Yes-associated protein reacts differently in vascular smooth muscle cells under different intensities of mechanical stretch.

Vascular smooth muscle cells (VSMCs) are stromal cells of the vascular wall and are continually exposed to mechanical signals. The loss of VSMCs is closely related to the occurrence of many vascular diseases, such as aortic aneurysms and aortic dissection. The proliferation and apoptosis of VSMCs are mechanically stimulated. Yes-associated protein (YAP), one of the core components of the Hippo pathway, plays a key role in the response of VSMCs to mechanical signals. In this study, we tested the impact of different intensities of mechanical stretch on the proliferation and apoptosis of VSMCs, as well as YAP. We tested VSMCs' proliferation and apoptosis and YAP reaction via immunocytochemistry, western blotting, CCK-8 and flow cytometric analysis. We found that 10% elongation could increase the phosphorylation of YAP and prevent it from entering the nucleus, as well as inhibit cell proliferation and promote apoptosis. However, 15% elongation reduced YAP phosphorylation and promoted its nuclear entry, thereby promoting cell proliferation and inhibiting apoptosis. Accordingly, YAP knockdown suppressed the phenotype of VMSCs induced by 15% elongation. Taken together, YAP regulates proliferation and apoptosis of VSMCs differently under different intensity of mechanical stretch. Mechanical stretch with appropriate intensity can promote the proliferation and inhibit apoptosis of VSMCs by activating YAP.

Treatment of femoral neck nonunion with a new fixation construct through the Watson-Jones approach.

OBJECTIVE: The aim of the study is to explore the clinical effect of a dynamic condylar screw (DCS) system, medial anatomical buttress plate (MABP), and autogenous iliac bone graft through the Watson-Jones approach in the treatment of femoral neck nonunion. METHODS: This prospective study included 15 patients (12 men and 3 women) with nonunion of femoral neck fracture, who were treated with the DCS and MABP with autogenous iliac bone graft through the Watson-Jones approach. The patients were followed up for an average of 16 months (range, 12-24 months). RESULTS: All patients achieved bone healing with an average fracture healing time of 3.4 months (2.8-4.6 months). The Harris score significantly increased from 30 ± 3.9 before the operation to 87.6 ± 7.9 at the last follow-up, and the visual analogue scale significantly decreased from 4 ± 1.3 before the operation to 1 ± 1.7 at the last follow-up. The average limb shortening was reduced from 1.8 cm (range, 0-3.1 cm) before the revision operation to 0.5 cm (range, 0.1-1.3 cm) after the last follow-up. The neck-shaft angle of the injured side was restored from an average of 118° (range, 108-139°) before the revision operation to an average of 132° (range, 127-144°) at the last follow-up. No collapse of the femoral head, wound infections, screw backout, screw or plate breakages, or nerve injury was found. CONCLUSION: TheDCS and MABP with autogenous iliac bone graft through the Watson-Jones approach is an effective option for the treatment of femoral neck nonunion or delayed healing. THE TRANSLATIONAL POTENTIAL OF THE ARTICLE: This article shows that the application of DCS and MABP provides a rigid fixation at the fracture site to promote bone graft integration and bone union. This new kind of technique could be one option of Hip conservation procedures, just special for young patients with femoral neck nonunion.

Hub genes and gene functions associated with postmenopausal osteoporosis predicted by an integrated method.

Postmenopausal osteoporosis (PO) imposes great burden on individuals and society. This study predicted hub genes and gene functions for PO by an integration of the convergent evidence (CE) method, rank product (RP) algorithm and the combing of P-values. Using the gene expression data, genes were ranked by the CE method, RP algorithm and combing P-values, respectively. Subsequently, the top 100 genes were selected from each of the three gene lists, and then the common genes for two or three methods were denoted as informative genes of PO. A mutual information network (MIN) was constructed for the informative genes utilizing the context likelihood of relatedness algorithm. Topological centrality (degree) analysis was conducted on the MIN to investigate hub genes. Then we performed Gene Ontology (GO) enrichment analysis dependent upon the Biological Networks Gene Ontology tool (BiNGO) plugin of Cytoscape to investigate hub gene functions for PO patients. Consequently, a total of 82 informative genes were obtained by integrating the results of the three methods. There were 82 nodes and 1,741 edges in the MIN, of which 8 hub genes were identified, such as PFN1, EEF2 and S100A9. The result of GO enrichment analysis showed that 49 GO terms with P<0.001 were detected, especially the top 5 gene sets were defined as hub gene functions of PO, for instance, translational elongation, translation and cellular macromolecule biosynthetic process. In conclusion, we have predicted 8 hub genes and 5 hub gene functions associated with PO patients. The findings might help understand the molecular mechanism underlying PO.

