Radiological evaluation of effectiveness of PCCP fixation for femoral neck fracture: med-term effectiveness in a retrospective multicenter.

Background It has been reported in the literature that the complication rate of percutaneous compression plate (PCCP) is the lowest among the new internal fixators for the treatment of femoral neck fracture (FNS). However, no multicenter studies of PCCP for FNS have been reported. This study aimed to evaluate the med-term effectiveness of PCCP in a multicenter mainly through radiology. Methods 265 patients with FNF treated with PCCP fixation in our five hospitals between January 2011 and December 2020 were retrospectively analyzed. 140 men and 125 women; aged 19-79 (mean 51.6）years. The follow-up time was 2-5 years (mean 3.1). Radiological evaluation of the therapeutic effect was the main outcome, and the function was the secondary outcome. Results One case of screw cutting out, 3 cases of screw back out, 25 cases of neck shortening, 2 cases of nonunion, 8 cases of delayed healing, and 29 cases of avascular necrosis (AVN). Bivariate correlation showed that shortening healing was correlated with age, Singh index, and Garden alignment index, poor healing was correlated with garden alignment index, and AVN was correlated with Pauwels and Garden classifications and operation timing. Further pairwise comparison analysis showed that age of > 65 and Singh index IV were dangerous factors for neck shortening, and the operation timing > 3 days, Pauwels II and III, and Garden III and IV were dangerous factors for AVN. The excellent and good rate of function in 198 patients who were readmitted for internal fixator removal or other surgery was 90.9%. Conclusion PCCP for FNS has satisfactory med-term efficacy with a low complication rate. The main complication is AVN, which is prone to occur in patients with displaced Pauwels II or III FNF and operation timing > 3 days. Another main complication is shortening healing, which is prone to occur in patients with an age of > 65 and Singh index IV.

The effect of layers of high tunnel covering and soil mulching on tomato fruit quality.

BACKGROUND: High tunnels (HT) and plastic mulch can increase yield, extend growing seasons, protect plants from harsh weather conditions, and produce more marketable and attractive tomatoes. However, plastic covering reduces solar radiation, which may affect the quality of tomatoes. This study investigated the effects of single-layer versus double-layer HT and plastic mulch versus bare soil on the quality of fully ripe tomato fruits. The study was conducted over 2 years (2021 and 2022). The fruit color (L*, a*, and b*), vitamin C, pH, total titratable acid (TTA), total soluble solids (TSS), and lycopene content of the two tomato cultivars (Brandywine and Rebelski) were quantified. RESULTS: The results showed that quality parameters varied with the plastic layers of HT, plastic mulch, and planting year. The double-layer HT only showed a slight but significant influence on the color of tomatoes of both cultivars in the same year (P < 0.05). Brandywine tomatoes grown in the double-layer HT had significantly lower pH and lycopene content than those grown in single-layer HT, regardless of mulching. The effect of plastic layers on TTA, TSS, and lycopene depended on whether the soil was mulched. Tomatoes grown on bare soil had higher TTA and TSS values than those grown on mulched soil in double-layer HT. Tomatoes grown in single-layer HTs had significantly higher vitamin C content than those in the double-layer HT for both cultivars regardless of mulching. CONCLUSION: This study demonstrates that double-layer HT is unnecessary for the improvement of the overall quality of tomatoes. © 2023 Society of Chemical Industry.

A novel modified McLaughlin surgery for treating locked chronic posterior shoulder dislocation.

