Characterization of 20 cases of humeral head necrosis after complex proximal humeral fracture / 中华创伤骨科杂志

Objective:To characterize the humeral head necrosis after open reduction and anatomic locking plate fixation of complex proximal humeral fractures.Methods:A retrospective study was conducted of the 20 patients who had been treated for humeral head necrosis after surgery of complex proximal humeral fracture at Department of Traumatic Orthopaedics, Beijing Jishuitan Hospital from September 2012 to June 2020. They were 7 males and 13 females with an average age of 57.4 years (from 35 to 84 years). Analyzed were their fracture types, time for diagnosis of humeral head necrosis, length of the medial residual bone, thickness of the humeral head and shoulder function.Results:The 20 patients were followed up for 8 to 104 months (average, 48.3 months). According to the Neer classification, there were 8 three-part fractures and 12 four-part fractures; shoulder dislocation was complicated in 10 cases. According to the AO-OTA classification, there were 16 type C fractures and 4 type B fractures. The length of the medial residual bone averaged 4.8 mm (from 0 to 10.7 mm); the medial soft tissue hinge was damaged in 18 cases and the thickness of the humeral head averaged 20.6 mm (from 13.6 to 33.0 mm). All fractures got united at the first stage after an average time of 8.4 weeks (from 5 to 12 weeks). The time for diagnosis of humeral head necrosis averaged 16.5 months (from 8 to 24 months). At the final follow-up, the Constant-Murley score of the affected side averaged 53.4 (from 22 to 74) while that of the healthy side 85.5 (from 53 to 98), with a ratio of affected side to healthy side of 62.43% (from 27.95 to 82.70%).Conclusions:Necrosis of the humeral head was common after surgery for complex proximal humerus fractures, most of which were three- or four-part ones or combined with shoulder dislocation. In most of the patients, the medial soft tissue hinge was damaged and the length of the residual medial bone usually shorter than 8 mm. Necrosis of the humeral head happened late after surgery. The function of the affected shoulder was significantly lower than that of the healthy side.

A preliminary investigation into rotator cuff injuries in patients with proximal humeral fracture / 中华创伤骨科杂志

Objective To investigate the incidence and associated factors of rotator cuff injuries in patients surgically treated for proximal humerus fracture.Methods A retrospective investigation was conducted in the patients over 40 years old who had been surgically treated for proximal humeral fracture from April 10th 2017 to December 1st 2017 at Department of Traumatic Orthopaedics,Beijing Jishuitan Hospital.Intraoperative direct visualization was used to collect their clinical data concerning rotator cuff injuries in combination with proximal humeral fracture.All the data were analyzed to find the incidence,gender ratio,age distribution and fracture type distribution concerning rotator cuff injuries.Results A total of 143 eligible patients were included in this investigation.Their average age was 61.95 years and their male-female ratio 1:2.3.The incidence was 46.2％ (66/143) for all the rotator cuff injuries in proximal humerus fracture and 23.1％ (33/143) just for rotator cuff tears.There were no significant differences in age,male to female ratio or distribution of Neer fracture type between patients with rotator cuff injury and those without rotator cuff injury (P ＞ 0.05).There was no significant difference in the age and or distribution of Neer fracture type between patients with rotator cuff tear and patients without rotator cuff tear (P ＞ 0.05).The proportion of females in patients with rotator cuff tears (84.8％,28/33) was significantly higher than that in patients with no rotator cuff tears (63.6％,21/33) (P ＜ 0.05).There was no significant difference between different age groups of the patients in incidence of combined rotator cuff injury (P ＞ 0.05).Conclusions Concomitant rotator cuff injuries are relatively common in patients over 40 years old with a proximal humerus fracture.About half of the injuries may be simple wear or wear plus degeneration while the other half rotator cuff tear happening mostly in female patients.The incidence of concomitant rotator cuff injury may increase with the age of the patients with a proximal humerus fracture.

