Interpretations of Management of Hip Fractures in Older Adults:Evidence-Based Clinical Practice Guideline dopted by AAOS 2021 / 中国骨伤

American Academy of Orthopaedic Surgeons (AAOS) just released the up-to-date <Management of Hip Fractures in Older Adults:Evidence-Based Clinical Practice Guideline>, which has become the principles to care hip fractures in the elderly. In comparison to the Guideline 2014, considerable changes are made in terms of guideline composition and focused items. The interval of 7 years yielded dramatic progress in the care of geriatric hip fractures, including the recommendation of cemented femoral stems in hip arthroplasty due to displaced femoral neck fractures, cephalomedullary device for unstable intertrochanteric fractures and tranexamic acid to reduce blood loss and blood transfusion. Additionally, the individualized properties of the elderly with hip fractures should be noted to balance an early operation within 24 and 48 hours and patient safety. The interpretation of <Management of Hip Fractures in Older Adults:Evidence-Based Clinical Practice Guideline> is helpful to comprehensively understand the progress of the care of geriatric hip fractures, thus to make orthopaedic surgeons master the key points of clinical practice, and to improve the quality of operations and decrease perioperative complications.

Simultaneous bilateral fractures of the femoral neck caused by high energy: A case report and literature review / 中华创伤杂志(英文版)

Simultaneous bilateral fractures of the femoral neck are rare injuries, which are reportedly induced by low-speed energy with predisposing factors including systemic diseases, medications and eclamptic seizures. Those caused by high energy are even rarer. High energy-induced bilateral fractures of the femoral neck conceive of high incidence of mortality and present great challenges in the early management. We report one case of a 52-year-old man with simultaneous bilateral fractures of the femoral neck which resulted from a motor pedestrian accident. One-stage closed reduction and internal fixation was done following the emergent resuscitation and neurosurgical management for concomitant brain injuries. The fractures united. There was no pain in the hips, and they had a normal range of motion. The treatment protocol, mechanism of the injury and possible postoperative complications were discussed to expand a comprehensive understanding about these infrequent types of fractures.

Subtrochanteric femur fracture treated by intramedullary fixation / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To discuss surgical technique, operative efficacy and clinical outcome of intramedullary fixation in the treatment of subtrochanteric femur fractures.</p><p><b>METHODS</b>From February 2011 to February 2013, 76 cases of subtrochanteric femur fractures were treated by intramedullary fixation in our hospital, including 53 males and 23 females, with the age range of 37 -72 years (mean 53.5 years). According to Seinsheimer classification, there were 2 cases of type I, 7 type II, 15 type III, 23 type IV and 29 type V. Firstly, all patients underwent closed reduction with the guidance of C-arm fluoroscopy in a traction table. Two cases of type I and 3 cases of type III fractures had ideal closed reduction followed by internal fixation. The others needed additional limited open reduction. Radiographic examination was used to evaluate callus formation and fracture healing in postoperative 1, 3, 6 and 12 months follow-up. Functional recovery was evaluated by Harris Hip Scoring (HHS) system.</p><p><b>RESULTS</b>Patients were followed up for 6-12 months. All fractures were healed except one patient with delayed union. The average bone union time was 4.5 months. According to HHS system, 65 cases were considered as excellent in functional recovery, 8 good, 2 fair and 1 poor. The proportion of the patients with excellent and good recovery was 96.05%.</p><p><b>CONCLUSION</b>Intramedullary fixation is feasible for the treatment of subtrochanteric femur fracture. The accuracy of intraoperative reduction and surgical skill are important for the clinical outcome and the patients' prognosis.</p>

Blood loss closely correlates with body mass index in total hip arthroplasty performed through direct lateral approach

To investigate total blood loss [TBL], intraoperative blood loss [IBL], post-operative drainage [POD], and other related variables in total hip arthroplasty [THA] performed through direct lateral approach. This study was completed in Shanghai Sixth People's Hospital, Shanghai, China, between January and December 2010. We analyzed 113 patients treated by THA through direct lateral approach. Recordable blood loss [RBL] was measured and TBL was calculated according to the Gross formula. Ordinal logistic regression analysis was used for TBL, IBL, and POD, with gender, age, body mass index [BMI], disease duration, and operative time as independent variables. The average operative time was 51.5 +/- 10.4 [range: 35-70] minutes, with an average RBL of 454 +/- 144 [range: 150-180] ml. Average TBL was significantly higher [975 +/- 355, range: 430-2020 ml; p<0.001]. In the analysis of variables, BMI closely correlated with TBL, IBL, and POD, with odds ratios of 4.80 [95% CI: 2.63-8.78 [TBL]], 5.39 [95% CI: 2.84-10.25 [IBL]], and 4.37 [95% CI: 2.43-7.89 [POD]]. Moreover, TBL [54.172], IBL [55.198], and POD [39.139] correlated with trend test BMI. The TBL, IBL, and POD closely correlate with BMI in patients undergoing THA through direct lateral approach