BACKGROUND: Posterior shoulder dislocation is an uncommon orthopaedics injury and is frequently missed or misdiagnosed, accounting for 2%-4% of all shoulder dislocations, and is associated with the reverse Hill-Sachs lesion. Once posterior shoulder dislocation develops into a chronic disease, it will bring a lot of trouble to the treatment, especially in repairing the humeral defects. Surgical strategies are also developing and innovating to deal with this injury, including transfer of subscapularis tendon or lesser tubercle, humeral rotational osteotomy, autogenous bone graft or allograft. Shoulder replacement seems to be the ultimate and only option when the injury becomes irreparable, although some studies have shown unsatisfactory follow-up results. Considering no gold-standard treatment for locked posterior shoulder dislocation, we described a novel modified McLaughlin procedure for locked chronic posterior shoulder dislocation and evaluated the functional outcomes. METHODS: This study included five locked chronic posterior shoulder dislocation patients with an associated reverse Hill-Sachs lesion, in which the compression surface covered 30-40% of the humeral head. The mean period from injury to receiving surgery was 11.6 weeks (6-24 weeks). All five patients underwent the modified McLaughlin procedure, mainly divided into three steps, including open reduction, transfer of the partial lesser tuberosity and artificial bone to repair the reverse Hill-Sachs defects. The kernel technique was to fix the transferred tuberosity with two lag screws and strengthen it with two Ethibond sutures. The Constant-Murley score (CMS), the range of shoulder motion and the complications were recorded to assess and compare the functional situation of the shoulder postoperatively and postoperatively. RESULTS: After an average of 19.8 months (12-30) of follow-up, the mean CMS improved to 85.8 ± 4.9 (79-91) compared with 46.0 ± 4.5 (40-52) preoperatively, which showed a significant difference (p = 0.001). In the final follow-up, all five patients showed no symptoms of shoulder instability, and there was no pain or limited activity in daily life, thus all patients were satisfied with the results. CONCLUSION: Repairing the reverse Hill-Sachs lesion by transferring the partial lesser tuberosity combined with artificial bone fixed by lag screws and sutures can ensure shoulder stability and provide pain relief and good function in patients with locked chronic posterior shoulder dislocation associated with the humeral head defect.

Radio-anatomical study of anterior-posterior placement sacroiliac screw channel.

PURPOSE: The outlet of the classic sacroiliac screw (SIS) cannot be precisely controlled by aiming devices, which may lead to malpositioned implants and neurovascular and visceral injury. This study aimed to radio-anatomically measure the parameters of the channel for anterior-posterior placement SIS (AP-SIS), which can be placed percutaneously with an aiming device. METHODS: Pelvic CT scan data of 80 healthy adults (40 males and 40 females) with an average age of 45 years (range 20-70 years) were collected. The length (L), width (W), height (H), cortical bone spacing (M), camber angle (E), anteversion angle (F), cross-sectional safety angle (P) and sagittal safety angle (Q) of the channel were measured by CT or Mimics software. RESULTS: The L, W, H, M, E, F, P and Q measures of S1 were 109.2 ± 8.0 mm, 18.5 ± 1.9 mm, 21.7 ± 1.7 mm, 8.1 ± 0.4 mm, 44.2 ± 3.2°, 42.4 ± 3.6°, 16.8 ± 1.1°, and 19.4 ± 2.0°, respectively, for S1, and 113.5 ± 9.4 mm, 18.2 ± 1.5 mm, 21.7 ± 1.7 mm, 7.7 ± 0.4 mm, 44.7 ± 3.2°, 31.2 ± 2.7°, 13.8 ± 1.0° and 15.4 ± 1.4°, respectively, for S2. Of the L measures, the intra-iliac segment was slightly longer than the intra-sacral segment. All parameters showed significant sex-related differences (p < 0.05). CONCLUSION: The AP-SIS channels of S1-2 have sufficient width and length to accommodate a cancellous screw with a Φ 7.0-8.0 mm and a length 90-130 mm. The intra-iliac segment is a long channel screw with better mechanical properties over classic SIS.

[Short- and medium-term effectiveness of percutaneous compression plate internal fixation in the treatment of femoral neck fractures in the elderly].