Diagnosis and treatment of adult capitellar fractures / 北京大学学报(医学版)

Objective:To discuss the diagnosis,differential diagnosis,classification methods and treat-ment of the capitellar fractures of the distal humerus.Methods:In the study,28 adult patients with the capitellar fractures were treated in Beijing Jishuitan Hospital from Sep.2008 to Jan.2014.There were 10 females and 18 males with an average age of 34 years (range:14-66 years).According to Dubber-ley classification:ⅠA type in 6 cases,ⅠB type in 2 cases,ⅡA type in 8 cases,ⅡB type in 4 cases,ⅢA type in 4 cases,and ⅢB type in 4 cases.Sixteen patients were treated with a single Kochr approach,1 with a lateral approach combined with a medial approach,2 combined with anterior elbow approach and 9 combined with posterior median approach.All of the fractures were fixed with Herbert screws,7 cases with support plates,and 4 cases with the hinged elbow external fixator.All of the pa-tients were followed up for clinical examination and radiograph check.They were evaluated with Broberg-Morrey score system.Results:The average follow-up time was 28.5 months (range 12 -72 months). The average bone union time was 8 weeks.The average ulnohumeral motion was 1 12°(60°-150°)and forearm rotation was 145°(100°-170°).The average Broberg-Morrey score was 92.5 points (range:62-100 points).The excellent and good rate was 91.8%.The complications of traumatic arthritis was in 2 cases and elbow stiffness was in 2 cases.Conclusion:Attention should be paid to the diagnosis and differential diagnosis of capitellar fractures without missing the combined injury.According to Dubberley classification,appropriate surgical approach and the internal and external fixed methods could be chosen. Early postoperative,reasonable and effective exercise is helpful to the recovery of elbow joint function.

Application of vacuum sealing drainage and closed irrigation-suction to manage infection after patellar facture surgery / 中华创伤骨科杂志

Objective To investigate the outcomes of infection mauagement after patellar fracture surgery using vacuum sealing drainage (VSD) combined with closed irrigation-suction within the articular cavity.Methods We treated 7 patients who had been inflicted by infection after patellar fracture surgery from June 2008 to March 2012.They were 5 men and 2 women,aged from 19 to 52 years (average,40.5years).There were one open aud 6 close patellar fractures.Their infections occurred 14 to 21 days (average,17.7 days) after internal fixation.One infection was superficial and 6 were deep,resulting in pyogenous arthritis of the knee.All cases were given debridement and VSD treatment and immobilized with braces.The 6 cases of deep infection were irrigated continuously with 4000 mL 0.9％ NaCl every day within the articular cavity.Direct skin suture or transplantation of local skin graft was performed after growth of fresh granulation tissue.Neer system was used to evaluate the knee functions at the last follow-up.Results After the VSD was applied for 7 to 12 days,the wound surface and knee cavity were very clean and fresh granulation tissue emerged.The wound was closed by direct suture for one superficial and one deep infection.Local skin grafts were transplanted for 5 deep infections.The infections were effectively controlled without pain,swelling or local fistula.The patients were followed up from 3 to 48 months (average,21 months).The functional outcome according to Neer' s criteria at the last follow-up was excellent in 2 cases,good in 3 and fair in 2.Conclusion In management of infection after patellar fracture surgery,VSD combined with closed irrigation-suction within the articular cavity can drain sufficiently,control infection effectively and stimulate fresh granulation growth,facilitating wound closure by direct suture or transplantation of a local skin flap.

Repair of sheep metatarsus defects by using tissue-engineering technique / 华中科技大学学报（医学）（英德文版）

