Meta-analysis of the role of fibular fixation in tibiofibular fractures / 中国骨伤

OBJECTIVE@#To compare the role and importance of fibular fixation in tibiofibular fractures by Meta-analysis.@*METHODS@#The literature related to the comparison of the efficacy of fixation of the fibula with or without fixation on the treatment of tibiofibular fractures was searched through the databases of China Knowledge Network, Wipu, Wanfang, The Cochrane Library, Web of science and Pubmed, and statistical analysis was performed using RevMan 5.3 software. The rates of malrotation, rotational deformity, internal/external deformity, anterior/posterior deformity, non-union, infection, secondary surgery and operative time were compared between the fibula fixation and non-fixation groups.@*RESULTS@#A total of 11 publications were included, six randomised controlled trials and five case-control trials, eight of which were of high quality. A total of 813 cases were included, of which 383 were treated with fibula fixation and 430 with unfixed fibulae.Meta-analysis results showed that fixation of the fibulae in the treatment of tibiofibular fractures reduced the rates of postoperative rotational deformity[RR=0.22, 95%CI(0.10, 0.45), P<0.000 1] and internal/external deformity[RR=0.34, 95%CI(0.14, 0.84), P=0.02] and promoted fracture healing [RR=0.76, 95%CI(0.58, 0.99), P=0.04]. In contrast, the rates of poor reduction [RR=0.48, 95% CI(0.10, 2.33), P=0.36], anterior/posterior deformity[RR=1.50, 95%CI(0.76, 2.96), P=0.24], infection[RR=1.43, 95%CI(0.76, 2.72), P=0.27], secondary surgery[RR=1.32, 95%CI(0.82, 2.11), P=0.25], and operative time[MD=10.21, 95%CI(-17.79, 38.21), P=0.47] were not statistically significant (P>0.05) for comparison.@*CONCLUSION@#Simultaneous fixation of the tibia and fibula is clinically more effective in the treatment of tibiofibular fractures.

Research progress on mechanism of traumatic brain injury promoting fracture healing / 中国修复重建外科杂志

OBJECTIVE@#To summarize the research progress on the mechanism related to traumatic brain injury (TBI) to promote fracture healing, and to provide theoretical basis for clinical treatment of fracture non-union.@*METHODS@#The research literature on TBI to promote fracture healing at home and abroad was reviewed, the role of TBI in fracture healing was summarized from three aspects of nerves, body fluids, and immunity, to explore new ideas for the treatment of fracture non-union.@*RESULTS@#Numerous studies have shown that fracture healing is faster in patients with fracture combined with TBI than in patients with simple fracture. It is found that the expression of various cytokines and hormones in the body fluids of patients with fracture and TBI is significantly higher than that of patients with simple fracture, and the neurofactors released by the nervous system reaches the fracture site through the damaged blood-brain barrier, and the chemotaxis and aggregation of inflammatory cells and inflammatory factors at the fracture end of patients with combined TBI also differs significantly from those of patients with simple fracture. A complex network of humoral, neural, and immunomodulatory networks together promote regeneration of blood vessels at the fracture site, osteoblasts differentiation, and inhibition of osteoclasts activity.@*CONCLUSION@#TBI promotes fracture healing through a complex network of neural, humoral, and immunomodulatory, and can treat fracture non-union by intervening in the perifracture microenvironment.

Fracture in Irradiated Rat Femur: A Description of an Experimental Model and Evaluation of its Effectiveness / Fratura em fêmur irradiado de rato: Descrição de um modelo experimental e avaliação de sua eficácia

Abstract Objective We aim to describe an experimental model for studying femoral fractures in rats after exposure to ionizing radiation, demonstrating a way to apply a substance for analysis, the method for patterning fracture and irradiation, and how to evaluate its effectiveness based on radiographic studies. Methods We used 24 rats divided into 2 groups of 12 animals each. The STUDY group was exposed to ionizing radiation and treated with saline solution, and the CONTROL group was not exposed to radiation and was treated with saline solution. All animals were subjected to standardized fracture of the right femur that was fixed with intramedullary wire. The efficiency of the bone union was assessed by radiographic exam. Results Fracture healing was more efficient in bones not exposed to ionizing radiation (p = 0.012). All fractures met the criteria of being simple, diaphyseal, transverse or short oblique. Conclusion The experimental model presented is an efficient alternative for the study of fractures in irradiated bones in rats.

Resumo Objetivo Nosso objetivo é descrever um modelo experimental para estudo de fraturas de fêmur em ratos após exposição a radiação ionizante, demonstrando uma forma de aplicação de uma substância para análise, o método de padronização de fratura e irradiação e a forma de avaliação de sua eficácia com base em estudos radiográficos. Métodos Utilizamos 24 ratos divididos em dois grupos de 12 animais cada. O grupo ESTUDO foi exposto à radiação ionizante e tratado com soro fisiológico, enquanto o grupo CONTROLE não foi exposto à radiação e foi tratado com soro fisiológico. Todos os animais foram submetidos à fratura padronizada do fêmur direito e sua fixação com fio intramedular. A eficácia da consolidação óssea foi determinada por exame radiográfico. Resultados A cicatrização de fraturas foi mais eficiente em ossos não expostos à radiação ionizante (p = 0,012). Todas as fraturas atenderam aos critérios de serem simples, diafisárias, transversas ou oblíquas curtas. Conclusão O modelo experimental apresentado é uma boa alternativa para o estudo de fraturas em ossos irradiados em ratos.