Prevention of Vascular Anastomotic Stenosis With 2-Octylcyanoacrylate.

Although conventional microvascular anastomoses are well-studied, postoperative anastomotic stenoses remain a common surgical complication. The use of 2-octylcyanoacrylate to stabilize vascular anastomoses using a rabbit anastomosis model was investigated. A carotid artery anastomosis model was established in 20 New Zealand rabbits (2.5-3.0 kg): 10 underwent conventional anastomosis surgery with sutures only, while 10 underwent suture ligation, followed by the application of 2-octylcyanoacrylate. Vascular patency and pulse strength were observed after adhesive solidification. The artery diameter was measured preoperatively and at 5 minutes, 2 weeks, and 4 weeks postoperatively. An angiography was performed at 4 weeks postoperatively. Hyperplasia and the induced nitric oxide synthase (iNOS) content of the intima and media layers from the anastomotic stoma were assessed using immunohistochemistry. The artery inner diameter of experimental group decreased at each time point postoperatively (1.686 ±â€Š0.066 cm; 1.656 ±â€Š0.069 cm; 1.646 ±â€Š0.074 cm) (P ≤ 0.01). At 4 weeks postoperatively, the intima and the media around the anastomosis was both significantly thinner in the experimental group (13.21 ±â€Š0.84 µm; 234.86 ±â€Š13.84 µm) than in the control group (17.06 ±â€Š0.96 µm; 279.88 ±â€Š34.22 µm) (P < 0.05). At 4 weeks postsurgery, intravascular iNOS expression was increased in both groups but was higher in the experimental group (82.5% versus 47.5%). The above results indicated that 2-octylcyanoacrylate adhesive can inhibit stenosis of vascular anastomoses.

[Testing System for Biomechanical Properties of Bone].

A novel testing system is designed to simulate the mechanical performance and evaluate the biomechanical properties of the bone and the corresponding bone fixator. It is mainly composed of movement platform and servo motor system, sensors and hardware circuit system and software system. In order to prove the feasibility of the design, on the basis of the calibration for the force sensor, the fatigue experiment is carried out using the tibia of the sheep. It is concluded from the result that under the condition of 1 Hz in frequency, 50 kg in loading force and 18 000 cycles, the bone fixator can be still in good condition, which proves the feasibility of the design.

Serum Mast Cell Tryptase as a Marker of Posttraumatic Joint Contracture in a Rabbit Model.

OBJECTIVES: Mast cells have been identified as key mediators of posttraumatic joint contracture, and stabilizing medications (ketotifen) have been shown to decrease contracture severity. Serum mast cell tryptase (SMCT) levels are used clinically to monitor mast cell-mediated conditions. The goals of this study were to determine if SMCT levels are elevated in the setting of joint contracture, if they can be decreased in association with ketotifen therapy, and if they correlate with contracture severity. METHODS: This study used a previously developed rabbit model in which 39 animals were divided into 4 groups: operatively created joint contracture (ORC, n = 13), operatively created contracture treated with ketotifen at 2 doses (KF0.5, n = 9; KF1.0, n = 9), and healthy rabbits (NC, n = 8). Range of motion measures were performed at 8 weeks after the surgery. Serum samples were collected on postoperative days 1, 3, 5, 7, 21, 35, and 49. SMCT levels were measured using a rabbit-specific enzyme-linked immunosorbent assay. RESULTS: Levels of SMCT were highest in the operatively created joint contracture group and were significantly greater compared with both ketotifen groups (P < 0.001). Levels were highest at postoperative day 1 with a trend to decrease over time. A positive correlation between SMCT levels and contracture severity was observed in all operative groups (P < 0.05). CONCLUSIONS: Levels of SMCT are elevated in the setting of joint contracture, decreased in association with ketotifen therapy, and positively correlated with contracture severity. This is the first study to establish a relationship between SMCT and joint injury. Measurement of SMCT may be valuable in identifying those at risk of posttraumatic joint contracture.

