Surgical Treatment of Intra-Articular Distal Humeral Fractures by using a Combined Medial and Lateral Approach: An Anatomic Study.

OBJECTIVE: To determine the visible size of the distal humeral articular surface by using a novel combined medial-lateral approach as an alternative method of surgical treatment for intra-articular distal humeral fractures. METHODS: In this anatomical study, 12 adult fresh-frozen cadaveric elbows were randomly divided into a medial-lateral group and an olecranon osteotomy group, with 6 in each group. In the medial-lateral group, a medial approach was first used, and then a lateral approach. The sizes of the distal humeral articular surface exposed by each incision and the joined size were measured and calculated. In the olecranon osteotomy group, a posterior olecranon osteotomy approach was applied, and the maximal visible sizes of the articular surface were marked and calculated. Ratios of the maximal sizes of the distal humeral articular surface of the two approaches were compared. RESULTS: In the medial-lateral group, the medial approach could expose 2/5 of the medial trochlea and 1/3 of the capitellum, while the mean visible size of the distal humeral articular surface was 6.8 cm2 , 34.8% of the entire surface; the lateral approach can expose 3/7 of the capitellum and 1/4 of the medial trochlea, while the mean visible size of the distal humeral articular surface was 6.7 cm2 , 33.9% of the whole surface; for the combined medial-lateral approach, the mean scope exposed of the medial and lateral visible articular surface was 38.2% and 43.1%, respectively. Meanwhile, in the olecranon osteotomy group, the posterior olecranon osteotomy was found to expose most of the posterior distal humeral articular surface, except for 1/3 of the anterior trochlea and 1/4 of the anterior capitellum, and the visible range of articular surface was 65.3%. The combined medial-lateral approach exposed 9.2 cm2 in total, 46.9% of the whole distal humeral articular surface, which averaged 19.6 cm2 . However, the visible size of the distal humeral articular surface for the olecranon osteotomy approach was 13.7 cm2 , 63.1% of the entire distal humeral articular surface, which averaged 21.3 cm2 . There was a significant difference observed between the medial-lateral group (46.9%) and the olecranon osteotomy group (63.1%) for the maximal visible size of the distal humeral articular surface (t = 7.201, P = 0.001). CONCLUSIONS: The combined medial-lateral approach can expose 46.9% of the distal humeral articular surface, concentrating on the anterior part, so it can be recommended to treat intra-articular fractures with a simple pattern in the posterior with the anterior side of the distal humerus less comminuted.

Advantages of Pure Platelet-Rich Plasma Compared with Leukocyte- and Platelet-Rich Plasma in Treating Rabbit Knee Osteoarthritis.

BACKGROUND Concentrated leukocytes in leukocyte- and platelet-rich plasma (L-PRP) may deliver increased levels of pro-inflammatory cytokines to activate the NF-κB signaling pathway, to counter the beneficial effects of growth factors on osteoarthritic cartilage. However, to date no relevant studies have substantiated that in vivo. MATERIAL AND METHODS Autologous L-PRP and pure platelet-rich plasma (P-PRP) were prepared, measured for componential composition, and injected intra-articularly after 4, 5, and 6 weeks post-anterior cruciate ligament transection. Caffeic acid phenethyl ester (CAPE) was injected intraperitoneally to inhibit NF-κB activation. All rabbits were sacrificed after 8 weeks postoperative. Enzyme-linked immunosorbent assays were performed to determine interleukin 1ß (IL-1ß) and prostaglandin E2 (PGE2) concentrations in the synovial fluid, Indian ink staining was performed for gross morphological assessment, and hematoxylin and eosin staining and toluidine blue staining were performed for histological assessment. RESULTS Compared with L-PRP, P-PRP injections achieved better outcomes regarding the prevention of cartilage destruction, preservation of cartilaginous matrix, and reduction of IL-1ß and PGE2 concentrations. CAPE injections reversed the increased IL-1ß and PGE2 concentrations in the synovial fluid after L-PRP injections and improved the outcome of L-PRP injections to a level similar to P-PRP injections, while they had no influence on the therapeutic efficacy of P-PRP injections. CONCLUSIONS Concentrated leukocytes in L-PRP may release increased levels of pro-inflammatory cytokines to activate the NF-κB signaling pathway, to counter the beneficial effects of growth factors on osteoarthritic cartilage, and finally, result in a inferior efficacy of L-PRP to P-PRP for the treatment of osteoarthritis.

Percutaneous vertebroplasty compared with conservative treatment in patients with chronic painful osteoporotic spinal fractures.

The efficacy of percutaneous vertebroplasty (PVP) for patients with chronic painful osteoporotic compression fractures remains unknown. The purpose of this study was to compare the efficacy of PVP and conservative treatment (CT) for pain relief and functional outcome in patients with chronic compression fractures and persistent pain. Ninety-six patients with chronic compression fractures confirmed by MRI and persistent severe pain for 3 months or longer were prospectively randomly assigned to undergo PVP (n=46, Group A) or CT (n=50, Group B). The primary outcome was pain relief and functional outcome at 1 week, 1 month, 3 months, 6 months and 1 year. A total of 89 patients (46 in Group A and 43 in Group B) completed the 1 year follow-up assessment. Pain relief and functional outcomes were significantly better in Group A than in Group B, as determined by visual analogue scale scores, Oswestry Disability Index scores, and Roland Morris Disability scores at 1 week, 1 month, 3 months, 6 months and 1 year (all p<0.001). The final clinical follow-up assessment indicated complete pain relief in 39 Group A patients and 15 Group B patients (p<0.001). PVP for patients with chronic compression fractures and persistent severe pain was associated with better pain relief and improved functional outcomes at 1 year compared to CT.

Surgical treatment of Ideberg type III glenoid fractures with associated superior shoulder suspensory complex injury.

Ideberg type III glenoid fractures with associated superior shoulder suspensory complex (SSSC) injuries are rare, and related treatments have not been reported in the literature. The purpose of this study was to evaluate the clinical outcomes of such injuries treated with open reduction and internal fixation (ORIF). Between July 2007 and April 2012, ten patients with Ideberg type III glenoid fractures were surgically treated using ORIF with 2 cannulated screws or a screw combined with a metacarpal plate through an anterior approach. Patients with associated SSSC injuries underwent ORIF with K-wires or plates. Information was available for 9 patients with a mean follow-up of 24.1±18.2 months. Mean bone-healing time was 8.4±2.2 weeks. At last follow-up, mean forward flexion of the operative shoulder was 157.8°±7.5°, mean external rotation was 62.9°±7.9°, and mean internal rotation was thoracic level T6±0.8. Mean Constant score was 84.1±3.7 points, which was a mean of 92.7%±3.4% of that seen in the contralateral shoulder. Mean UCLA score and Disabilities of the Arm, Shoulder and Hand score were 33.6±1.7 and 16.6±7.7, respectively. The results show that Ideberg type III glenoid fractures with associated SSSC injuries can be successfully treated using ORIF through an anterior approach. Glenoid fractures and SCCC injuries should be treated simultaneously.