Characteristics and reliability of a novel sub-classification of Wilkins type III lateral-flexion supracondylar fracture of the humerus in children / 中华创伤杂志

Objective:To investigate the characteristics and reliability of a novel sub-classification of Wilkins type III lateral-flexion supracondylar fracture of the humerus in children.Methods:A retrospective cohort study was used to analyze the clinical data of 92 children with supracondylar fracture of the humerus admitted to Provincial Children′s Hospital of Anhui Medical University from January 2013 to August 2021, including 38 males and 54 females, aged 2-13 years [(8.5±2.4)years]. Lateral-flexion Wilkins type III supracondylar humeral fractures were classified into two subtypes according to the fracture features: type IIIA ( n=14), complete fracture with the distal fragment displaced anteriorly and laterally, with no obvious anterior or posterior inclination (<10°) or rotation; type IIIB ( n=78), complete fracture with the distal fragment displaced anteriorly and laterally, with significant anterior or posterior inclination (>10°) or rotation. The incidence and risk ratio of ulnar nerve injury and open reduction were compared between the two subtypes of the fracture. The weighted Kappa method was used to test the inter- and intra-observer agreement of the two new subtypes. Results:Of all, 15 children had ulnar nerve injury, among which 1(6.7%) was type IIIA and 14(93.3%) were type IIIB; while other 77 children had no ulnar nerve injury. The risk of ulnar nerve injury in children with type IIIB was 3-fold higher than that in children with type IIIA ( OR=2.84, 95% CI 0.34- 25.56, P>0.05). The open reduction was performed in 11(73.3%) out of the 15 children with ulnar nerve injury, but in 18(23.4%) out of the 77 children with no ulnar nerve injury. The risk of open reduction in children with ulnar nerve injury was 9-fold higher than that in children without ulnar nerve injury ( OR=9.01, 95% CI 2.28- 33.17, P<0.01). Open reduction was performed in 29 children, among which 2(6.9%) were type IIIA and 27(93.1%) were type IIIB. The risk of open reduction in children with type IIIB was 3-fold higher than that in children with type IIIA ( OR=3.17, 95% CI 0.66-15.24, P>0.05). The intra-observer Kappa value was 0.49±0.09(95% CI 0.31-0.66), indicating a moderate agreement. The inter-observer Kappa value was 0.80±0.06(95% CI 0.68-0.91), indicating a strong or very strong agreement. Conclusions:Wilkins type IIIB lateral-flexion supracondylar fracture of the humerus in children is more likely to be accompanied by ulnar nerve injury and to be opt to open reduction in comparion with type IIIA. The new subtyping has reliable inter-observer and intra-observer consistency, and is able to facilitate the prediction of surgical plans.

Applying the femoral neck-lesser trochanter anteversion to evaluate the proximal femoral deformity of unilateral developmental dislocation of the hip in children / 中华骨科杂志

Objective:A new measurement index, femoral neck-lesser trochanter anteversion (FN-LTA), is proposed. To explore the feasibility and advantage of applying the FN-LTA to evaluate the proximal femoral deformity of unilateral developmental dislocation of the hip in children, so as to solve the current clinical problems.Methods:The imaging data of 90 patients with unilateral DDH admitted to our department from February 2016 to April 2017 were retrospectively analyzed, There were 13 males and 77 females. The age ranged from 0.6 to 11 years, with an average of 2.6±2.3 years. Femoral neck anteversion (FNA) and FN-LTA were measured at the affected and healthy sides. Analyze the correlation between FN-LTA and FNA, analyze the influence of gender, age, side, dislocation degree and other factors on FN-LTA, compare the difference between the affected side and the healthy side of FNA, FN-LTA, and analyze the influence of dislocation degree on this difference, compare the diagnostic efficacy and intra group consistency of FNA and FN-LTA. The possible advantages of FN-LTA in clinical application were preliminarily analyzed.Results:There was a positive correlation between FN-LTA and FNA in both healthy and affected sides (healthy side r=0.217, P=0.040, affected side r=0.298, P=0.004). FNA and FN-LTA in the affected side of DDH children were both larger than the healthy side, FNA affected side 38.86°±11.70°, healthy side 35.44°±11.16°; FN-LTA affected side 72.19°±9.17°, healthy side 61.17°±10.30°. The difference had statistical significance. FN-LTA was not affected by gender, side, degree of dislocation and other factors (gender P=0.060, side P=0.550, degree of dislocation of healthy side P=0.130, affected side P=0.705), but negatively correlated with age (healthy side r=-0.261, P=0.013, affected side r=-0.287, P=0.006). The diagnostic efficiency of FN-LTA is better, AUC FNA=0.561, AUC FN-LTA=0.736 ( P<0.05). FN-LTA and FNA had excellent intra group and inter group consistency. Inter group ICCFNA=0.956, ICCFN-LTA=0.973; intra group ICCFNA1=0.937, ICCFNA2=0.893, ICCFN-LTA1=0.887, ICCFN-LTA2=0.874. With the increase of dislocation degree, the difference between FNA and FN-LTA decreased. This decreasing trend was statistically significant in FNA ( P=0.030) but not in FN-LTA ( P=0.180). Conclusion:FN-LTA is a reliable method with a higher degree of differentiation for the assessment of anteverted deformity in DDH children' proximal end of femur, the measured data are more capable of guiding the rotation of osteotomy.