OBJECTIVE: To investigate the short- and medium-term effectiveness of percutaneous compression plate (PCCP) internal fixation for femoral neck fractures in the elderly. METHODS: The clinical data of 32 elderly patients with femoral neck fracture treated with PCCP internal fixation between January 2012 and January 2019 were retrospectively analyzed. All of them were traumatic fractures. The causes of injury were falling in 20 cases, traffic accident in 7 cases, and falling from height in 5 cases. According to Garden classification, there were 7 cases of type Ⅱ, 15 cases of type Ⅲ, and 10 cases of type Ⅳ; there were 12 cases with Singh index level Ⅳ, 14 cases with level Ⅴ, and 6 cases with level Ⅵ; the bone mineral density of femoral neck was 0.610-0.860 g/cm 2 (mean, 0.713 g/cm 2). The time from injury to operation was 3-14 days, with an average of 5.8 days. Patients began to weight-bear gradually within 3 days postoperatively. The operation time, intraoperative blood loss, hospitalization stay, fracture reduction (Garden alignment index), fracture healing, failure of internal fixation, femoral neck shortening, and osteonecrosis of the femoral head were observed; hip function recovery was evaluated by Harris score. RESULTS: The operation time was 35-135 minutes (mean, 73.4 minutes), the intraoperative blood loss was 75-385 mL (mean, 116.4 mL), the hospitalization stay was 3-15 days (mean, 8.3 days). At 1 week after operation, the Garden alignment index of fracture reduction was grade Ⅰ in 25 cases, grade Ⅱ in 6 cases, and grade Ⅲ in 1 case. One case of superficial infection of the incision occurred after operation, and no early complications such as deep vein thrombosis in the lower extremities, pulmonary embolism, or bedsores occurred. All the patients were followed up 2.1-4.0 years, with an average of 2.7 years. Except for 2 cases of delayed union (displaced trans-neck and subhead fractures), no nonunion of fracture and failure of internal fixation occurred, the fracture healing time was 4-8 months, with an average of 4.9 months. Femoral neck shortening occurred in 12 cases (37.5%); osteonecrosis of the femoral head occurred in 3 cases (9.4%), all of which were displaced trans-neck and subhead fractures, of which 2 cases received total hip arthroplasty and the other received conservative treatment. The Harris scores of the hip joint at 3 months, 2 years after operation and at last follow-up were significantly improved when compared with those before operation ( P<0.05); there was no significant difference between each time point after operation ( P>0.05). At last follow-up, the hip joint function was evaluated according to Harris score, the results were excellent in 15 cases, good in 12 cases, and fair in 5 cases, with an excellent and good rate of 84.4%. There was no significant difference in postoperative hip function composition among patients with different ages, Garden classification, Singh index, and Garden alignment index ( P>0.05). CONCLUSION: For elderly patients with femoral neck fractures without severe osteoporosis and with relatively good physical conditions, PCCP internal fixation can achieve satisfactory short- and medium-term effectiveness, but there is a certain risk of osteonecrosis of the femoral head.

Changes in local bone mineral density can guide the treatment plan for patients with rupture of the anterior cruciate ligament.

BACKGROUND: Many factors affect the outcomes of anterior cruciate ligament (ACL) reconstruction surgery. However, few studies have examined the effects of local bone conditions on the reconstruction of the ACL. This study investigated the changes in the local bone mineral density (BMD) of the knee after rupture of the ACL with the view of using this information to guide treatment options. METHODS: Patients with ACL rupture treated in our department from January 2017 to April 2019 were enrolled in this study. Prior to surgery, local BMD measurements were obtained from all patients and used to determine the appropriate method of ligament fixation. If the local BMD of the affected knee was not significantly lower than that of the healthy side, extrusion fixation was conducted. If the BMD was significantly lower than that of the healthy knee, suspension fixation was applied. The conditions of tunnel cutting or screw splitting, and tunnel enlargement or screw pull-out were observed during the surgery. The post-surgical function of the knee joint was evaluated regularly by physical examination, imaging data, the IKDC scale score, and the Lysholm score. RESULTS: A total of 80 patients with unilateral ACL rupture were included. There were 64 males and 16 females. Decreased BMD was observed in the affected knee compared to the healthy knee for 68 patients. Patients with an ACL history of more than 3 months had lower BMD compared to patients with a history of less than 3 months. Tunnel enlargement and screw pull-out occurred in 2 patients, screw splitting occurred in 1 patient. The fixation mode was adjusted in real-time during the surgery for 3 patients. All patients were followed up for at least 12 months (mean 20.65±5.12 months). The IKDC score increased from 43.07±2.66 pre-surgery to 89.17±3.28 at the final follow-up, and similarly, the Lysholm score increased from 43.49±2.38 pre-surgery to 89.67±2.97 post-surgery. CONCLUSIONS: The measurement of local BMD before surgery may play a significant role in guiding the type of graft fixation. It is recommended that patients undergo surgical reconstruction within 3 months after injury.

Outcomes of tibial avulsion fracture of the posterior cruciate ligament treated with a homemade hook plate.

