Replantation and Lengthening of a Lower Leg in a 7-Year-Old Child: A Case Report.

Replantation of the lower leg has controversial indications, but it may be considered in carefully selected patients. Although the function of prosthetic lower legs has been improved in recent decades, leg salvage remains a laudable goal. We present the case of a 7-year-old child who sustained a traumatic amputation at the level of the middle tibia with loss of the middle portion of the lower leg. We performed successful replantation, and tibia lengthening was performed starting 10 days after replantation and lasted 6 months.

Distal Finger Reconstruction by Bilateral Lateral Hallux Osteo-onychocutaneous Free Flap.

OBJECTIVE: In this report, we present our experience on the use of bilateral lateral hallux osteo-onychocutaneous free flaps for reconstruction of distal finger and the aesthetic and functional results of this technique in a series of cases. PATIENTS AND METHODS: From February 2005 to May 2015, 7 patients underwent finger reconstruction distal to the distal interphalangeal joint using the bilateral lateral hallux osteo-onychocutaneous free flaps. The mean age was 29.3 years (range, 24-33 years). The lateral hallux osteo-onychocutaneous flaps were harvested from bilateral donor sites. The size of each flap was designed based on the size of half distal finger defect. The lateral hallux osteo-onychocutaneous free flaps from both donor sites were combined to reconstruct the distal finger. More than 50% of hallux nail was preserved in each of donor sites, which was covered with a local flap. RESULTS: All flaps used for reconstruction survived without complications after surgery. The average length of follow-up was 93.4 months (range, 16-163 months). All reconstructed distal fingers showed good aesthetic appearance, except one that underwent a secondary debulking procedure. The average total active motion of the finger was 215.7 degrees (range, 200-230 degrees). Neither pain nor numbness sensation in the reconstructed fingers was complained by the patients. The donor site morbidity was minimal. All patients had pain-free and good function outcome in both feet. CONCLUSIONS: The use of the bilateral lateral hallux osteo-onychocutaneous free flaps may provide an option for distal finger reconstruction with satisfactory function and anesthetic outcomes with minimal hallux donor site morbidity.

The psychological impact of external fixation using the Ilizarov or Orthofix LRS method to treat tibial osteomyelitis with a bone defect.

OBJECTIVE: To examine the psychological impact of external fixation for a tibial bone defect due to osteomyelitis, and to compare the Orthofix limb reconstruction system (LRS) with the Ilizarov external fixator. MATERIALS AND METHODS: The SCL-90-R questionnaire was administered at four different time points (before surgery, while patients wore the external fixation device, when the device was removed, and two to three months after). The scores at the four time points were compared, as were the two different methods of external fixation (Orthofix LRS vs. Ilizarov). RESULTS: The patients experienced a significant adverse impact on their mental health, with the worst outcomes at Time 2 (while wearing the external fixator), but with some negative effects still present even several months after removal of the fixation device. Although the Orthofix LRS and Ilizarov groups showed similar mental health scores at Time 1 (preoperatively) and Time 3 (upon removal of the fixation device), the Orthofix LRS was associated with better scores, specifically in the Hostility (Time 2), Phobic Anxiety (Time 2), Psychoticism (Times 2 and 4), and Other (Time 2) sub-scores, as well as the total score (Times 2 and 4). CONCLUSIONS: Although both Ilizarov and Orthofix LRS fixation resolved the bone defects, external fixation had a negative impact on the patients' mental health, which persisted even after removal of the devices. Although both methods led to negative effects on the patients' mental, the impact of the Orthofix LRS was less severe.

Outcomes of post-traumatic tibial osteomyelitis treated with an Orthofix LRS versus an Ilizarov external fixator.

OBJECTIVE: To compare the therapeutic effects of the Orthofix limb reconstruction system (LRS) versus the Ilizarov external fixator on osteomyelitis of a tibial bone defect. MATERIALS AND METHODS: Among 153 patients hospitalized for bone lengthening therapy from January 1, 1996 to January 1, 2015, 129 patients were selected for a retrospective analysis. Forty-three of the candidate patients were treated using the Orthofix LRS and the other 86 were treated using an Ilizarov external fixator. The average follow-up was 96 months. We evaluated the patients at follow-up visits, and compared the length of time the patients wore the fixation devices. We also examined the scores of Activities of Daily Living (ADL) tests and a Self-rated Anxiety Scale (SAS), the range of motion, and the incidence of pin track infections. RESULTS: The results indicated that both approaches were effective for treating the bone defect. Compared with the patients who wore an Ilizarov fixator for the treatment of post-traumatic osteomyelitis, those who wore an Orthofix LRS tended to be more satisfied with their quality of life and the outcome after the operation. CONCLUSION: Although both approaches were effective for treating the bone defect, the overall patient outcomes were superior for the Orthofix LRS, suggesting that it should be considered as the first option in the treatment of traumatic osteomyelitis of the tibial diaphysis.