[Development on Early Treatment Technique of Vascular Injury in Wartime].

In the background of the high incidence of vascular injury in wartime, this paper introduces the characteristics of vascular injury in war environment and the development of early treatment technique of vascular injury applied in wars since World War Ⅱ. Then, the advantages and limitations of various treatment techniques are also analyzed. Finally, The development of technology and research direction are summarized and prospected.

[Development of Wound Quick Closing Device].

Complex and huge wound closure is a key step in pre hospital emergency care. Wound closure can effectively reduce the loss of blood and fluid inpatients before arriving hospital. Also, it has important significance to save the lives of patients. In this paper, a new type of wound closure device is developed, which is used for the rapid closure of complex and huge wound. Firstly, based on the detailed introduction of the structure working principle, the finite element simulation technology is adopted to analyze the stress of the structure. The results show that the stress of the structure has not beyond the allowable stress of the material. On the basis of this, the experiment was carried out in vitro. Test results show that the closure device operating time is 18.24 s and the minimum penetration of the skin force is 4.08 kg. The closure device can resist the horizontal tension of 1.53 kg and vertical tension of 2.25 kg. It also has good sealing performance and meets the design requirements. The results show that the device designed is reasonable, which can be quickly and effectively to achieve closure of the wound.

[Testing Equipment on Vascular Mechanical Properties].

The vascular mechanical parameters are important indicators for human vascular and they play important roles in clinical research. This paper developed a new vascular mechanical properties testing system. This system not only realizes the tensile rupture test in one dimensional, but also the reciprocating tensile test for vascular, which provides more comprehensive experimental data and theoretical basis for the study of human vascular. The system consists of three parts: the mechanical platform, hardware circuit and upper computer system. The mechanical platform transforms the rotation movement of motor into linear movement via the structure of bal screw. And the bal screw and tension sensor are connected, which is used for mechanical data reading. The displacement data is col ected by displacement sensor. Experiments show that the accuracy is better than 0.292%, and could meet the demand of the testing of vascular biomechanical characteristics.

Channel-assisted minimally invasive repair of acute Achilles tendon rupture.

BACKGROUND: Percutaneous (minimally invasive) suturing is a promising option for Achilles tendon (AT) repair with low rerupture and infection rates. Sural nerve lesions are the major problem to avoid with the technique. A new device was therefore designed for suturing the AT, resulting in channel-assisted minimally invasive repair (CAMIR). The purpose of this study was to compare the clinical and functional outcomes of CAMIR with traditional open techniques. METHOD: Eighty two patients with AT rupture were included: 41 for CAMIR, 41 for open repair. All patients followed a standardized rehabilitation protocol. Follow-ups were at 12 and 24 months after surgery. Functional evaluation was based on the clinical American Orthopaedic Foot & Ankle Society score associated with neurologic deficit (sural nerve), calf circumference, range of motion (ROM), and isometric testing. RESULTS: There was no difference between groups regarding plantar flexor strength, ankle ROM, or calf circumference. CAMIR significantly decreased the operative time compared to open repair (17 vs. 56 min, P < 0.0001). Mean scar length was greater in the open repair group (10 vs. 2 cm, P < 0.0001). There were no wound complications in the CAMIR group but four in the open repair group (P < 0.0001). No deep vein thrombosis, rerupture, or sural nerve injury occurred. CONCLUSION: CAMIR and open repair yielded essentially identical clinical and functional outcomes. Sural nerve injuries can be minimized using CAMIR by carefully placing the suture channel with a stab incision and special trocar based on a modified Bunnell suture technique.