OBJECTIVE: To compare the clinical effects of an inverted L-shaped postero-medial approach with a homemade hook plate and arthroscopic fixation with Endobutton for tibial avulsion fractures of the posterior cruciate ligament. METHODS: The clinical data of 36 patients with PCL tibial avulsion fractures from January 2012 to December 2019 were analyzed retrospectively. The fractures were classified into Meyers-McKeever types II and III. Among them, 20 cases were treated with a homemade hook plate through an inverted L-shaped postero-medial approach (incision group), and 16 cases were treated with Endobutton under arthroscopy (arthroscopic group). The operative time, fracture union time, operative complications and range of motion of the knee joint were compared between the two groups. The stability of the knee joint was tested by the posterior drawer test, the functional recovery of the knee joint was evaluated by the Lysholm score, and the gastrocnemius muscle strength of the incision group was tested by performing heel raises with a single leg stance. RESULTS: There were no adverse events, such as fracture nonunion, infection, deep-vein thrombosis, abnormal hematoma or joint stiffness, in either group. The operative time was shorter in the incision group, and the difference was statistically significant (P < 0.05). There was no significant difference in fracture union time between the two groups (P > 0.05). At the last follow-up, there was no significant difference in range of motion or the Lysholm score between the two groups. There was no decrease in gastrocnemius muscle strength in the incision group. CONCLUSIONS: The fixation of PCL tibial avulsion fractures with a homemade hook plate through an inverted L-shaped postero-medial approach is safe and effective. It showed almost the same satisfactory outcomes as arthroscopic Endobutton fixation.

[Effectiveness of percutaneous compression plate fixation for femoral neck fractures].

OBJECTIVE: To investigate the effectiveness of percutaneous compression plate (PCCP) fixation for femoral neck fracture. METHODS: A clinical data of 100 patients with femoral neck fractures who were treated with internal fixation were analyzed retrospectively. The fractures were fixed with the cannulated screws (CS) in 55 patients (CS group) and with the PCCP in 45 patients (PCCP group). There was no significant difference in gender, age, the cause of injury, the fracture type, complications, and disease duration between the two groups ( P>0.05). The quality of fracture reduction, bone resorption, screw slipping, femoral neck shortening, complications (nonunion, failure of fixation, and osteonecrosis of femoral head), and functional recovery of hip (Harris score) were compared between the two groups. RESULTS: All incisions healed by first intention. All patients were followed up 24-56 months, with an average of 30.7 months. The quality of fracture reduction was excellent in 26 cases, good in 18 cases, fair in 9 cases, and poor in 2 cases in CS group and excellent in 21 cases, good in 17 cases, fair in 4 cases, and poor in 3 cases in PCCP group, showing no significant difference between the two groups ( Z=-0.283， P=0.773). The incidence of nonunion in PCCP group was significantly lower than that in CS group ( P=0.046), and the fracture healing time in PCCP group was shorter than that in CS group ( t=2.155, P=0.034). There was no significant difference in the incidences of bone resorption, screw slipping, femoral neck shortening, failure of fixation, and osteonecrosis of femoral head between the two groups ( P>0.05). The overall complication rates were 27.27% (15/55) in CS group and 8.89% (4/45) in PCCP group, showing significant difference ( χ 2=5.435, P=0.020). The Harris score in PCCP group at 6 months after operation was significantly higher than that in CS group ( t=-2.073, P=0.041). However, there was no significant difference in the Harris score at 12, 18, and 24 months after operation between the two groups ( P>0.05). CONCLUSION: Stable sliding compression of PCCP is benefit for the femoral neck fracture healing, especially shortening union.

Retraction of transporting bone segment during Ilizarov bone transport.

BACKGROUND: Retraction of transporting bone segment (TBS) may occur when the fixator of the TBS is removed prior to full consolidation of the distracted callus, which has adverse effect on the healing of the docking site. However, there are few reports on the retraction of TBS. The purpose of this study is to analyze the causes and risk factors of the retraction of TBS. METHODS: The clinical data of 37 cases with tibial bone defect treated by Ilizarov bone transport were analyzed retrospectively, in whom the TBS fixator was removed prior to full consolidation of the distracted callus and union of the docking site. Bivariate correlation was used to analyze relationship between the retraction distance of TBS and potential risk factors including age, gender, course, length of bone defect, number of operations, size of TBS, transport distance, timing and time interval of removal of TBS fixator. Risk factors with significant level were further identified using multivariate linear regression. RESULTS: Bivariate correlation showed that the timing of removal was negatively correlated with the retraction distance, and the time interval and transport distance were positively correlated with the retraction distance(p < 0.05), the age, gender, course, length of bone defect, size of TBS and number of operations were not correlated with the retraction distance(p > 0.05). Multivariate linear regression of the 3 risk factors showed that the timing of removal and time interval were the main risk factors affecting the retraction distance (p < 0.05), but the transport distance was not (p > 0.05). CONCLUSION: The traction forces of TBS endured from the soft tissues and the unconsolidated distracted callus have elastic properties, which can make retraction of TBS. The timing of removal and time interval are the main risk factors of the retraction of TBS. In the case of early removal, another external fixation or quickly converted to internal fixation should be performed to avoid the adverse effect of more retraction.