Peri-implant femoral fractures: Challenges, outcomes, and proposal of a treatment algorithm / 中华创伤杂志(英文版)

PURPOSE@#Non-prosthetic peri-implant fractures are challenging injuries. Multiple factors must be carefully evaluated for an adequate therapeutic strategy, such as the state of bone healing, the type of implant, the time and performed personnel of previous surgery, and the stability of fixation. The aim of this study is to propose a rationale for the treatment.@*METHODS@#The peri-implant femoral fractures (PIFFs) system, a therapeutic algorithm was developed for the management of all patients presenting a subtype A PIFF, based on the type of the original implant (extra- vs. intra-medullary), implant length and fracture location. The adequacy and reliability of the proposed algorithm and the fracture healing process were assessed at the last clinical follow-up using the Parker mobility score and radiological assessment, respectively. In addition, all complications were noticed. Continuous variables were expressed as mean and standard deviation, or median and range according to their distribution. Categorical variables were expressed as frequency and percentages.@*RESULTS@#This is a retrospective case series of 33 PIFFs, and the mean post-operative Parker mobility score was (5.60 ± 2.54) points. Five patients (15.1%) achieved complete mobility without aids (9 points) and 1 (3.0%) patient was not able to walk. Two other patients (6.1%) were non-ambulatory prior to PPIF. The mean follow-up was (21.51 ± 9.12) months (range 6 - 48 months). There were 7 (21.2%) complications equally distributed between patients managed either with nailing or plating. There were no cases of nonunion or mechanical failure of the original implant.@*CONCLUSION@#The proposed treatment algorithm shows adequate, reliable and straightforward to assist the orthopaedic trauma surgeon on the difficult decision-making process regarding the management of PIFF occurring in previously healed fractures. In addition, it may become a useful tool to optimize the use of the classification, thus potentially improving the outcomes and minimizing complications.

Establishment and evaluation of rabbit model of closed tibial fracture / 中国骨伤

OBJECTIVE@#To explore the effect of a modified three-point bending fracture device for establishing a rabbit model of closed tibial fracture.@*METHODS@#The model of closed tibial fracture was established in 40 6-month-old male New Zealand white rabbits with a body weight of 2.5 to 3.0 kg, and the model was verified at 6 weeks after operation. Five rabbits underwent pre modeling without temporary external fixation before modeling, and then were fractured with a modified three-point bending fracture device;35 rabbits underwent formal modeling. Before modeling, needles were inserted, and splints were fixed externally, and then the fracture was performed with a modified three-point bending fracture device. The fracture model and healing process were evaluated by imaging and histopathology at 2 hours, 4 weeks, and 6 weeks after operation.@*RESULTS@#Two hours after modeling, the prefabricated module showed oblique fracture in varying degrees and the broken end shifted significantly;Except for 1 comminuted fracture, 2 curved butterfly fractures and 2 without obvious fracture line, the rest were simple transverse and oblique fractures without obvious displacement in formal modeling group. According to the judgment criteria, the success rate of the model was 85.71%. Four weeks after modeling, the fixed needle and splint of the experimental rabbits were in good position, the fracture alignment was good, the fracture line was blurred, many continuous callus growths could be seen around the fracture end, and the callus density was high. Six weeks after modeling, many thick new bone trabeculae at the fracture, marginal osteoblasts attached, and a small number of macrophages were seen under the microscope. The intramembrane osteogenesis area was in the preparation bone stage, the medullary cavity at the fracture had been partially reopened, the callus was in the absorption plastic stage, and many osteoclasts were visible. The X-ray showed that the fracture line almost disappeared, part of the medullary cavity had been opened, the external callus was reduced around, the callus was in the plastic stage, and the bone cortex was continuous. It suggests that the fracture model showed secondary healing.@*CONCLUSION@#The improved three-point bending fracture device can establish a stable rabbit model of closed tibial fracture, and the operation is simple, which meets the requirements of closed fracture model in basic research related to fracture healing.

Advances on pentraxin 3 in osteoporosis and fracture healing / 中国骨伤

Pentaxin 3 (PTX3), as a multifunctional glycoprotein, plays an important role in regulating inflammatory response, promoting tissue repair, inducing ectopic calcification and maintaining bone homeostasis. The effect of PTX3 on bone mineral density (BMD) may be affected by many factors. In PTX3 knockout mice and osteoporosis (OP) patients, the deletion of PTX3 will lead to decrease of BMD. In Korean community "Dong-gu study", it was found that plasma PTX3 was negatively correlated with BMD of femoral neck in male elderly patients. In terms of bone related cells, PTX3 plays an important role in maintaining the phenotype and function of osteoblasts (OB) in OP state;for osteoclast (OC), PTX3 in inflammatory state could stimulate nuclear factor κ receptor activator of nuclear factor-κB ligand (RANKL) production and its combination with TNF-stimulated gene 6(TSG-6) could improve activity of osteoclasts and promote bone resorption;for mesenchymal stem cells (MSCs), PTX3 could promote osteogenic differentiation of MSCs through PI3K/Akt signaling pathway. In recent years, the role of PTX3 as a new bone metabolism regulator in OP and fracture healing has been gradually concerned by scholars. In OP patients, PTX3 regulates bone mass mainly by promoting bone regeneration. In the process of fracture healing, PTX3 promotes fracture healing by coordinating bone regeneration and bone resorption to maintain bone homeostasis. In view of the above biological characteristics, PTX3 is expected to become a new target for the diagnosis and treatment of OP and other age-related bone diseases and fracture healing.