Tissue-engineering bone with porous ,betatricalcium phosphate (3-TCP) ceramic and autologous bone marrow mesenchymal stem cells (MSC) was constructed and the effect of this composite on healing of segmental bone defects was investigated. 10-15 ml bone marrow aspirates were harvested from the iliac crest of sheep, and enriched for MSC by density gradient centrifugation over a Percoll cushion (1. 073 g/ml). After cultured and proliferated, tissue-engineering bones were constructed with these,cellS seeded onto porous f-TCP, and then the constructs were implanted in 8 sheep left metatarsus defect (25 mm in length) as experimental group. Porous ,-TCP only were implanted to bridge same size and position defects in 8 sheep as control group, and 25 mm segmental bone defects of left metatarsus were left empty in 4 sheep as blank group. Sheep were sacrificed on the 6th, 12th, and 24th week postoperatively and the implants samples were examined by radiograph, histology, and biomechanical test. The 4 sheep in blank group were sacrificed on the 24th week postoperatively. The results showed that new bone tissues were observed either radiographic or histologically at the defects of experimental group as early as 6th week postoperatively, but not in control group, and osteoid tissue, woven bone and lamellar bone occurred earlier than in control group in which the bone defects were repaired in "creep substitution" way, because of the new bone formed in direct manner without progression through a cartilaginous intermediate. At the 24th week, radiographs and biomechanical test revealed an almost complete repair of the defect of experimental group, only partly in control group. The bone defects in blank group were non-healing at the 24th week. It was concluded that engineering bones constructed with porous -TCP and autologous MSC were capable of repairing segmental bone defects in sheep metatarsus beyond "creep substitution" way and making it healed earlier. Porous ,-TCP being constituted with autologous MSC may be a good option in healing critical segmental bone defects in clinical practice and provide insight for future clinical repair of segmental defect.

Repair of Sheep Metatarsus Defects by Using Tissue-engineering Technique / 华中科技大学学报（医学）（英德文版）

Tissue-engineering bone with porous β-tricalcium phosphate (β-TCP) ceramic and autologous bone marrow mesenchymal stem cells (MSC) was constructed and the effect of this composite on healing of segmental bone defects was investigated. 10-15 ml bone marrow aspirates were harvested from the iliac crestof sheep, and enriched for MSC by density gradient centrifugation over a Percoll cushion (1. 073 g/ml). After cultured and proliferated, tissue-engineering bones were constructed with these cells seeded onto porous β-TCP, and then the constructs were implanted in 8 sheep left metatarsus defect (25 mm in length) as experimental group. Porous β-TCP only were implanted to bridge same size and position defects in 8 sheep as control group, and 25 mm segmental bone defects of left metatarsus were left empty in 4 sheep as blank group. Sheep were sacrificed on the 6th, 12th, and 24th week postoperatively and the implants samples were examined by radiograph, histology, and biomechanical test. The 4 sheep in blank group were sacrificed on the 24th week postoperatively. The results showed that new bone tissues were observed either radiographic or histologically at the defects of experimental group as early as 6th week postoperatively, but not in control group, and osteoid tissue, woven bone and lamellar bone occurred earlier than in control group in which the bone defects were repaired in "creep substitution" way, because of the new bone formed in direct manner without progression through a cartilaginous intermediate. At the 24th week, radiographs and biomechanical test revealed an almost complete repair of the defect of experimental group, only partly in control group. The bone defects in blank group were non-healing at the 24th week. It was concluded that engineering bones constructed with porous β-TCP and autologous MSC were capable of repairing segmental bone defects in sheep metatarsus beyond "creep substitution" way and making it healed earlier. Porous β-TCP being constituted with autologous MSC may be a good option in healing critical segmental bonedefects in clinical practice and provide insight for future clinical repair of segmental defect.

Examination of dynamic changes of different-type collagens in bone fracture healing with a polarized light microscopy / 中国组织工程研究

