Comparison of Functional and Cosmetic Outcomes According to Fracture Level in Gartland Type III Pediatric Supracondylar Humerus Fractures

Background@#Supracondylar humerus (SCH) fractures in children have been traditionally categorized according to the Wilkins-modified Gartland classification scheme, which is solely based on the degree of displacement. As this classification does not consider fracture patterns in the coronal or sagittal plane, the relationship between the fracture pattern and prognosis in SCH fractures remains unclear.Therefore, the purpose of this study was to evaluate the relationship between the fracture level and prognosis of pediatric SCH fractures. @*Methods@#Medical records and radiographs of 786 patients with SCH fractures who underwent surgical treatment between March 2004 and December 2017 were reviewed. A total of 192 patients were included in this study. Anteroposterior elbow radiographs taken at the time of injury were evaluated to obtain the level of fracture. Functional outcomes were evaluated based on modified Flynn grading at the last follow-up. @*Results@#Of 192 patients included in this study, 24 (12.1%), 148 (74.8%), and 20 (10.1%) had fractures in zone 1 (metaphyseal-diaphyseal area), zone 2 (between zones 1 and 3), and zone 3 (metaphyseal-epiphyseal area), respectively. There were significant differences in age at the time of injury (p = 0.011), direction of fracture displacement (p = 0.014), and loss of carrying angle (p < 0.001) between fractures in zone 3 and those in zone 1 or zone 2. Zone 3 fractures and classic zone 2 fractures also showed significant difference in outcomes, with zone 3 fractures having more unsatisfactory outcome than classic zone 2 fractures (p = 0.049). @*Conclusions@#For SCH fractures, varus deformity of the elbow was more common in zone 3 (metaphyseal-epiphyseal area) than in the other zones. Thus, pediatric orthopedic surgeons should be mindful of the possibility of cubitus varus deformity when treating SCH fractures in zone 3. A thorough postoperative follow-up is required.

SPA0355 prevents ovariectomy-induced bone loss in mice

Estrogen withdrawal in post-menopausal women leads to overactivation of osteoclasts, which contributes to the development of osteoporosis. Inflammatory cytokines are known as one of mechanisms of osteoclast activation after estrogen deficiency. SPA0355 is a thiourea derivative that has been investigated for its antioxidant and anti-inflammatory activities. However, its efficacy in bone resorption has not been previously investigated. The aim of this study was to investigate the impact of SPA0355 on the development of osteoporosis and to explore its mode of action. In vitro experiments showed that SPA0355 inhibited receptor activator of NF-κB ligand (RANKL)-induced osteoclastogenesis in primary bone marrow-derived macrophages. This effect appears to be independent of estrogen receptor activation as ICI 180,782 failed to abrogate its effects on osteoclasts. Further signaling studies revealed that SPA0355 suppressed activation of the MAPKs, Akt, and NF-κB pathways. SPA0355 also increased osteoblastic differentiation, as evidenced by its effects on alkaline phosphatase activity and mineralization nodule formation. Intraperitoneal administration of SPA0355 to ovariectomized mice prevented bone loss, as verified by three-dimensional images and bone morphometric parameters derived from µCT analysis. Noticeably, SPA0355 did not show hepatotoxicity and nephrotoxicity and also had little effect on hematological parameters. Taken together, the results indicate that SPA0355 may protect against bone loss in ovariectomized mice by stimulation of osteoblast differentiation and by inhibition of osteoclast resorption. Therefore, SPA0355 is a safe and potential candidate for management of postmenopausal osteoporosis.

Smad4 controls bone homeostasis through regulation of osteoblast/osteocyte viability