Short-term effectiveness of transverse antecubital incision for failed closed reduction of Gartland type Ⅲ supracondylar humerus fractures in children / 中国修复重建外科杂志

OBJECTIVE@#To investigate the short-term effectiveness of transverse antecubital incision in the treatment of failed closed reduction of Gartland type Ⅲ supracondylar humeral fractures (SHFs) in children.@*METHODS@#Between July 2020 and April 2022, 20 children with Gartland type Ⅲ SHFs who failed in closed reduction were treated with internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision. There were 9 boys and 11 girls with an average age of 3.1 years (range, 1.1-6.0 years). The causes of injuries were fall in 12 cases and fall from height in 8 cases. The time from admission to operation ranged from 7 to 18 hours, with an average of 12.4 hours. The healing of the incision and the occurrence of complications such as nerve injury and cubitus varus were observed after operation; the elbow flexion and extension range of motion after removing the gypsum, after removing the Kirschner wire, and at last follow-up were recorded and compared, as well as the elbow flexion and extension and forearm rotation range of motion at last follow-up between healthy and affected sides; the Baumann angle was measured on the X-ray film, and the fracture healing was observed. At last follow-up, the effectiveness was evaluated according to the Flynn elbow function evaluation criteria.@*RESULTS@#All incisions healed by first intention, and there was no skin necrosis, scar contracture, ulnar nerve injury, and cubitus varus. Postoperative pain occurred in the radial-dorsal thumb in 2 cases. The gypsum was removed and elbow flexion and extension exercises were started at 2-4 weeks (mean, 2.7 weeks) after operation, and the Kirschner wire was removed at 4-5 weeks (mean, 4.3 weeks). All the 20 patients were followed up 6-16 months, with an average of 12.4 months. The fracture healing time was 4-5 weeks, with an average of 4.5 weeks, and there was no complication such as delayed healing and myositis ossificans. The flexion and extension range of motion of the elbow joint gradually improved after operation, and there were significant differences between the time after removing the gypsum, after removing the Kirschner wire, and at last follow-up ( P<0.017). There was no significant difference in the flexion and extension of the elbow joint and the forearm rotation range of motion between the healthy and affected sides at last follow-up ( P>0.05). There was no significant difference in Baumann angle between the time of immediate after operation, after removing the Kirschner wire, and at last follow-up ( P>0.05). According to Flynn elbow function evaluation standard, 16 cases were excellent and 4 cases were good, the excellent and good rate was 100%.@*CONCLUSION@#The treatment of Gartland type Ⅲ SHFs in children with failed closed reduction by internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision has the advantages of complete soft tissue hinge behind the fracture for easy reduction and wire fixation, small incision, less complications, fast fracture healing, early functional recovery, reliable reduction and fixation, and can obtain satisfactory results.

Review of closed reduction techniques for femoral neck fracture / 中国骨伤

For patients with femoral neck fractures who plan to undergo internal fixation, satisfied alignment of fracture ends is an important prerequisite for internal fixation stability and fracture healing. There are many reports on the reduction methods of displaced femoral neck fractures, which can be summarized into three categories:First, the solely longitudinal traction of lower limbs, supplemented by other manipulations such as rotation and compression; Second, the resultant force formed by the longitudinal traction of lower limbs and the lateral traction;the third is accomplished by vertical traction in the axis of femur with hip joint flexed. Each reduction method has its own advantages, but no single method can be applied to all fracture displacement. In this paper, some classical reduction techniques in the literatures are briefly reviewed. It is hoped that clinicians will not be limited to a certain reduction method, they should analyze the injury mechanism and fracture displacement process according to the morphology features and flexibly select targeted reduction methods to improve the success rate of closed reduction of femoral neck fracture.

Augmenting locking plate with autologous bone graft for the treatment of nonunion of long bone fracture in the lower extremity with retaining of the original intramedullary nail / 中国骨伤

OBJECTIVE@#To explore clinical effect of attaching locking plate with bone grafting based on retaining the original intramedullary nail in treating non-union after intramedullary nail fixation of long shaft fractures of lower limbs.@*METHODS@#A retrospective study was conducted on 20 patients treated with non-union fractures after intramedullary nailing of long shaft fractures of lower limbs from June 2015 to June 2020. All patients were treated with the original intramedullary nailing and bone grafting from the iliac bone, and were underwent open reduction plate internal fixation and bone grafting for old fractures. Among them, 14 were males and 6 were females, aged from 35 to 56 years old with an average of (42.2±9.6) years old. Nine patients were femoral shaft fracture and 11 patients were tibial shaft fracture. According to characteristics of fracture end nonunion, 6 patients were stable/atrophic, 9 patients were unstable/large, and 5 patients were unstable/atrophic. The nonunion time ranged from 8 to 12 months with an average of(9.8±2.0) months after the initial surgery. Visual analogue scale (VAS), knee range of motion, bone healing time, complications and fracture-end healing were recorded before and at the latest follow-up.@*RESULTS@#All patients were followed up for 18 to 48 months with an average of (36.3±10.5) months. The incision of all patients were healed at stageⅠwithout complications such as infection or internal fixation ruptur. Healing time of femur and tibia was (8.5±2.6) months and (9.5±2.2) months. Knee joint motion increased from preoperative (101.05±8.98) ° to postoperative (139.35±8.78) ° at the latest follow-up (t=-12.845, P<0.001). VAS decreased from preoperative (5.15±1.72) to postoperative (0.75±0.96) at the latest follow-up (t=11.186, P<0.001).@*CONCLUSION@#On the basis of retaining the original intramedullary nail, the addition of locking plate internal fixation and autogenous iliac bone grafting have advantages of simple operation, less trauma, fewer complications and high fracture healing rate. It is one of the effective surgical schemes for the treatment of nonunion after intramedullary nail fixation of long bone fracture of lower extremity.