[REPAIR OF ACUTE CLOSED ACHILLES TENDON RUPTURES BY CHANNEL-ASSISTED MINIMALLY INVASIVE REPAIR SYSTEM].

OBJECTIVE: To evaluate the effectiveness of channel-assisted minimally invasive repair (CAMIR) for acute closed Achilles tendon ruptures. METHODS: Between January 2011 and June 2012, 30 patients (30 sides) with acute closed Achilles tendon ruptures were treated with CAMIR technique. Among 30 patients, 18 were male and 12 were female with an average age of 30.4 years (range, 22-50 years); the locations were left side in 10 cases and right side in 20 cases. All the causes were sports injury. B-ultrasound was used to confirm the diagnosis, with the average distance from the rupture site to the Achilles tendon insertion of 4.4 cm (range, 2-8 cm). The time from injury to operation was 3 hours to 9 days (median, 4 days). All injuries were repaired by CAMIR technique. RESULTS: The average operation time was 17.0 minutes (range, 10-25 minutes), and the mean incision length was 2.0 cm (range, 1.5-2.5 cm). All the incisions healed by first intention. There was no complication of wound problem, deep vein thrombosis, re-rupture, or sural nerve injury. All cases were followed up 12-24 months with an average of 16 months. At last follow-up, the patients could walk normally with powerful raising heels and restored to normal activity level. MRI imaging suggested the continuity and healing of ruptured tendon. The circumference difference between affected leg and normal leg was less than 1 cm, and the ankle dorsi-extension was 20-30°, plantar flexion was 20-30°. Arner Lindholm score showed that the surgical results were excellent in 28 cases and good in 2 cases, with an excellent and good rate of 100%. CONCLUSION: CAMIR is a safe and reliable method to repair acute closed Achilles tendon rupture, with many advantages of minimal injury, low re-rupture and infection. Sural nerve injury can be minimized using CAMIR by carefully placing the suture channel with a stab incision and special trocar based on a modified Bunnel suture technique.

Clinical outcomes of allograft with locking compression plates for elderly four-part proximal humerus fractures.

BACKGROUND: The aim of this study is to explore the clinical outcomes of anatomical allograft or fibula shaft augmentation with locking compression plates (LCPs) in elderly patients with four-part proximal humeral fracture (PHF). METHODS: A total of 22 elderly patients with four-part PHF underwent allograft augmentation with LCPs for treatment. Among them, 7 cases received anatomical allograft and 15 patients received fibula shaft. Constant-Murley score (CMS), the disability of the arm, shoulder and hand (DASH) score, and subjective ratings, radiographic imaging, range of motion (ROM), and complications were recorded as postoperative evaluations. RESULTS: Although the ROM and strength were considerably limited compared with the normal side, there were no significant differences in pain and daily activity between the unaffected and affected sides at the last follow-up according to the CMS. Additionally, no significant differences were found in the subjective ratings and CMS and DASH scores between the patients augmented with fibular shaft and anatomical allograft. Among the 15 patients who received fibular shaft, one case developed avascular necrosis (AVN) and screw cutout, but satisfactory outcomes were obtained after removal of implant. Besides, varus displacement occurred in one case, the patient acquired good function without revision. There were no infection, bone nonunion, and hardware-related complications occurred in any case. CONCLUSIONS: Both anatomical allograft and fibula shaft with LCPs showed relatively good clinical outcomes for elderly patients with four-part PHF.

Sciatic nerve repair using adhesive bonding and a modified conduit.

When repairing nerves with adhesives, most researchers place glue directly on the nerve stumps, but this method does not fix the nerve ends well and allows glue to easily invade the nerve ends. In this study, we established a rat model of completely transected sciatic nerve injury and repaired it using a modified 1 cm-length conduit with inner diameter of 1.5 mm. Each end of the cylindrical conduit contains a short linear channel, while the enclosed central tube protects the nerve ends well. Nerves were repaired with 2-octyl-cyanoacrylate and suture, which complement the function of the modified conduit. The results demonstrated that for the same conduit, the average operation time using the adhesive method was much shorter than with the suture method. No significant differences were found between the two groups in sciatic function index, motor evoked potential latency, motor evoked potential amplitude, muscular recovery rate, number of medullated nerve fibers, axon diameter, or medullary sheath thickness. Thus, the adhesive method for repairing nerves using a modified conduit is feasible and effective, and reduces the operation time while providing an equivalent repair effect.

