to Hospital-Acquired Cases","volume":"132","author":"McGowan","year":"1975","journal-title":"J. Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1186\/s13756-019-0547-x","article-title":"Gender-related risk factors for surgical site infections. Results from 10 years of surveillance in Germany","volume":"8","author":"Aghdassi","year":"2019","journal-title":"Antimicrob. Resist. Infect. Control."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1097\/01.shk.0000239767.64786.de","article-title":"Influence of sex and age on mods and cytokines after multiple injuries","volume":"27","author":"Frink","year":"2007","journal-title":"Shock"},{"key":"ref_13","first-page":"572","article-title":"Male Gender is Associated with Excessive IL-6 Expression Following Severe Injury","volume":"64","author":"Sperry","year":"2008","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Chou, F.-P., Chang, H.-C., Yeh, C.-C., Wu, C.-H., Cherng, Y.-G., Chen, T.-L., and Liao, C.-C. (2020). Sex differences in fracture outcomes within Taiwan population: A nationwide matched study. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0234229"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1097\/00003086-200003000-00015","article-title":"Stress Fractures and the Female Athlete","volume":"372","author":"Arendt","year":"2000","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1016\/j.injury.2011.12.007","article-title":"The epidemiology of open fractures in adults. A 15-year review","volume":"43","author":"Bugler","year":"2012","journal-title":"Injury"},{"key":"ref_17","first-page":"665","article-title":"The Incidence of Fractures Among the Adult Population of Germany-an Analysis From 2009 through 2019","volume":"118","author":"Rupp","year":"2021","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/S0736-0266(00)00010-3","article-title":"Age- and gender-related changes in the cellularity of human bone marrow and the prevalence of osteoblastic progenitors","volume":"19","author":"Muschler","year":"2001","journal-title":"J. Orthop. Res."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Pawelke, J., Vinayahalingam, V., El Khassawna, T., Heiss, C., Eckl, L., and Knapp, G. (2023). Complication and Infection Risk Using Bone Substitute Materials to Treat Long Bone Defects in Geriatric Patients: An Observational Study. Medicina, 59.","DOI":"10.20944\/preprints202301.0311.v1"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1902\/jop.1998.69.4.470","article-title":"Ability of Commercial Demineralized Freeze-Dried Bone Allograft to Induce New Bone Formation Is Dependent on Donor Age but Not Gender","volume":"69","author":"Schwartz","year":"1998","journal-title":"J. Periodontol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Ortona, E., Pagano, M.T., Capossela, L., and Malorni, W. (2023). The Role of Sex Differences in Bone Health and Healing. Biology, 12.","DOI":"10.3390\/biology12070993"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"75","DOI":"10.2214\/ajr.175.1.1750075","article-title":"Development and Duration of Radiographic Signs of Bone Healing in Children","volume":"175","author":"Islam","year":"2000","journal-title":"Am. J. Roentgenol."},{"key":"ref_23","unstructured":"Klaus Bohnhof, H.I. (2006). Radiologische Diagnostik der Knochen und Gelenke, Georg Thieme Verlag KG."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Freyschmidt, J. (2016). Skeletterkankungen, Springer Verlag.","DOI":"10.1007\/978-3-662-48137-0"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav. Res. Methods"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1016\/j.injury.2023.02.004","article-title":"The more you have, the more you lose: Muscle mass changes in trauma patients with prolonged hospitalizations","volume":"54","author":"Bradford","year":"2023","journal-title":"Injury"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/j.jamcollsurg.2019.01.009","article-title":"Trauma Resuscitation Consideration: Sex Matters","volume":"228","author":"Coleman","year":"2019","journal-title":"J. Am. Coll. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/S0196-0644(99)70308-2","article-title":"Number Needed to Treat (NNT)","volume":"33","author":"Cordell","year":"1999","journal-title":"Ann. Emerg. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s00586-003-0627-7","article-title":"Prediction of fusion and importance of radiological variables for the outcome of anterior cervical decompression and fusion","volume":"13","author":"Peolsson","year":"2004","journal-title":"Eur. Spine J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1007\/s10143-018-0951-3","article-title":"Pseudarthrosis in adult and pediatric spinal deformity surgery: A systematic review of the literature and meta-analysis of incidence, characteristics, and risk factors","volume":"42","author":"How","year":"2019","journal-title":"Neurosurg. Rev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"114","DOI":"10.4161\/org.23306","article-title":"Bone grafts, bone substitutes and orthobiologics: The bridge between basic science and clinical advancements in fracture healing","volume":"8","author":"Roberts","year":"2012","journal-title":"Organogenesis"},{"key":"ref_32","first-page":"413105","article-title":"Gender Differences in Pain Perception and Functional Ability in Subjects with Knee Osteoarthritis","volume":"2012","author":"Rozen","year":"2012","journal-title":"ISRN Orthop."},{"key":"ref_33","unstructured":"Doyle, D.J., Hendrix, J.M., and Garmon, E.H. (2022). American Society of Anesthesiologists Classification, StatPearls."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/24\/18\/14232\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:52:59Z","timestamp":1760129579000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/24\/18\/14232"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,18]]},"references-count":33,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["ijms241814232"],"URL":"https:\/\/doi.org\/10.3390\/ijms241814232","relation":{},"ISSN":["1422-0067"],"issn-type":[{"type":"electronic","value":"1422-0067"}],"subject":[],"published":{"date-parts":[[2023,9,18]]}}}