Effects of isopsoralen on tibial fracture and vascular healing in mice / 中国骨伤

OBJECTIVE@#To explore effects of isopsoralen (ISO) with different doses on fracture and vascular healing in mice.@*METHODS@#Sixty 2-month-old male C57BL/6 mices with body mass of (20±2) g were selected and divided into 4 groups by random number table method:model group (model), low dose group (isopsoralen-low dose, ISO-L), medium dose group (isopsoralen-medium dose, ISO-M) and high dose group (isopsoralen-high dose, ISO-H), with 15 animals in each group. The right tibial fracture model was established. After operation, ISO-L group, ISO-M group and ISO-H group were given ISO concentration of 10 mg·kg-1, 20 mg·kg-1 and 40 mg·kg-1, respectively. Model group was given same volume of normal saline once a day for 28 days. Weighed once a week. X-ray was performed on 7, 14, 21 and 28 days, respectively, and modified I.R. Garrett scoring method was used to evaluate callus growth. After 28 days, the main organs were stripped and weighed, and organ coefficients were calculated. Hematoxylin eosin staining (HE staining) was performed on the organs to observe whether there were pathological structural changes. Micro-computed tomography (Micro-CT) was used to scan fracture area and conduct three-dimensional reconstruction to obtain the effect map, and quantify bone volume fraction (bone volume/total volume, BV/TV). After decalcification, the tibia was embedded in paraffin wax and sectioned. The healing and shape of fracture end were observed by HE staining and ferruxin solid green staining. The right tibia was removed and decalcified after intravascular infusion of Microfil contrast agent. Micro-CT was used to scan the callus microvessels in the fracture area, and the vascular volume fraction and vessel diameter were quantified.@*RESULTS@#After 28 days of administration, there was no significant difference in body mass and organ coefficient among all groups (P>0.05), and no significant pathological changes were found in HE staining of organs. The results of X-ray and improved I.R. Garrett score showed that ISO-M group was higher than that of Model group at 28 days (P<0.05). Scores of ISO-H group at 14, 21 and 28 days were higher than those of the other 3 groups (P<0.05). Micro-CT results showed intracavitary callus in ISO-M group was significantly reduced, which was lower than that in Model group (P<0.05), most of the callus in ISO-H group were subsided, and BV/TV in ISO-H group was lower than that in the other 3 groups (P<0.05). The results of HE staining and ferrubens solid green staining showed fracture area of ISO-H group was closed, continuous laminar bone had appeared, and the fracture healing process was higher than that of other groups. Angiographic results showed vascular volume fraction in ISO-H and ISO-M groups was higher than that in Model and ISO-L groups (P<0.05), and the vascular diameter in ISO-H and ISO-M groups was higher than that in Model and ISO-L groups (P<0.05).@*CONCLUSION@#In the concentration range of 10-40 mg·kg-1, ISO has no obvious toxic and side effects, and could improve bone microstructure, promote formation of callus microvessels, and accelerate healing of fracture ends in a concentration-dependent manner.

Comparative study of the effects of intramedullary nail fixation and minimally invasive percutaneous plate internal fixation technique on platelet activation and serum transforming growth factor-β1(TGF-β) 1 and bone morphogenetic protein-2 (BMP-2) in patients with tibial and fibular fracture / 中国骨伤

OBJECTIVE@#To investigate the effect of intramedullary nail fixation (IMN) and minimally invasive percutaneous plate internal fixation (MIPPO) techniques on tibiofibular fractures and their effect on platelet activation and serum transforming growth factor-β1 (TGF-β1) and bone morphogenetic protein-2 (BMP-2).@*METHODS@#Total of 105 patients with tibiofibular fractures from February 2019 to February 2020 were selected and divided into 53 cases in the MIPPO group and 52 cases in the IMN group. There were 29 males and 24 females with an average age of (41.74±6.05) years old in MIPPO group;in IMN group, 31 males and 21 females with an average age of (40.59±5.26) years old. The perioperative surgical indexes, postoperative complications, ankle function recovery at 12 months postoperatively, platelet activation indexes at 3 and 7 days preoperatively and postoperatively, and serum TGF-β1 and BMP-2 levels at 4 and 8 weeks preoperatively and postoperatively were compared between the two groups.@*RESULTS@#The operating time and fracture healing time in the MIPPO group were shorter than those in the IMN group(P<0.05); Compared with the preoperative period, the levels of GMP-140, PAC-1, CD63, and CD61 increased in both groups at 3 and 7 days after surgery, but were lower in the MIPPO group than in the IMN group(P<0.05);the levels of serum TGF-β1 and BMP-2 increased in both groups at 4 and 8 weeks after surgery compared with the preoperative period, and the postoperative complication rate in the MIPPO group was lower than that in the IMN group(P<0.05);the difference was not statistically significant in the excellent rate of ankle function recovery at 12 months follow-up after surgery between two groups(P>0.05).@*CONCLUSION@#Both intramedullary nail fixation and MIPO technique for treatment of tibia and fibula fractures can improve ankle joint function, but the latter has the advantages of short operation time, fast fracture healing, fewer complications, and light platelet activation. Serum TGF-β1, BMP-2 level improves quickly.