Experimental study on new self and mutual-aiding occlusive dressing for wound.

BACKGROUND: Self and mutual-aiding occlusive dressing is a novel method to treat with the wounds in special circumstances. This study aims to prepare a new antimicrobial adhesive for the dressing and evaluate the application effects of the adhesive. METHODS: The main component of the new antimicrobial adhesive was 5% triclosan / cyanoacrylate (CA) antimicrobial adhesive. The adhesive was modified with carboxylic multi-walled carbon nanotubes (MWCNTs-COOH), multi-walled carbon nanotubes (MWCNTs), hydrophobic nano-silica, nitrile rubber, epoxy resin and polymethyl methacrylate (PMMA) respectively. The bond strength, toughness and viscosity of the modified adhesive in different concentrations were examined to select the optimal modifying material and the best ratio to prepare the new antimicrobial adhesive according to the results. After that, the antimicrobial property of the new antimicrobial adhesive was tested by filter paper method. At last, we disposed the injury models in rats using the new antimicrobial adhesive to examine the application effects. RESULTS: In individual tests, the bond strength modification performance of 0.064% MWCNTS-COOH is the best, the bond strength is (14.71 ± 1.48) Mpa. 8% nano-silica shows the best toughness modification performance, the Tg is (1.10 ± 0.24)°C. The viscosity modification performance of 8% nano-silica is the best, the viscosity is (15 536.68 ± 28.4) cP. However, consolidating three test results, 6% nano-silica/antimicrobial adhesive has the balanced bond strength, toughness and viscosity. Its bond strength is (14.03±1.92) Mpa, the Tg is (3.60 ± 0.68)°C, and the viscosity is (5 278.87 ± 31.68) cP. The inhibition zone diameter of 6% nano-silica/antimicrobial adhesive and antimicrobial adhesive group in Day 5 is (28.61 ± 0.91) mm versus (28.24 ± 2.69) mm (P > 0.05). In animal studies, both in blood routine test and pathological section, 6% nano-silica/antimicrobial adhesive group shows lower white blood cells count than gauze bandage group (P < 0.05). CONCLUSIONS: 6% nano-silica has the optimal effect of bond strength modification, toughness modification and viscosity modification, and the antimicrobial adhesive modified with it has a good antimicrobial property (resistant staphylococcus aureus).

Comparison of lateral and posterior surgical approach in management of extra-articular distal humeral shaft fractures.

OBJECTIVE: The objective of this study was to compare treatment results and complication rates between lateral and posterior approaches in surgical treatment of extra-articular distal humeral shaft fractures. MATERIAL AND METHODS: Between June 2008 and May 2012, a total of 68 patients with extra-articular distal humeral shaft fractures were treated by lateral and posterior approaches. Of the patients, 30 were operated by a lateral approach (group I) and 26 patients were operated by a posterior approach (group II). There was no statistical significance between the two groups in sex distribution, age, the mechanism of the injury, injured arms, AO/ASIF (Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation) classification, and the time from injury to surgery (P>0.05). Operation time, intraoperative bleeding volume, hospitalisation, clinical outcomes, and complications were compared between the two groups. The elbow functional results were evaluated by the Mayo Elbow Performance Score (MEPS). RESULTS: All patients were followed up. The average of follow-up in group I was 15.53±2.636 months (range, 12-22 months), and was 16.12±2.889 months (range, 12-22 months) in group II. There was no significant difference in the operation time, intraoperative bleeding time, and hospitalisation between the two groups (P>0.05). In group I, the mean time of bone union was 12.87±1.852 weeks (range, 10-16 weeks), the mean degrees of elbow flexion was 139.20°±3.274° (range, 134-146°), the mean degrees of elbow extension was 4.77°±1.906° (range, 0-8°), and the mean points of MEPS was 87.00±7.724 (range, 70-100 points). In group II, the mean time of bone union was 12.96±2.218 weeks (range, 10-16 weeks), the mean degrees of elbow flexion was 137.85°±4.076° (range, 130-145°), the mean degrees of elbow extension was 5.15°±2.327° (range, 0-9°), and the mean points of MEPS was 86.15±7.656 (range, 70-100 points). There was no significant difference in the bone union, range of elbow flexion, range of elbow extension and MEPS between the two groups (P>0.05). The overall complication rate in group I was lower than that in group II (P=0.041). CONCLUSIONS: Both lateral and posterior surgical approaches acquired satisfied treatment results in the management of extra-articular distal humeral shaft fractures, and there was a lower complication rate using the lateral approach.