NRSN2 promotes osteosarcoma cell proliferation and growth through PI3K/Akt/MTOR and Wnt/ß-catenin signaling.

Osteosarcoma is the most common bone cancer in children and adults. However, its pathogenesis, especially molecular mechanisms remain elusive. In current study, we screened GEO Database and found a poorly studied protein Neurensin-2 (NRSN2), which is highly expressed in osteosarcoma tissues. Neurensin-2 (NRSN2) is a small neuronal membrane protein and localized in small vesicles in neural cells, previous study found that it has been implicated in hepatocellular carcinoma (HCC) and non-small cell lung cancer (NSCLC). We here report that the expression of NRSN2 is more commonlyelevated in 18 fresh osteosarcoma tissues. Furthermore, both loss- and gain-functions assays revealed that NRSN2 could promote osteosarcoma cell proliferation and growth both in vitro and in vivo. In addition, we further found that those effects on osteosarcoma by NRSN2 are associated with the dysregulated PI3K/AKT/mTOR signaling and Wnt/ß-catenin signaling. In conclusion, our study found a novel oncogenic protein, NRSN2, which promotes osteosarcoma cell proliferation and as a membrane protein, NRSN2 also could be a potential treatment target for osteosarcoma.

Bone defects following post-traumatic tibial osteomyelitis treated by bone transportation with Orthofix versus Ilizarov external fixation / 中华创伤骨科杂志

Objective To compare the curative effects of Orthofix extended external fixator versus Ilizarov external fixator in the treatment of bone defects following post-traumatic tibial osteomyelitis.Methods During the period from January,1996 through January,2015,129 patients were selected for a retrospective analysis.They were 106 males and 23 females,aged from 14 to 60 years (average,36.5 years).Orthofix extended external fixator was used in 43 of them and Ilizarov external fixator in 86.Bone transportation started 7 to 10 dlays after surgery at a speed of 1 mm/d and was completed in 4 turns.The 2 groups were compared in terms of mineralization time for the extended bone,hone lengthening length,fixation time,union indexes,Activity of Daily Living Scale (ADL),Self-Rating Anxiety Scale (SAS),knee range of motion (ROM) and complications.Results The patients were followed up for 13 to 216 months (average,96 months).Orthofix group and llizarov group were not significantly different in mineralization time for the extended bone,bone lengthening length,fixation time or union indexes (P ＞ 0.05).In Orthofix group and Ilizarov group respectively,there were 6 versus 73 patients with mildly limited self-living abilities and 37 versus 13 patients with little limited self-living abilities by ADL scores;there were 33 versus 16 cases of mild anxiety,8 versus 63 cases of moderate anxiety and 2 versus 7 cases of grave anxiety by SAS scores;there were 39 versus 10 cases of limited knee ROM of 15° to 30° and 4 versus 76 cases of limited knee ROM of 30° to 60°.There were significant differences between the 2 groups in the above indexes (P ＜ 0.05).The rate of complications in Orthofix treatment group(79.1％,34/43) was significantly lower than in Ilizarov group (88.4％,76/86) (P ＜ 0.05).Conclusions In the treatment of bone defects following post-traumatic tibial osteomyelitis,the curative effects of Orthofix extended external fixator are similar to those of Ilizarov external fixator.However,they may have different effects on the life and psychology of the patients in the long run.Therefore,specific therapeutic scheme should be decided in consideration of the advantages of the 2 treatments as well as the conditions of specific patients.

Post-traumatic osteomyelitis treat with trifocal bone transportations: a case report and review of lecture / 中华显微外科杂志

Objective To explore the possibility of reduce the treatment cycle of post-traumatic osteomyelitis patients treat with bone transportations. Methods In February, 2017, a patient was diagnosis as left tibial os-teomyelitis with soft tissue defects and treated. Before start trifocal bone transportation with Orthofix external fixator, we did preoperative practice with computer and model. Except this case we also had some article review in this report. Results This case not only finished 12.5 cm bone transportation in 45 days but also treated soft tissue defect before bone transportations. In this method we save almost 2/3 time to compare with monofocal bone transportations, and frame time were also faster than previous method. But because of some mishaps when we follow-up, the gap was occurred in docking side after 140 days follow-up that may need bone transplants. After 140 days of operation, the gap was disap-peared. Conclusion A new type bone transportations in this study and it may reduce treatment time of osteomyelitis.