Effect of Cissus quadrangularis on Fracture Healing in Laboratory Animal / Efeito do Cissus quadrangularis na cicatrização de fraturas em animais de laboratório

Objectives: The present study was designed to examine the efficacy of Cissus quadrangularis paste on fracture healing in artificially induced fractured rabbits. Methods: Fifteen rabbits were separated into three groups namely A, B, and C. Veldt grape paste was applied in groups B and C (Treatment Group) by close reduction and open reduction methods of fracture management; respectively, while group A was kept as control. The blood parameter and fracture healing properties in all animals have been monitored and examined routinely during the study period. Results: Both treated groups revealed lower serum calcium levels (SCL) than the control group after 24 hours of fracture that became within the normal range on the 14th day. Fracture healing in the treated groups has been commenced more rapidly than the control group with complete bridging of discontinuity by a distinct osseous callus in the fracture line on day 7 and complete effacing of fracture line on day 14. Conclusion: We did not find any type of anomalousness, clinical deviations, and alteration of serum calcium level on the 14th day of the fracture in treated animals hence Veldt Grape paste could be readily applicable to the management of the fracture in animals.

Objetivos: avaliar a eficácia da pasta de Cissus quadrangularis na consolidação de fraturas em coelhos fraturados artificialmente. Metodos: quinze coelhos foram separados em três grupos (A, B e C). A pasta foi aplicada nos grupos B e C (Grupo de Tratamento) pelos métodos de redução fechada e redução aberta de gerenciamento de fraturas; respectivamente. O grupo A foi mantido como controle. O parâmetro sanguíneo e as propriedades de cicatrização de fraturas em todos os animais foram monitorados e examinados, rotineiramente, durante o período do estudo. Resultados: ambos os grupos tratados revelaram níveis séricos de cálcio (SCL) mais baixos do que o grupo controle, após 24 horas de fratura que se tornou normal no 14º dia. A cicatrização da fratura nos grupos tratados foi iniciada mais rapidamente do que o grupo controle, com ponte completa de descontinuidade por um calo ósseo distinto na linha de fratura no dia 7 e apagamento completo da linha de fratura no dia 14. Conclusao: não encontramos nenhum tipo de anomalia, desvios clínicos e alteração do nível sérico de cálcio no 14º dia da fratura nos animais tratados, portanto, a pasta Veldt Grape pode ser aplicável ao manejo da fratura em animais.

Hematological Changes after Caprine Demineralized Bone Matrix Implantation in Ulnar Critical Defect of Rabbit Model / Alterações hematológicas após implante de matriz óssea desmineralizada caprina em modelo de defeito ulnar crítico em coelhos

Abstract Objective Several animal models have been used in fracture healing and bone graft studies, but hematological responses are seldom reported. Therefore, the present study reported the hematological changes observed in rabbits that underwent xenografting of caprine demineralized bone matrix (CDBM). Method Twenty-four (24) male rabbits (2.5 0.5kg) were acquired for the purpose of this study and were randomly assigned to three groups: autologous bone graft (ABG), unfilled (NC), and caprine demineralized bone matrix (CDBM). Blood samples were collected through cardiac puncture under xylazine-ketamine anesthesia on day 0 (baseline), and on days 28 and 56 postsurgery and were analyzed manually within 2hours of collection. Statistical analysis was performed using a two-way analysis of variance (ANOVA) with repeated measures, and a p-value< 0.05 was considered significant. Result There was an overall significant difference in the values of total white blood cell count (p» 0.0043), neutrophil count (p< 0.0001), monocyte count (p» 0.0184), red blood cell count (p» 0.003), hemoglobin concentration (p< 0.0001) and packed cell volume (p< 0.0001) across the days and the treatment groups. There was, however, no overall significant difference in lymphocyte count (p» 0.4923), basophil count (p» 0.4183), and eosinophil count (0.4806) within days. Conclusion Response to CDBM grafting in rabbits could, therefore, be said to be characterized by marked leukocytosis with neutrophilia, lymphocytosis, and monocytosis by day 28 of postgrafting. This could form the basis with which hematology can be used to monitor body response of bone graft animal models.

Resumo Objetivo Diversos modelos animais têm sido usados em estudos sobre enxertos ósseos e o tratamento de fraturas, mas as respostas hematológicas são raramente relatadas. Este estudo descreveu as alterações hematológicas observadas em coelhos submetidos a xenoenxertos de matriz óssea desmineralizada caprina (MODC). Métodos Vinte e quatro (24) coelhos machos (2,5 0,5 kg) foram adquiridos para este estudo e divididos aleatoriamente em três grupos: enxerto ósseo autólogo (EOA); controle negativo sem preenchimento (SP) e matriz óssea desmineralizada caprina (MODC). Amostras de sangue foram coletadas por punção cardíaca sob anestesia com xilazina-quetamina no dia 0 (para estabelecimento dos valores basais) e aos dias 28 e 56 após a cirurgia; essas amostras foram submetidas à análise manual em até 2 horas após a coleta. A análise estatística foi composta por análise de variância (ANOVA) de dois fatores com medidas repetidas, e o valor de p< 0,05 foi considerado significativo. Resultados Houve uma diferença geral significativa nos números de leucócitos totais (p» 0,0043), neutrófilos (p< 0,0001), monócitos (p» 0,0184) e hemácias (p» 0,003), na concentração de hemoglobina (p< 0,0001) e no hematócrito (p< 0,0001) ao longo dos dias e entre os grupos de tratamento. No entanto, não houve diferença global significativa no número de linfócitos (p» 0,4923), basófilos (p» 0,4183) e eosinófilos (p» 0,4806) entre os dias. Conclusão A resposta ao enxerto de MODC em coelhos é, portanto, caracterizada por leucocitose intensa com neutrofilia, linfocitose e monocitose no 28° dia após o procedimento. Esses dados podem basear a utilização da hematologia no monitoramento da resposta corporal em modelos animais de enxerto ósseo.