The influence of obesity on clinical outcomes following primary total knee arthroplasty: A prospective cohort study.

BACKGROUND: The aim of this study was to evaluate the influence of obesity on patients' function, pain, and complications following primary total knee arthroplasty (TKA) with an enhanced-recovery program. METHODS: A total of 157 patients were enrolled into a prospective study and assigned into one of three groups on the basis of their body mass index (BMI): normal (BMI 18.0-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2), or obese (BMI ≥30.0 kg/m2). The primary outcome was knee range of motion (ROM) on postoperative day (POD) 3, 15, 30, and 90, and secondary outcomes were visual analog scale (VAS) on POD 1, 2, 3, 15, 30, and 90, length of stay, and complications. RESULTS: The ROM of patients in the obese group on POD 3 was higher than in the normal (104.4 ±â€¯8.5 vs. 98.9 ±â€¯8.9, P = .010) and overweight (104.4 ±â€¯8.5 vs. 97.7 ±â€¯7.8, P = .001) groups. Similarly, the VAS in the obese group at rest on POD 1 was lower than in the normal (2.0 ±â€¯0.7 vs. 2.2 ±â€¯0.6, P = .043) and overweight (2.0 ±â€¯0.7 vs. 2.3 ±â€¯0.6, P = .010) groups. In addition, the incidence of complications did not differ significantly among the three groups, but the length of hospital stay in the obese group was longer (P = .027). CONCLUSIONS: Obesity may not affect patients' function and pain, and may not increase the incidence of complications following primary TKA. Obese patients may obtain satisfactory functional rehabilitation outcomes, but with a longer duration of rehabilitation.

Similarities and Differences of Induced Membrane Technique Versus Wrap Bone Graft Technique.

BACKGROUND: There are no reports on the similarities and differences between induced membrane (IM) technique and wrap bone graft(WBG) technique. OBJECTIVE: The aims of this study are to investigate the effects of IM technique and WBR technique in repairing segmental bone defects, and to analyze the similarities and differences between them. MATERIALS AND METHODS: 66 patients of tibial segmental bone defects treated by IM technique and WBG technique were retrospectively analyzed. Aged 13-69 years old with an average of 35.3 years old. IM technique was divided into early IM group (bone grafting at 6-8 weeks of bone cement filling) and late IM group (bone grafting after 8 weeks of bone cement filling). WBG was divided into titanium mesh group and line suturing cortical bone blocks group. There were 11 cases, 25 cases, 10 cases and 20 cases in the early IM group, late IM group, titanium mesh group and line suturing group, respectively. Bone healing, complications and functional recovery (Paley's method) were observed, the causes of nonunion and delayed union and factors affecting bone healing were analyzed. RESULTS: There were no significant differences in terms of age, sex, defect length, course, fixation method, defect location and preoperative function of adjacent joints among the 4 groups. All patients were followed up for 12-50 months, with an average of 20.1 months. The clinical healing time of early IM group, late IM group, titanium mesh group and line suturing group were (5.81 ± 0.75) months, (7.56 ± 1.66) months, (7.50 ± 0.70) months and (7.81 ± 1.81) months, respectively, showing significant differences among the 4 groups (P = 0.005). However, only early IM group had significant difference with other groups (P < 0.05), while no significance was found between late IM group and WBR group, between titanium mesh group and suture group (P > 0.05). There were no significant differences in healing ration, complications and functional recovery of adjacent joints among the 4 groups (P > 0.05). There were 4 cases of nonunion and delayed union, all of which were caused by poor quantity or quality of bone graft or unstable bone graft or internal fixation. CONCLUSION: Both IM technique and WBG technique are effective method for repairing segmental bone defects. In addition to mechanical encapsulation, early IM has biological osteogenesis. However, mechanical encapsulation is a common basis for repairing bone defects, and biological osteogenesis can enhance bone healing.

The P2X7 receptor (P2X7R)-specific antagonist A804598 inhibits inflammatory reaction in human fibroblast-like synoviocytes.

