Application of PHILOS plate through mini-open deltoid-splitting approach for the treatment of proximal humeral fractures / 中国骨伤

<p><b>OBJECTIVE</b>To study clinical effects of PHILOS (proximal humeral internal locking system) plates through mini-open deltoid-splitting approach for the treatment of proximal humeral fractures.</p><p><b>METHODS</b>From March 2006 to August 2010, 22 patients with proximal humeral fractures were treated with PHILOS plates through mini-open deltoid-splitting approach. According to Neer classification, 6 cases were type II, 15 cases were type III and 1 case was type IV. Through the anterolateral approach to the shoulder, anterolateral vertical incision of 4 cm length was perforrmed from 1 cm under acromion, and separated deltoideus muscle vertically to touch the fracture,reduced the end of fracture directly and indirectly. PHILOS plate was inserted downward into anterolateral surface of humerus through deltoideus muscle, the distal end and proximal end was fixed by locking screws. The Neer score for shoulder function was evaluated within 1 year after operation.</p><p><b>RESULTS</b>The operative time ranged from 30 to 70 minutes with an average of 45 minutes. No blood transfusion was required during the operation, and all incisions healed in stage I. All the patients were followed up, and the duration ranged from 6 to 18 months with a mean time of 12.5 months. All the fractures healed up perfectly, and the union time ranged from 6 to 12 weeks. According to Neer criteria for shoulder joint function, 10 patients got an excellent result, 9 good, 2 poor and 1 bad. There were no complications such as axillary nerve injuries, screw loosening, steel plate breakage, dislocation of shoulder joint and necrosis of humeral bone.</p><p><b>CONCLUSION</b>PHILOS plate through mini-open deltoid-splittin approach for the treatment of proximal humeral fractures has follow advantages: simple recover,minor-injuries and small tissue invasion, which is an ideal method to treat proximal humeral fractures.</p>

Functional reconstruction of ischemic contracture in the lower limb / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To discuss the method of functional reconstruction of ischemic contracture in the lower limb and propose a classification protocol for ischemic contracture in the lower limb based on its severity and prognosis.</p><p><b>METHODS</b>A total of 42 patients with ischemic contracture in the lower limb were included in this study. According to different types of disturbance and degrees of severity, surgical reconstructions consisting of nerve decompression, tendon lengthening or transfer, intrinsic foot muscle release and sural-tibial nerve anastomosis were performed in every patient.</p><p><b>RESULTS</b>Postoperatively, all patients were able to walk on flat ground. Drop foot was corrected in 10 patients, and 5 patients still felt some difficulty during stair activity. Split Achilles tendon transfer to flexor hallucis longus tendon was performed in 12 patients, and their walking stability was improved. Seven patients accepted ipsilateral sural-tibial nerve anastomosis, and sensitivity recovery reached to S2 in 2 patients and S3 in 5 patients.</p><p><b>CONCLUSIONS</b>Ischemic contracture in the lower limb is a devastating complication after lower limb trauma. The prevention of contracture is much more important than the treatment of an established contracture. Split Achilles tendon transfer to flexor hallucis longus tendon and sural-tibial nerve anastomosis, which was initially implemented by us, could improve the functional recovery of ischemic contracture in lower limbs, and thus provides a new alternative for functional reconstruction of ischemic contracture in the lower limb.</p>

Gene profiling of MAPK pathway in human osteosarcoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the functional effects of MAPK pathway in the pathogenesis of human osteosarcoma.</p><p><b>METHODS</b>Gene microarray (Human Genome U133A, Affymetrix) was used to screen the differential expression of genes involved in MAPK pathway between osteosarcoma cell lines and 3 osteoblastic cell lines. KEGG metabolic pathway analysis was performed among significantly increased or decreased genes using the MATLAB software. Immunohistochemical technique was used to detect the expressions of ERK1/2, JNK and p38 proteins among 48 osteosarcoma and benign 24 osteoblastic tumor samples.</p><p><b>RESULTS</b>Using an entrance limit of > or = 2.0, 18 differentially expressed MAPK pathway-related genes were selected (10 up-regulated, 8 down-regulated) to mapped to the MAPK pathway of KEGG which are all important node genes. The positive rates of ERK1/2, JNK and p38 proteins were 83.3% (40/48), 72.9% (35/48) and 85.4% (41/48) in osteosarcomas,and 12.5% (3/24), 8.3% (2/24) and 16.7% (4/24) in the control group, respectively. The positive rates and expression intensities were statistically different between the 2 groups (P<0.01).</p><p><b>CONCLUSION</b>MAPK pathway plays an important role in the pathogenesis of osteosarcoma. ERK, JNK and p38 form an intercoordinating network and regulate the cell proliferation, differentiation, apoptosis, invasion and migration in osteosarcoma.</p>

Treatment of type C3 distal radius fracture resulted from high-energy injuries by volar plate in combination with external fixator / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>With a type C3 distal radius fracture it is extremely difficult to maintain the reduction and to restore congruity of the articular surface because the support for the volar and dorsal bone cortex has been lost. An external fixator crossing wrist in combination with Kirschner wire (K-wire) fixation was popularly used by most studies in recent years. But loss of reduction often occurred especially in the volar sides.</p><p><b>METHODS</b>A total of 30 cases of type C3 distal radius fracture were treated by a volar buttress plate combined with a transarticular external fixator and other techniques such as K-wire fixation and bone grafting if necessary. The postoperative volar tilt angles, ulnar inclinations, radial heights, range of motion, grip strength and complications were recorded to assess the therapeutic effects.</p><p><b>RESULTS</b>Of the 30 patients, 27 patients were followed up for 12 - 29 (mean 18) months and all fractures healed in 8 - 13 weeks after surgery (mean 10 weeks). The wrist function was excellent in 8 cases, good in 16 cases and fair in 3 cases according to the Sarmiento scoring system (modified by Stewart).</p><p><b>CONCLUSIONS</b>For type C3 comminuted fracture with severe volar and dorsal instability, fixation by volar buttress plate combined with transarticular external fixator should be adopted. Dorsal instability could be further stabilized by other techniques such as Kirschner wire fixation, and bone grafting.</p>

Combination of volar buttress plate with external fixator for the distal radial fractures of type C3 caused by high-energy injuries / 中国骨伤

<p><b>OBJECTIVE</b>To preliminarily explore the effect of combination of volar buttress plate with external fixator for the distal radial fractures of type C3 caused by high-energy injuries.</p><p><b>METHODS</b>From January 2001 to June 2007, 13 patients with distal radial fracture of type C3, 9 males and 4 females aged from 26 to 47 (average 37 years), were treated with volar buttress plate combined with external fixator plus the techniques of K-wires and bone grafting as necessary, whose effects were evaluated preliminarily through comparing the volar tilt, radial inclination, radial shortening and wrist function.</p><p><b>RESULTS</b>Followed up from 7 to 29 months (average 18 months), the volar tilt, radial inclination, radial shortening and wrist function of all patients recovered remarkably. Nine patients achieved excellent and 4 good according to Sarmiento score (modified by Stewart) in the radiological manifestation, while 5 patients displayed excellent, 6 good, and 2 fair according to Gartland-Werley functional assessment system.</p><p><b>CONCLUSION</b>1) Volar buttress plate could support the valor cortex in order to prevent comminuted fragment from displacing and maintain volar tilt and to provide the volar fulcrum for external fixator. 2) External fixator, with the assistance of volar fulcrum, could maintain the volar tilt and the height of distal radius and help unload the fossa. 3) Supplemental K-wires fixation and the bone graft may assist fracture stable.</p>