Micro-locking plate external fixation for the treatment of proximal phalanx comminuted fractures / 中国骨伤

OBJECTIVE@#To explore clinical efficacy of external placement of micro-locking plate combined with small incision reduction in treating proximal phalanx comminuted fractures.@*METHODS@#From January 2018 to December 2019, 17 patients with proximal phalanx comminuted fractures were treated with micro-locking plate combined with small incision open reduction, including 13 males and 4 females, aged from 16 to 64 years old with an average of (37.2±20.1) years old. Two patients were accompanied by soft tissue extrusion and opening injuries, which were treated with fixed treatment after the first-stage emergency debridement. Curative effect was evaluated according to total active flexion scale (TAFS) of American Hand Surgery Association at 6 months after operation;and fracture healing, nailing, local soft tissue healing, complications were observed.@*RESULTS@#All patients were followed up from 6 to 12 months with an avaerge of(9.3±3.6) months. Two patients occurred delayed union, 1 occurred local skin necrosis and was treated with the second-stage skin grafting to repair wound surface. No external screw breakage or infection was reported, skin soft tissue healed favorably and reached bony union, the union time from 12 to 24 weeks with an average of (15.7±2.1) weeks. According to TAFS standard, 9 patients got excellent result, 5 good and 3 poor at 6 months after operation.@*CONCLUSION@#External micro-locking plate combined with small incision reduction in treating proximal phalanx comminuted fracture, which has advantages of good condition of skin and soft tissue, simple operation, early functional exercise, good range of motion of interphalanx joint, and function score of recovery period is high.

Comparative study between intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis for distal tibia extra-articular fractures / 中华创伤杂志(英文版)

PURPOSE@#Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods.@*METHODS@#This was the prospective comparative study of 100 patients with distal third tibia fractures divided into two groups. The first group of patients were treated with MIPPO technique while the second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, nonunion, superficial and deep infection between the two groups. Statistical analyses were performed using the SPSS software (version 16.0).@*RESULTS@#Average malunion (degrees) in the MIPPO group was 5 (3-7) ± 1.41 vs. 10.22 (8-14) ± 2.04 in the IMIL group (p = 0.001). Similarly postoperative knee pain in the IMIL group was 10% vs. 2% in the MIPPO group (p = 0.001). In terms of superficial infection and nonunion, the results were 8% vs. 4% and 2% vs. 6% for the MIPPO and IMIL group, respectively (p = 0.001).@*CONCLUSION@#Both procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique.

Effect of Taohong Siwu Decoction() early intervention on mesenchymal stem cells homing in fracture healing in rats / 中国骨伤

OBJECTIVE@#To observe the effects of Taohong Siwu Decoction(, THSWD) on the mesenchymal stem cells(MSCs) migration, homing number and cytokine expression in callus during the early process of fracture healing, and to explore the mechanism of THSWD on accelerationg fracture healing by regulating the homing of MSCs in rats.@*METHODS@#A rat model of right femoral shaft open fracture was established. Thirty-two 5-week-old male Sprague-Dawley rats, weighting 110 to 130 g, were divided into control group, low-dose group, medium-dose group and high-dose group by using random number table. Distilled water was given to the control group, and the other groups were given Taohong Siwu Decoction. The rats were gavaged twice a day for 5 consecutive days after surgery. Bone volume/tissue volume(BV/TV) and bone mineral density(BMD) were observed using micro-computed tomography (micro-CT) at 21 days after surgery. At 5 days post-fracture, peripheral blood MSCs from THSWD treated and untreated rats were cultured in vitro. Subsequently, the migration ability of MSCs was observed by cell migration assay. The number of MSCs homing to the callus at the early stage of fracture (5 d) was detected by Immunohistochemistry (IHC). Protein chip was used to detect the expression of cytokines in callus.@*RESULTS@#Micro-CT results showed that BV/TV was higher in the high-dose group than in the medium-dose group (P=0.032), and higher in the medium-dose group than in the low-dose group(P=0.041), with no difference between the control and low-dose group (P=0.651). In addition, there was no difference in BMD between low-dose group and the model group (P=0.671), and lower in the low-dose group than in the medium-dose group(P=0.018), and the medium-dose group was lower than the high-dose group(P=0.008). Cell migration assay showed that THSWD promotes enhanced the migration ability of peripheral blood MSCs. IHC assay revealed that CD45-, CD90+, CD29+ MSCs significantly increased in bone callus after THSWD intervention compared with the control group. Protein chip showed that THSWD promoted the upregulation of CINC-1(×2.91), CINC-3(×1.59), LIX(×1.5), Thymus Chemokine (×2.55), VEGF (×1.22) and the down-regulation of TIMP-1 (×2.98).@*CONCLUSION@#THSWD, a representative formula of "promoting blood circulation and removing blood stasis", can significantly accelerate fracture healing, and its mechanism may be related to enhancing the migration ability of peripheral blood MSCs and up-regulating CINC-1, CINC-3, LIX, Thymus Chemokine, VEGF and down-regulating TIMP-1 in bone callus, which promotes the peripheral blood MSCs homing in the early stage of fracture.