Activation of the P2X7 receptor (P2X7R) has been found to increase expression of tumor necrosis factor-α (TNF-α) in the joints and synovial lining of patients with rheumatoid arthritis (RA). Increased expression of TNF-α promotes joint destruction through deterioration of type II collagen by matrix metalloproteinases (MMPs), expression of proinflammatory cytokines, oxidative stress, and activation of cellular signaling pathways. In the present study, we exposed fibroblast-like synoviocytes (FLSs) to TNF-α in the presence and absence of the P2X7R antagonist A804598. We then employed real time PCR and western blot analysis to analyze the mRNA and protein expression levels of P2X7R in both control and RA-FLSs. We confirmed that P2X7R is expressed on FLSs and is upregulated in RA-FLSs and FLSs exposed to TNF-α. Importantly, we also demonstrate the ability of P2X7R antagonism using A804598 to suppress oxidative stress, expression of interleukin (IL)-1ß, IL-6, MMP-1, MMP-3, MMP-13 as well as activation of the Janus family of tyrosine kinase/signal transducer and activator of transcription (JAK1/STAT3) proinflammatory signaling pathway. These findings implicate a novel role of antagonism of P2X7R as a target for the treatment and prevention of RA.

SNHG16 promotes osteosarcoma progression and enhances cisplatin resistance by sponging miR-16 to upregulate ATG4B expression.

BACKGROUND: Human osteosarcoma is the most common primary cancer of the bone. Multiple mechanisms underlying cell growth, apoptosis, bone development, and drug resistance are important in the development of osteosarcoma therapy, which remains to be fully studied. METHODS: We collected thirty-paired tumor tissues and the adjacent normal ones from osteosarcoma patients. Two osteosarcoma cell lines (SAOS2, U2OS) were used for in vitro experiments. RT-qPCR and Western blot were used for gene expression detection. We applied starBase to predict the potential binding sites. Then, the luciferase reporter assay was used to confirm the potential direct interaction. Besides, we applied CCK-8, EdU assay, and flow cytometric assays to detect cell growth and apoptosis rate. We used wound healing and transwell assays to determine cell migration and invasion abilities. Additionally, we constructed a cisplatin-resistant osteosarcoma cell line to study the potential impact of the regulatory axis on drug resistance. RESULTS: Small nucleolar RNA host gene 16 (SNHG16) and autophagy-related 4B (ATG4B) were significantly upregulated in osteosarcoma tissues than the normal ones, and the higher expression level of SNHG16 predicted a poor prognosis in osteosarcoma patients. By contrast, the expression level of miR-16 was markedly lower in tumor tissues and was negatively correlated with SNHG16 (p < 0.001). SNHG16 was shown to promote cell growth, migration, and invasion, while miR-16 reversed this impact. Meanwhile, overexpression of ATG4B significantly promoted the development of osteosarcoma cells attenuated by SNHG16 knockdown or miR-16 mimics. Specifically, overexpression of ATG4B promoted cisplatin-induced autophagy and inhibited cell apoptosis rate, which enhanced the cisplatin resistance in osteosarcoma cell lines. CONCLUSIONS: Overall, our findings showed the importance of the regulatory axis of SNHG16/miR-16/ATG4B underlying osteosarcoma progression and chemoresistance to cisplatin. This research would benefit the therapy development in the treatment of osteosarcoma.

Application of multiple wrapped cancellous bone graft methods for treatment of segmental bone defects.

BACKGROUND: The aims of this study were to discuss the principle, therapeutic effect and influencing factors of multiple wrapped cancellous bone graft methods for treatment of segmental bone defects. METHODS: This study retrospectively analyzed the therapeutic effect of different wrapped autologous cancellous bone graft techniques on 51 patients aged (34.5 ± 11.5) years with segmental bone defects. Cancellous bones were wrapped with titanium mesh (n = 9), line mesh (n = 10), line suturing or line binding cortical block, (n = 13), or induced membrane (n = 19). The bone defeats were as follows: tibia (n = 23), radial bone (n = 10), humerus (n = 8), ulnar bone (n = 7), and femur (n = 3). The defect lengths were (5.9 ± 1.1) cm. The functionary recovery of adjacent joint was evaluated by the Paley's method and DASH, respectively. RESULTS: The incision healed by first intention in 48 cases and secondary healing in 3 cases. All patients were followed up for 19.1 ± 7.1 (12-48) months. Other than one patient with nonunion who received a secondary bone graft, all the patients were first intention of bone healing (the healing rate was 98.0%). The healing time was 6.1 ± 2.1 (3-15) months. There were no significant differences in the healing time among the 4 groups (χ2 = 1.864, P = 0.601). The incidence of complications in the grafted site was 11.8%, whereas it was 21.6% in the harvest site. At the last follow-up, all the patients had recovered and were able to engage in weight-bearing activities. The functional recovery was good to excellent in 78.4% of cases, there were no significant difference among the 4 groups (χ2 = 5.429, P = 0.143). CONCLUSIONS: Wrapped cancellous bone grafting is a modified free bone graft method that can be used in the treatment of small and large segmental bone defects as it prevents loosening and bone absorption after bone grafting. The effect of bone healing is related with the quality and quantity of grafted bone, stability of bone defects, property of wrapping material and peripheral blood supply.