A novel method of defective vascular reconstruction using 2-octyl-cyanoacrylate and homemade prosthetic component.

BACKGROUND: Currently, adhesive technique is popular in vascular repair but not widely used for defective vessels. This study aimed to determine the feasibility and effectiveness of repairing defective vessels with 2-octyl-cyanoacrylate and a homemade prosthetic component. METHODS: Homemade prosthetic component consisting of expanded polytetrofluoroethylene (ePTFE), terylene film, and homemade soluble hollow stent mixed with adhesive can replace autologous graft and suture in repairing defective vessels, can fix vessels better using the stent without occlusive bleeding. Forty male mongrel dogs were used, 20 for biomechanical tests and 20 for animal experiments. In the biomechanical test, dogs were randomly divided into two groups (n = 10 each), one group repaired on the two sides of the carotid arteries with 2-octyl-cyanoacrylate and homemade component and another group repaired with suture and ePTFE. Of the 40 specimens, 10 were used for adhesive and 10 for suture specimens for tension strength test, whereas the remaining specimens were used for bursting pressure test. In animal experiments, dogs were also divided into adhesive and suture groups (n = 10), only of the left carotid artery. Recording the operational time, bleeding or not. Vessels were tested using color Doppler ultrasound, the inner diameter was measured, and the degree of stenosis at 8 weeks was evaluated digital subtraction angiography (DSA) were also performed. Specimens were then analyzed histologically. RESULTS: In the adhesive and suture groups, the specimens could afford atension strength of (23.80 ± 1.51) N versus (24.60 ± 1.08) N (P > 0.05), the bursting pressure was (52.03 ± 2.43) kPa versus (50.04 ± 3.51) kPa (P > 0.05), and the mean time of anastomosis was (15.20 ± 0.55) minutes versus (25.97 ± 0.58) minutes (P < 0.05). One dog in the adhesive group was bleeding from the suture. One dog from each group presented with thrombosis at 1 week. After measuring using ultrasound, the stenosis degree of all dogs were no more than 30% except the two thromboses. DSA and histological observation showed no obvious difference between the two groups. CONCLUSION: Defective vascular anastomosis with 2-octyl-cyanoacrylate and our homemade prosthetic component is feasible, effective, timesaving, and easy to master.

Microvascular sutureless adhesive bonding anastomosis with a new soluble hollow stent.

The aim of this study was to assess a new soluble hollow stent used in an experimental sutureless adhesive bonding technique for microvascular anastomosis. Twenty-four New Zealand white rabbits were randomized into 2 groups. Twelve end-to-end anastomoses of carotid arteries were performed with glue and stent in group A. In control group B, 12 anastomoses were performed by manual suturing. Anastomoses were timed; immediate and late patency at 1 day, 7 days, and 3 weeks after surgery were evaluated by ultrasonography. Specimens were then analyzed histologically. This adhesive bonding technique took 7.02 ± 1.26 minutes to perform while the hand-sewn technique took 15.48 ± 2.10 minutes. Immediate and late patencies of the 2 groups were not statistically different. The new technique using glue and stent appeared to be timesaving, feasible, and efficient.

Comparative study of perpendicular versus parallel double plating methods for type C distal humeral fractures.