Cura quirúrgica de pseudoartrosis atrófica infectada de diáfisis tibial / Surgical Cure of Infected Atrophic Nonunion of the Tibial Shaft

Introducción: La fractura de un hueso se define como la solución de continuidad de cierta porción ósea. Las fracturas diafisarias representan un bajo porcentaje de todas las fracturas, y el hueso tibial es el más afectado, debido a su escasa vascularidad, poca protección y existencia de diversos factores que hacen más propensos algunos problemas como pseudoartrosis y osteomielitis, que complican el tratamiento. Objetivo: Demostrar la eficacia de los resultados clínicos funcionales con la cura quirúrgica de pseudoartrosis infectada de diáfisis tibial con aporte de injerto óseo heterólogo de cadáver, y autoinjerto cortical esponjoso de cresta iliaca. Presentación del caso: Se presenta el caso de un paciente varón de 42 años que ingresa con diagnóstico de fractura expuesta II postraumática. Se realiza fijación externa en 2 ocasiones, con un intervalo de 6 días para corrección de valgo. El paciente se ausenta de sus controles clínicos y reingresa después de 10 meses aproximadamente por diagnóstico de pseudoartrosis atrófica infectada de tibia izquierda, según clasificación anatómica de Cierny-Mader IV. Se hospitaliza para cura quirúrgica y reconstrucción con aloinjerto óseo y autoinjerto de cresta iliaca, lo que da lugar a la consolidación y controles favorables. Actualmente el paciente ha recuperado la funcionalidad de su pierna izquierda, y queda como secuela una fístula con exposición de aloinjerto. Conclusiones: La cura quirúrgica de pseudoartrosis infectada de diáfisis tibial con aporte de injerto óseo heterólogo de cadáver, y autoinjerto cortical esponjoso de cresta iliaca presenta buenos resultados clínicos y funcionales, lo que constituye un método eficaz(AU)

Introduction: The fracture of a bone is defined as the solution of continuity of a certain bone portion. Diaphyseal fractures represent a low percentage of all fractures, and the tibial bone is the most affected, due to its scarce vascularity, little protection and the existence of various factors that make them more prone to some problems such as pseudoarthrosis and osteomyelitis, which complicate treatment. Objective: To demonstrate the efficacy of functional clinical results with the surgical cure of infected pseudoarthrosis of the tibial shaft with the contribution of heterologous cadaveric bone graft, and cortical cancellous autograft of the iliac crest. Case report: The case of a 42-year-old male patient admitted with a diagnosis of post-traumatic exposed fracture II is reported here. External fixation was performed on 2 occasions, with an interval of 6 days for valgus correction. The patient was absent from his clinical check-ups and was readmitted after approximately 10 months due to a diagnosis of infected atrophic nonunion of the left tibia, according to the anatomical classification of Cierny-Mader IV. He was hospitalized for surgical cure and reconstruction with bone allograft and iliac crest autograft, resulting in consolidation and favorable controls. Currently, the patient has recovered the functionality of his left leg, and a fistula with allograft exposure remains. Conclusions: Surgical treatment of infected tibial shaft pseudoarthrosis with provision of heterologous cadaveric bone graft and cortical cancellous autograft of iliac crest presents good clinical and functional results, which constitutes an effective method(AU)

Microscopic morphology observation of fracture healing process promoted by panax notoginseng saponins / Observación microscópica de la morfología del proceso de curación de fracturas promovida por panax notoginseng saponins

SUMMARY: The aim of this study was to explore promoting effect of external applying Panax Notoginseng Saponins (PNS) on fractures. For this analysis 18 New Zealand male rabbits were divided into control group, splintage group and PNS group. All rabbits were performed left radius fractures and natural healing, splintage healing and splintage coated with PNS healing. 2 rabbits in each group were sacrificed on day 14, day 28 and day 42 after surgery, separately. Atomic force microscope scanning and nanoindentation tests were performed on the callus sections. The particle size and roughness in PNS group was both less than that in splintage group. The elastic modulus of callus in PNS group was consistent with normal bone tissue started from day 28 after surgery, two weeks earlier than that in splintage group. PNS could significantly reduce fracture healing time and increase strength of callus.

RESUMEN: El objetivo de este estudio fue evaluar el efecto de la aplicación externa de Panax Notoginseng Saponins (PNS) en fracturas óseas. Se usaron 18 conejos machos de raza Nueva Zelanda divididos en grupos control, entablillado y PNS. Se realizaron fracturas del radio izquierdo y cicatrización natural en todos los animales, además de la cicatrización con entablillado y entablillado recubierto con PNS. Se sacrificaron, posterior a la cirugía, dos conejos de cada grupo los día 14, 28 y 42. Se realizaron pruebas de escaneo con microscopio de fuerza atómica y nanoindentación en las secciones de callos. El tamaño de la partícula y la rugosidad en el grupo de PNS fue menor que en el grupo entablillado. El módulo elástico del callo en el grupo de PNS fue consistente con el tejido óseo normal iniciado el día 28 después de la cirugía, dos semanas antes que en el grupo de entablillado. El PNS podría redu- cir significativamente el tiempo de curación de la fractura y aumentar la fuerza del callo.