Surgical treatment of avulsion fracture around joints of extremities using hook plate fixation.

PURPOSE: This study proposed to access the clinical outcome of avulsion fractures around joints of extremities using the hook plate. METHODS: A total of 60 patients with avulsion fractures of joints admitted in our hospital between January 2011 and June 2016 were performed the surgery of hook plate fixation. Functional recovery was evaluated using the Lysholm knee score, Kaikkonen ankle injury score, Mayo elbow and wrist function score, and Neer shoulder function score. RESULTS: All the patients were healed within 3 months after surgery with stage I healing incision without vascular or nerve injuries. The average follow-up period was 18.1 months. At the last follow-up, no instability of joints, looseness of internal fixation or traumatic arthritis was observed. Mild joint fibrosis occurred in 5 cases. A total of 57 patients were well recovered with the excellent and good rate of 95%. Three patients with humeral avulsion fracture of the greater tuberosity had shoulder joint adhesion and peri humeral inflammation at the last follow-up due to the poor cooperation for early rehabilitation exercise. In the last follow-ups, the functional score of the affected limb was markedly greater than that in the 3-month follow-ups (p < 0.05). CONCLUSION: Hook plate fixation has the therapeutic effect on treating avulsion fractures around joints of extremities with the advantages of reliable fixation, early rehabilitation after operation, high recovery rates of joint function, wide indications, and convenient uses.

Clinical observation of C3-type patellar fractures treated by operation methods with or without a turned-over patella.

OBJECTIVE: To evaluate the clinical efficacy of operation methods with or without a turned-over patella for treatment of C3-type patellar fractures. METHODS: A total of 68 patients with C3-type patellar fractures undergoing open reduction and internal fixation were retrospectively selected and treated with a turned-over patella surgery (turned-over patella group, n = 30) or conventional therapy without turning over the patella (conventional group, n = 38). The intraoperative and postoperative indicators of the two groups were assessed and comparatively analyzed. RESULTS: The bedridden time was significantly shorter in the turned-over patella group than in the conventional group (P = 0.002), while the range of motion (ROM) of knee joint was significantly higher in the turned-over patella group (P = 0.044). The Lysholm score was slightly higher in the turned-over patella group than in the conventional group, but the difference was not statistically significant (P = 0.055). No significant difference was observed between the two groups in terms of the operation time (P = 0.096), intraoperative blood loss (P = 0.543), time of weight bearing (P = 0.312), fracture healing time (P = 0.272), or complications (P = 1). CONCLUSION: The turned-over patella operation method exhibited some superiority to conventional reduction-fixation approach for treatment of C3-type patellar fractures in terms of efficacy and safety by enlarging the ROM of the knee joint and promoting functional recovery.

Induced membrane technique in the treatment of infectious bone defect: A clinical analysis.

BACKGROUND: At present, it is still a challenge for repairing a wide range of bone defect caused by various reasons. We aimed to investigate the effect of induced membrane technique in the treatment of infectious bone defect. PATIENTS AND METHODS: The clinical data of twenty-one patients with infectious bone defect that received induced membrane technique treatment from January 2008 to August 2017 were collected for this study. The complications were recorded, and the bone defect healing and the recovery of joint function were evaluated by Paley method. The adjacent joint activities were also evaluated. RESULTS: One month after the first stage of surgery, one case had wound dehiscence, and others healed well without infection. Six cases had induced membrane injury during the second stage of surgery, and 4 of them received induced membrane wrapping reconstruction. At the last follow-up, bone defect healing was excellent, the joint function was restored (the rate of excellent and good was 90.5%). The joint range of motion recovered well and the rate of excellent and good was 81.0%. CONCLUSION: Induction membrane technique in the treatment of infectious bone defect has advantages of simple operation, rapid healing of bone defects, and low recurrence rate of infection.