BACKGROUND: Double plate osteosynthesis is the standard treatment for intra-articular fractures of the distal humerus. However, there is still controversy concerning dual plate positions in terms of providing optimal stability. The purpose of this retrospective study was to compare the clinical outcomes in patients with type C intra-articular distal humeral fractures using perpendicular and parallel plating methods. METHODS: Between March 2008 and June 2011, a total of 45 patients with type C distal humerus fractures were treated using two different dual plating methods. Of them, 24 patients were treated by perpendicular plating (group I) and 21 patients were treated by parallel plating (group II). The surgical time, blood loss, and union time were compared between the two groups. The flexion-extension arc, the total range of flexion and extension at the end of follow-up were compared between the two groups. The Mayo Elbow Performance Score (MEPS) was used to determine the elbow functional results. RESULTS: All patients were followed up. The mean duration of follow-up was 16 months (range 12 - 25 months) in group I and 15.5 months in group II (range 12 - 25 months). There were no significant differences in the surgical time, blood loss, and the bone union time between the two groups. In group I, the mean elbow flexion-extension arc was 101° and the mean MEPS was 85 points. The rate of excellent and good results was 87.5%. In group II, the mean flexion-extension arc was 100° and the mean MEPS was 86.1 points. The rate of excellent and good results was 90.5%. There were no significant differences in the MEPS, flexion-extension arc, and the total range of flexion and extension between the two groups. CONCLUSIONS: Perpendicular and parallel plate configurations with the appropriate surgical techniques can provide anatomical reconstruction and stable fixation of type C intra-articular distal humeral fractures and allow early mobilization of the elbow after an operation. The occurrence of post-operative elbow stiffness can be reduced and good outcomes can be obtained.

[Effectiveness comparison between locking compression plate fixation and locked intramedullary nail fixation for humeral shaft fracture of types B and C].

OBJECTIVE: To compare the effectiveness between locking compression plate (LCP) and locked intramedullary nail (IMN) for humeral shaft fractures of types B and C. METHODS: Between January 2010 and January 2012, 46 patients with humeral shaft fractures of types B and C were treated, and the clinical data were retrospectively analyzed. LCP was used for internal fixation in 22 cases (LCP group), and IMN in 24 cases (IMN group). There was no significant difference in gender, age, injury causes, the side of fracture, the site of fracture, the type of fracture, associated injury, and time from injury to operation between 2 groups (P > 0.05). The regular clinical examination and evaluation of radiography were done. Shoulder function was evaluated by Neer grading system and elbow function was evaluated by Mayo elbow performance score after operation. RESULTS: The operation time and intraoperative blood loss in IMN group were significantly lower than those in LCP group (P < 0.05). There was no significant difference in hospitalization time between 2 groups (t=0.344, P=0.733). All patients were followed up 16.8 months on average (range, 12-24 months). At 6 months after operation, bone nonunion occurred in 1 patient of LCP group and in 2 patients of IMN group; the bone healing rate was 95.5% (21/22) in LCP group and 91.7% (22/24) in IMN group, showing no significant difference (chi2=0.000, P=1.000). Except for nonunion patients, the bone healing time was (11.77 +/- 0.75) weeks in LCP group and (11.38 +/- 0.82) weeks in IMN group, showing no significant difference (t=1.705, P=0.095). Between LCP and IMN groups, significant differences were found in radial nerve injury (4 cases vs. 0 case) and impingement of shoulder (0 case vs. 6 cases) (P < 0.05), but no significant difference in superficial infection (1 case vs. 0 case) and iatrogenic fracture (1 case vs. 2 cases) (P > 0.05). There was no significant difference in shoulder function and elbow CONCLUSION: LCP fixation and IMN fixation for humeral shaft function at 1 year after operation between 2 groups (P > 0.05). fractures of types B and C can achieved satisfactory results. More attention should be paid to avoiding radial nerve injury by fixation of LCP; nail tail should be buried deeply into the cortex of the greater tuberosity and rotator cuff should be protected to decrease the rate of impingement of shoulder by fixation of IMN.