Influence of Hypovitaminosis D on the Ocurrence of Fractures / Influência da hipovitaminose D na ocorrência das fraturas

Abstract Objective To measure the levels of vitamin D in patients hospitalized for fractures and to evaluate its relationship with fractures. Methods A primary, analytical, cross-sectional, non-interventional, observational, controlled study was conducted in humans. The serum measurement of: vitamin D, parathyroid hormone (PTH), calcium, phosphorus, magnesium and albumin was performed in 49 patients who were consecutively hospitalized for surgery due to fracture(s) (study group), and in 50 patients without fractures, from the various outpatient clinics, and who underwent routine tests (control group). Results The mean level of 25-hydroxyvitaminD (25[OH]D) in patients with fractures was of 23.78 ± 8.01 ng/mL (61.22% of patients with fractures had hypovitaminosis D). The mean 25(OH)D of the control group was of 37.52 ± 9.21 ng/mL (10% of the patients had hypovitaminosis D). Most cases of hypovitaminosis (96%) did not course with secondary hyperparathyroidism (mean PTH = 41.80 ± 22.75 pg/mL). Conclusion Hypovitaminosis D was found in a significant percentage (61.22%) of the patients who suffered fractures. Further studies on the subject are needed to better understand the influence of hypovitaminosis D on the occurrence of fractures, as well as the benefits of vitamin D supplementation in these patients.

Resumo Objetivo Dosar a vitamina D nos pacientes internados por fratura e avaliar sua relação com as fraturas. Métodos Realizou-se estudo primário, analítico, transversal, não intervencional, observacional, controlado, em seres humanos. Fez-se a dosagem sérica de: vitamina D, paratormônio(PTH), cálcio, fósforo, magnésio e albumina em 49 pacientes que foram internados consecutivamente para cirurgia devido a fratura(s) (grupo de estudo), e em 50 pacientes, dos diversos ambulatórios, sem fraturas, e que realizaram exames de rotina (grupo de controle). Resultados A média de 25-hidroxivitamina D (25[OH]D) nos pacientes com fraturas foi de 23,78 ± 8,01 ng/mL (61,22% dos pacientes com fraturas apresentaram hipovitaminose D). A média de 25(OH)D do grupo de controle foi de 37,52 ± 9,21 ng/mL (10% dos pacientes apresentaram hipovitaminose D). A maioria dos casos de hipovitaminose (96%) não cursou com hiperparatireoidismo secundário (média do PTH = 41,80 ± 22,75 pg/mL). Conclusão A hipovitaminose D foi encontrada em um percentual expressivo (61,22%) dos pacientes que sofreram fraturas. Mais estudos sobre o assunto são necessários para se compreender melhor a influência da hipovitaminose D na ocorrência das fraturas e os benefícios da suplementação com vitamina D nesses pacientes.

Bridge plating for simple tibial fractures treated by minimally invasive plate osteosynthesis / [Estabilização em ponte de fraturas tibiais simples por osteossíntese minimamente invasiva com placa]

This study aimed to evaluate the effectiveness of bridge plating of simple tibial fractures in dogs by minimally invasive plate osteosynthesis (MIPO). Medical and radiographic records of twenty-nine dogs with simple tibial fractures that underwent bridge fixation by MIPO were retrospectively evaluated. The clinical outcome was classified considering the presence of lameness at the end of the treatment. The tibial mechanical joint angles were measured and compared with the values described in the literature. Additionally, fragment apposition and implant disposition were evaluated. Based on the modified Radiographic Union Scale for Tibial fractures, the moment of clinical union was determined. Clinically, at the end of treatment, only one patient presented lameness at a trot. While there was no significant difference between the bone alignment in the frontal plane values and the values described in the literature (P>0.05), the caudal proximal tibial angle was significantly higher (P=0.001). The median fragment apposition was considered acceptable. The average bridge plate ratio, plate working length, and plate screw density were 0.8, 0.57, and 0.48, respectively. The median time to clinical union was 30 days. Bridge plating in simple tibial fractures resulted in fast healing and low complication rates.(AU)

Objetivou-se avaliar a efetividade da estabilização em ponte de fraturas tibiais simples em cães utilizando-se a técnica de osteossíntese minimamente invasiva com placa (MIPO). Registros médicos e radiográficos de 29 cães com fraturas simples de tíbia, fixadas em ponte por meio da MIPO, foram retrospectivamente avaliados. O resultado clínico foi classificado com base na deambulação ao final do tratamento. Os ângulos articulares mecânicos da tíbia foram aferidos e comparados aos valores descritos na literatura. Adicionalmente, foram avaliadas a aposição dos fragmentos e a disposição dos implantes. Por meio da escala modificada de união radiográfica para fraturas de tíbia, determinou-se o momento de união clínica. Clinicamente, ao final do tratamento, apenas um animal apresentou claudicação ao trote. Não houve diferença significativa entre o alinhamento ósseo no plano frontal quando comparado com dados da literatura (P>0,05), enquanto, no plano sagital, o ângulo mecânico caudal proximal da tíbia foi significativamente maior (P=0,001). A mediana para aposição dos fragmentos foi considerada aceitável. As médias para relação placa em ponte, comprimento de trabalho da placa e densidade de parafusos da placa foram, respectivamente, 0,8; 0,57 e 0,48. A mediana para união clínica foi de 30 dias. A estabilização em ponte de fraturas tibiais simples resultou em rápida consolidação óssea, com baixas taxas de complicação.(AU)