CircRUNX2 through has-miR-203 regulates RUNX2 to prevent osteoporosis.

OBJECTIVE: We aimed to discover the molecular mechanism of hsa_circ_0076694 (circRUNX2) on osteogenic differentiation. We also explored the interaction between circRUNX2, miR-203 and RUNX2. METHODS: Clinical samples obtained from femoral neck fracture patients' bone tissues were used to collect circRUNX2, miR-203, and RUNX2 expression data, while their expression changes were observed in human bone mesenchymal stem cells (hBMSCs) during osteogenic differentiation. QRT-PCR and Western blot were used to analyse levels of RNAs and proteins. Biotin pull down, RIP, RNA FISH, and Dual-Luciferase Reporter assays demonstrated the relationship between circRUNX2, miR-203, and RUNX2. ALP and ARS staining were used to measure the degree of osteogenic differentiation under the control of circRUNX2, miR-203. RESULTS: CircRUNX2 were down-regulated in osteoporotic patients' bone tissues. CircRUNX2 could inhibit miR-203 expression by sponging miR-203. MiR-203 inhibited osteogenic differentiation by targeting the 3'-UTR of RUNX2 and down-regulate RUNX2 expression. Overexpression of circRUNX2 promoted the expression of osteogenic differentiation-related proteins such as RUNX2, OCN, OPN, BSP, and prevented osteoporosis. CONCLUSION: circRUNX2 could sponge miR-203 and enhance RUNX2 expression, thus circRUNX2 prevents osteoporosis and may provide a novel therapeutic strategy for it.

Ilizarov technique: Bone transport versus bone shortening-lengthening for tibial bone and soft-tissue defects.

OBJECTIVE: To compare the outcomes of bone transport and bone shortening-lengthening by Ilizarov technique for treatment of tibial bone and soft-tissue defects. METHODS: Fifty patients with tibial bone and soft-tissue defects were treated by Ilizarov technique from January 2007 to June 2016. Two subgroups were treated by either bone transport (group A) containing 28 cases or bone shortening-lengthening (group B) including 22 cases. RESULTS: Bony union was achieved at the distracted sites with a mean of 236 days in group A, while 240 days in group B, showing no significant difference (t = -0.931, P = 0.308). The mean fixation index was 3.91 d/mm and 3.92 d/mm, respectively. There was no obvious difference (t = 2.839, P = 0.006) of the mean union time at the docking sites with 376 days and 320 days, respectively. According to the Paley's criterion, 21 patients had excellent bony union and 5 good in group A, as compared to 18 excellent and 4 good in group B, but no significant difference (X2 = -0.308, P = 0.741) was observed. The functional results were excellent in 11 patients, good in 10 and fair in 7, as well as 15 complications in group A, compared with 7 excellent, 10 good and 5 fair, together with 12 complications in group B, and there were no remarkable difference (X2 = -0.323, P = 0.751; X2 = -0.590, P = 0.562). CONCLUSION: Overall, the outcomes are similar of bone transport or bone shortening-lengthening by using Ilizarov technique for treatment of tibial bone and soft-tissue defects, although the latter has less union time and higher healing rate.

Image classification for Die-punch fracture of intermediate column of the distal radius.

OBJECTIVE: The aim of the study was to analyze the imaging findings of Die-punch fracture of intermediate column of the distal radius, and to explore the clinical application value of image classification. METHODS: The clinical data of 45 patients who were admitted to our hospital from May 2010 to October 2016 were analyzed retrospectively. All patients met the inclusion criteria for Die-punch fracture. X-ray and CT scan were performed to examine the fracture, and the results were assessed by two doctors in a double blind method. Finally, the image classification of Die-punch fracture was formulated. RESULTS: According to the imaging features of Die-punch fracture, it was divided into four types: type I (dorsal type, 15 cases), type II (volar type, 8 cases), type III (splitting type, 10 cases), type IV (collapsed type, 12 cases). The accuracy rate of CT was 100% (45/45). The misclassification rate of X-ray was 15.6% (7/45) and the missed diagnosis rate was 11.1% (5/45). CONCLUSIONS: CT examination could accurately diagnose Die-punch fracture and perform preoperative image classification.