Regulation of osteoblast and osteocyte viability is essential for bone homeostasis. Smad4, a major transducer of bone morphogenetic protein and transforming growth factor-β signaling pathways, regulates apoptosis in various cell types through a mitochondrial pathway. However, it remains poorly understood whether Smad4 is necessary for the regulation of osteoblast and osteocyte viability. In this study, we analyzed Smad4Δ(Os) mice, in which Smad4 was subjected to tissue-specific disruption under the control of the 2.3-kb Col1a1 promoter, to understand the functional significance of Smad4 in regulating osteoblast/osteocyte viability during bone formation and remodeling. Smad4Δ(Os) mice showed a significant increase in osteoblast number and osteocyte density in the trabecular and cortical regions of the femur, whereas osteoclast activity was significantly decreased. The proliferation of osteoblasts/osteocytes did not alter, as shown by measuring 5′-bromo-2′deoxyuridine incorporation. By contrast, the percentage of TUNEL-positive cells decreased, together with a decrease in the Bax/Bcl-2 ratio and in the proteolytic cleavage of caspase 3, in Smad4Δ(Os) mice. Apoptosis in isolated calvaria cells from Smad4Δ(Os) mice decreased after differentiation, which was consistent with the results of the TUNEL assay and western blotting in Smad4Δ(Os) mice. Conversely, osteoblast cells overexpressing Smad4 showed increased apoptosis. In an apoptosis induction model of Smad4Δ(Os) mice, osteoblasts/osteocytes were more resistant to apoptosis than were control cells, and, consequently, bone remodeling was attenuated. These findings indicate that Smad4 has a significant role in regulating osteoblast/osteocyte viability and therefore controls bone homeostasis.

Clinical Analysis of Lower Cervical Spine Injury according to Injury Mechanism: Data of 277 Surgical Patients / 대한정형외과학회잡지

PURPOSE: To analyze the incidence and treatment outcomes of lower cervical spine injury since there is no long term, large Korean data available. MATERIALS AND METHODS: We analyzed 277 patients with lower cervical spine injury who underwent surgical treatments between May 1994 and October 2008. The injury types are based on Allen's classification, and neurologic injury was classified as complete, incomplete cord injury, root injury and no neurologic status. We analyzed postoperative complications, neurologic recovery and the relief of pain. RESULTS: Distractive-extension injury occurred most commonly in 140 patients (50.5%). Neurologic injury was detected in 232 cases (83.8%); 46 (16.6%) complete cord injury; 154 (55.6%) incomplete cord injury; and 32 (11.6%) root injury. Incomplete cord injury of distractive extension injury was poorly recovered. Clinical outcomes demonstrated improvement compared with the preoperative values in mean visual analogue scale. Complications were respiratory failure, neurogenic bladder, urinary tract infection and gastritis. CONCLUSION: This study showed the highest incidence of distractive extension injury and neurologic injury contrary to previous studies. This result was caused by the use of plain radiograph to establish Allen's classification in the past. Therefore, we suggest the use of magnetic resonance imaging for evaluating soft tissue injury with Allen's classification to achieve accurate assessment.

Thumb Tip Reconstruction with Subcutaneous Pocket Graft: 2 Cases Report

PURPOSE: The subcutaneous pocket graft of the thumb tip amputation across or proximal to the lunula is chosen in case of impossible microvascular anastomosis and in patient who strongly desired to preserve the thumb tip after failed replantation. MATERIALS AND METHODS: Two patients who underwent a subcutaneous pocket graft for a thumb tip reconstruction between August 2008 and November 2009 were reviewed retrospectively. They were all males with a mean age at the time of surgery of 48 years and had sustained complete thumb tip amputations across or proximal to the lunula. In one case, the microsurgical replantation was not feasible and the other one revealed arterial insufficiency at the 7th day after microsurgical replantation. RESULTS: Authors had experienced 2 cases of flaps which survived completely. The results of sensibility was good, the range of motion at interphalangeal joint and tip to tip pinch was acceptable and color mismatch and loss of thumb finger nail was unacceptable after more than 1 year follow up with conventional successful thumb tip replantation. CONCLUSION: The subcutaneous pocket graft could be chosen in thumb tip amputation in case of impossible microvascular anastomosis as well as who strongly desires to preserve thumb tip after failed replantation.

Low-density lipoprotein protects Vibrio vulnificus-induced lethality through blocking lipopolysaccharide action

Lipoprotein plays a role in the host defense against bacterial infection, and its serum level has been demonstrated to be an important prognosis factor of survival. We have previously demonstrated that LDL directly inactivates the hemolytic activity of Vibrio vulnificus cytolysin (VVC) in vitro. The object of this study was therefore to examine whether the LDL-mediated inactivation of VVC leads to protection against lethal infection of V. vulnificus in vivo, using wild and VVC-deficient V. vulnificus strains. Unexpectedly, we found that LDL protects mouse lethality induced by VVC-deficient as well as wild V. vulnificus strain. We also demonstrated that LDL blocks V. vulnificus LPS-induced lethality in mice. These results suggest that LDL preferentially act on endotoxin rather than exotoxin in the protection against V. vulnificus-induced mice lethality.