Needle acupuncture for osteoarthritis of the knee: a systematic review and updated meta-analysis

To evaluate the efficacy of treatment with acupuncture for knee osteoarthritis. We searched PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials databases from July to October 2011 for randomized controlled trials that compared needle acupuncture with sham acupuncture, standard care, or waiting list control groups in patients with knee osteoarthritis. Of the 490 potentially relevant articles, 14 RCTs involving 3,835 patients were included in the metaanalysis. Two authors independently extracted outcome data on short-term and long-term pain and functional measures. Standardized mean differences and 95% confidence intervals were calculated using the mean differences in improvements from baseline and the associated standard deviations in patients assigned to acupuncture and those assigned to control groups according to measurement time points. Compared with sham acupuncture control treatment, acupuncture was significantly better at relieving pain [p=0.002] and restoring function [p=0.01] in the short-term period, and relieving pain [p=0.06] and restoring function [p=0.06] in the long-term. Compared with the standard care and waiting list control treatments, acupuncture was significantly better at relieving pain and restoring function. Acupuncture provided significantly better relief from knee osteoarthritis pain and a larger improvement in function than sham acupuncture, standard care treatment, or waiting for further treatment.

Effects of primary tumor excision on angiogenesis and pulmonary metastasis in osteosarcoma-bearing nude mice / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the effects of primary tumor excision on osteosarcoma angiogenesis and pulmonary metastasis, and explore its possible mechanism and clinical significance.</p><p><b>METHODS</b>The tumor-bearing nude mice were constructed by injection of human osteosarcoma cell suspension, and divided into primary tumor resection, amputation and normal groups. The level of VEGF and endostatin was examined by ELISA assay. The hemoglobin content in Matrigel pellets was measured with HiCN method. Pulmonary metastasis was detected with dilated-squash technique and immunohistochemical staining.</p><p><b>RESULTS</b>The serum VEGF and endostatin level was significantly decreased in the primary tumor excision group compared with that in the normal and control groups after operation, but endostatin decreased more prominently [VEGF: (71.43 +/- 9.15) pg/ml vs. (115.81 +/- 4.38) pg/ml, (111.68 +/- 12.26) pg/ml, P < 0.01; ES: (40.77 +/- 5.41) ng/ml vs. (123.18 +/- 5.94) ng/ml, (128.06 +/- 4.52) ng/ml, P < 0.01]. The HB contents in Matrigel pellets increased in the primary tumor excision group compared with that in normal and control groups [(36.55 +/- 2.35) g/L vs. (16.84 +/- 1.15) g/L, (16.29 +/- 1.10) g/L, P < 0.01]. The rate of pulmonary metastasis in tumor excision group was much higher than that in the un-excised groups (80.0% vs. 40.0% and 35.0%, P < 0.05).</p><p><b>CONCLUSION</b>The excision of primary tumor can promote osteosarcoma angiogenesis and pulmonary metastasis, so anti-angiogenic treatment after operation has instructive clinical significance in preventing tumor metastasis.</p>

Inhibitory effect of adenovirus mediated VEGF-siRNA on transplanted osteosarcoma in nude mice / 中国肿瘤生物治疗杂志

Objective: To investigate the inhibitory effect of adenovirus-mediated VEGF-siRNA on transplanted osteo- sarcoma in nude mice.Methods: VEGF-siRNA gene was cloned into the genome of replication-deficient adenovirus to construct Ad-VEGF-siRNA;the latter was then used to infect osteosarcoma MG63 cell line in vitro;and the expression of VEGF gene was detected by RT-PCR.Osteosarcoma transplantation model was established in nude mice;VEGF expression in tumor tissue was analyzed and the inhibitory effect on tumor growth and lung metastasis were also observed.Results: The recombinant adenovirus vector Ad-VEGF-siRNA was successfully constructed.In vivo and in vitro experiment both showed that Ad-VEGF-siRNA significantly downregulated VEGF expression in MG63 cells and transplanted tumor tissue. It was found that Ad-VEGF-siRNA significantly inhibited transplanted osteosarcoma growth(P