BACKGROUND:Sirius red is a strong acid anionic dye. Being not-easyto-fade and specific, sirius red becomes the best dye for collagen staining.Collagen is a major component of extracellular matrix and has some specific physiological functions. Through synthesis and reconstruction of collagen, bone fracture repair will be accomplished.OBJECTIVE: Picric acid-Sirius red stained slides were observed under a polarized light microscopy for evaluation the dynamic changes in the ratio of different collagen types and their distributions in bone fracture healing.DESIGN: It was a controlled observation.SETTING: It was conducted in the Department of Orthopedics, Renmin Hospital, Wuhan University; Department of Traumatic Orthopaedics, Tianjin Hospital; Department of Traumatic Orthopaedics, Jishuitan Hospital,Medical Department, Peking University; Tissue Engineering Center of Institute of Basic Medical Sciences, Academy of Military Medical Sciences of Chinese PLAMATERIALS: It was conducted at Tissue Engineering Center of Institute of Basic Medical Sciences, Academy of Military Medical Sciences of Chinese PLA from March 2002 to September 2003. Three healthy adult Chinese sheep, male and in weight from 25 to 35 g, were selected.METHODS: All the animals were anesthesized and sterilized; a transverse osteotomy of the trunk of metatarsus was performed; and the end of fracture was fixed with a six-hole Medoff sliding plate. At the post-operative month 1, 3 and 6, samples were taken from bone fractures. After decalcification with EDTA, they were stained with Picric acid-sirius red, and the types and distribution of collagens were observed under a polarized light microscopy.MAIN OUTCOME MEASURES: Types and distributions of collagens in bone lesion in different period of bone healing were investigated.RESULTS: Three sheep used in this study entered the statistical analysis.①Morphological features of various collagens under a polarized light microscopy postoperatively: Type Ⅰ collagen packed tightly, with a strong refraction and yellow, orange or red thick fibres. Type Ⅱ collagen formed a loose reticulation with fibres exhibiting different colour and a weak refraction. Thin fibres of type Ⅲ collagen with weak refraction and green colour formed a loose reticulation. ②Quantitative studies on various collagens under a polarized light microscopy postoperatively: At postoperative month 1,red or orange fibres (type Ⅰ collagen) were rarely seen in bone fracture,while green fibres (typical of type Ⅲ collagen) were dominant with a disorder pack. At postoperative month 3, red or orange fibres increased significantly and the ratio of type Ⅲ collagen reduced. The collagen fibres assembled regularly. At postoperative month 6, thick yellow-red collagen became dominant and thin green type Ⅲ collagen decreased dramatically and arranged in an obvious oblique, spiral and crossed orientations.CONCLUSION: Picric acid-sirius red stain combined with polarized light microscopy technique is not only capable of identifing type Ⅰ and type Ⅲ collagens in bone fraction, but also can reflect the morphological features,distribution and the ratio of these two type collagens. This approach has the virtues of easiness in operation, strong specificity and high sensitivity.

In vitro chondrogenic phenotype differentiation of bone marrow-derived mesenchymal stem cells / 华中科技大学学报（医学）（英德文版）

In order to study the chondrogenic phenotype differentiation of adult sheep bone marrow-derived mesenchymal stem cells (MSCs) in a defined medium as potential seed cells for cartilage tissue engineering. MSCs were isolated by density centrifugation with Percoll solution from bone marrow aspirated from sheep iliac crest. The third passage of MSCs were induced with H-DMEM containing TGF-beta3, IGF-I, Dexamethasone and VitC. The shape and ultrastructure of cells were observed, toluidine blue stain for GAG and immunohistochemistry for type II collagen were applied for chondrogenic phenotype identification. After 14 days of induction, MSCs changed from a spindle-like appearance to a polynal shape, a large amount of endoplasmic reticulum, Golgi complex and mitochondria were observed, and the differentiation of MSCs chondrogenic phenotype was verified by positive staining of toluidine blue and immunohistochemistry. MSCs derived from bone marrow can differentiate to chondrogenic phenotype when induced in vitro and can be used as optimal seed cells for cartilage tissue engineering.

In vitro chondrogenic phenotype differentiation of bone marrow-derived mesenchymal stem cells / 华中科技大学学报（医学）（英德文版）

In order to study the chondrogenic phenotype differentiation of adult sheep bone marrow-derived mesenchymal stem cells (MSCs) in a defined medium as potential seed cells for cartilage tissue engineering. MSCs were isolated by density centrifugation with Percoll solution from bone marrow aspirated from sheep iliac crest. The third passage of MSCs were induced with H-DMEM containing TGF-beta3, IGF-I, Dexamethasone and VitC. The shape and ultrastructure of cells were observed, toluidine blue stain for GAG and immunohistochemistry for type II collagen were applied for chondrogenic phenotype identification. After 14 days of induction, MSCs changed from a spindle-like appearance to a polynal shape, a large amount of endoplasmic reticulum, Golgi complex and mitochondria were observed, and the differentiation of MSCs chondrogenic phenotype was verified by positive staining of toluidine blue and immunohistochemistry. MSCs derived from bone marrow can differentiate to chondrogenic phenotype when induced in vitro and can be used as optimal seed cells for cartilage tissue engineering.