Effects of operation timing on postoperative complications and operative duration in children undergoing non-emergency operation for femoral neck fracture / 中华创伤骨科杂志

Objective:To explore the effects of operation timing on postoperative complications and operative duration in children undergoing non-emergency operation for femoral neck fracture.Methods:Fifty-nine children and adolescents with femoral neck fracture were retrospectively analyzed who had been admitted to Department of Pediatric Orthopedics, Zhengzhou Orthopedic Hospital Affiliated to Henan University from February, 2015 to September, 2019. They were 39 boys and 20 girls with a mean age of 11.7 (7.1, 13.7) years. By Delbet fracture classification, 7 cases were type Ⅰ, 27 cases type Ⅱ, 20 cases type Ⅲ, and 5 cases type Ⅳ. The patients were divided into 4 groups by the time from injury to operation (TFITO): 17 cases were assigned into group A with TFITO from 24 to 48 hours, 14 cases into group B with TFITO from 49 to 72 hours, 12 cases into group C with TFITO from 73 to 96 hours, and 16 cases into group D with TFITO>96 hours. The effects of TFITO on postoperative complications and operative duration were analyzed.Results:There were no significant differences between the 4 groups in their preoperative general data, showing they were comparable ( P>0.05). This cohort was followed up for 12 to 62 months (average, 20 months). The operation time was not included for this study in 6 cases whose associated injury had to be treated simultaneously. The median operation time for the other 53 patients was 80 (70, 105) min. The correlation coefficient between TFITO and operation time was 0.098 ( P=0.484). Postoperative complications occurred in 37.3% of the patients (22/59), including 14 cases of avascular necrosis of femoral head. For groups A, B, C and D, the incidences of complications were 47.1% (8/17), 50.0% (7/14), 25.0% (3/12) and 25.0% (4/16) while the incidences of avascular necrosis of femoral head 23.5% (4/17), 31.3% (5/16), 16.7% (2/12) and 18.8% (3/16), showing insignificant differences between the 4 groups in all the comparisons ( P>0.05). Conclusion:The time from injury to operation may not increase operative duration or postoperative complications such as avascular necrosis of femoral head in children undergoing non-emergency operation for femoral neck fracture.

Factors associated with refracture after surgery for femoral shaft fracture in children / 中华创伤骨科杂志

Objective To analyze the factors influencing the incidence of refracture after surgery for femoral shaft fracture in children and put forward their countermeasures.Methods A retrospective study was conducted in the children who had been treated at Department I of Pediatric Orthopaedics,Zhengzhou Orthopaedic Hospital from September 2013 to May 2017 for primary femoral shaft fracture or refracture after surgery for femoral shaft fracture.Their clinic data were collected concerning age,gender,height,weight,primary fracture,treatment protocol,time for removal of fixation,time and site of refracture,and violence for refracture.The likely factors associated with refracture were identified by comparing the gender ratios,age distributions and primary fractures between the children with primary fracture and those with refracture,and by comparing the proportions of overweight and obese ones between the children with refracture and their normal counterparts.Results A total of 278 children,with a male to female ratio of 2.43∶ 1,were treated for primary femoral shaft fracture while 22 children,with a male to female ratio of 0.83∶ 1,for refracture contemporarily.In the children with primary fracture and those with refracture,respectively,there were 172 (61.9％) cases and 2 cases (9％) aged from 0 to 4 years,85 cases (30.6％) and 10 cases (45.5％) aged from 5 to 9 years,21 cases (7.5％)and 10 cases (45.5％) aged from 10 to 14 years.There were significant differences between the 2 groups in gender ratio and proportions of age (P ＜ 0.05).Compared to the normal children of the same age,the proportions of overweight and obese ones were significantly higher in those with refracture (P ＜ 0.05).There were no significant differences between the children with refracture and those with primary fracture in the site or type of primary fractures (P ＞ 0.05).Conclusions Refracture after surgery for femoral shaft fracture in children may be closely associated with their gender,age and overweight.Care should be taken to avoid refracture in children with high risks.

Matrix Metalloproteinases and Hemorrhagic Transformation / 国际脑血管病杂志

Thrombolysis can effectively treat ischemic stroke, but it has the risk of resulting in hemorrhagic transformation. A number of studies have suggested that hemorrhagic transforma-tion is closely correlated with matrix metalloproteinase mediated disruption of blood-brain barrier and the increase of vasopermeability. The increase plasma matrix metalloproteinase(MMP) -9 can be used as an independent predictor of hemorrhagic transformation. Using MMP inhibitors during the early cerebral ischemia may reduce the incidence and severity of hemor-rhagic transformation, however, it needs to be further validated.

TNEAK-Fn14 Pathway and Central Nervous System / 国际脑血管病杂志

Tumor necrosis factor-like weak inducer of apoptosis(TWEAK)is a new member of the tumor necrosis factor family.After TWEAK binding to its receptor Fn14.it induces extensive biological activities.TWEAK-Fn14 pathway participates in pathophysiological mechanisms of cell apoptosis,regulation of the blood-brain barrier permeability and inflammation in central nervous system,and it is closely correlated with the diseases such as ischernic stroke.multiple sclerosis and gliocytoma.

The Roles of Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand and Its Receptors in Central Nervous System Diseases / 国际脑血管病杂志

Tumor necrosis factor-related apoptosis-inducing ligand(TRAIL)is the third member of the tumor necrosis factor(TNF)superfamily.It has received much concern because of its selective killing effect on tumor cells and virus infected cells.However,the subsequent studies have suggested that TRAIL also induces normal cells,such as the death of neurons and oligodendrocytes.TRAIL is associated with a variety of central nervous system diseases including primary brain tumor,multipie sclerosis and ischemic stroke.