Evaluation of surgical or conservative treatment of forearm fracture in pediatric floating elbow injuries.

OBJECTIVE: Floating elbow, which refers to a humerus fracture in the supracondylar region and a forearm fracture, is a very unusual injury. The purpose of this study is to compare the clinical results of patients with "floating elbows" who underwent surgical therapy and who were given forearm immobilization with a splint as follow-up care. PATIENTS AND METHODS: Fifteen patients who had been diagnosed with floating elbow owing to trauma were scanned retrospectively and followed up for at least a year. Eight individuals who suffered from broken forearms underwent surgical repair. After initial treatment, a lengthy arm splint was used to immobilize seven patients' arms. The modified Flynn criteria were used to analyze the data, and comparisons were made between the groups. RESULTS: The median age and mean follow-up time for patients whose forearms were conservatively followed was 6.1 years and 13.8 months, respectively. The median age of the patients who underwent forearm surgery was 8.5 years, and the average follow-up was 14.2 months. Five of the seven patients whose forearms underwent conservative follow-up had outstanding clinical outcomes, while two had poor and moderate outcomes. Four individuals who got surgical treatment for their forearms had excellent and good clinical outcomes, while the other four had intermediate and poor outcomes. Between the two groups, there was no discernible difference (p = 0.60). CONCLUSIONS: In the pediatric population with floating elbow injuries, using a cast for forearm fractures may not necessarily result in worse outcomes compared to surgical management.

Endothelin 1, NF-κB, and ADAM-15 expression in diabetic foot wounds.

OBJECTIVES: The diabetic foot is an important and destructive complication of diabetes. This study examined 65 individuals (35 males, 30 females) diagnosed with diabetic foot with open wounds on their feet. METHODS: After washing the foot with isotonic solution, the wound was debrided and the excised tissues (diabetic dermis) were fixed with neutral buffered 10 % formalin solution. Specimens stained with haematoxylin-eosin, endothelin-1 (ET-1), nuclear factor kappa B (NF-κB), and ADAM 15 antibodies were used to examine angiogenesis, cytokine activity, and the extracellular matrix, respectively. RESULTS: Histopathologically, in the diabetic feet of males, leukocytes, lymphocytes, and macrophages were spread diffusely throughout the lesion, with inflammatory cells invading all layers of blood vessels. In the diabetic feet of females, dilation and congestion of the blood vessels, degenerative changes in the subendothelial layer, and perivascular infiltration by lymphocytes were observed. ET-1 was expressed in inflammatory cells around pre-capillary vessels in the stromal area. NF-κB was expressed in macrophages around blood vessels, and in nodular organised cells distributed throughout the perivascular space. ADAM 15 were expressed in fibroblasts, endothelial cells, and inflammatory cells. Blood parameters differed significantly between diabetic and non-diabetic patients (Significant at p < 0.005, p < 0.001 and p < 0.0001)Conclusion: ET-1 expression in the endothelial cells of diabetic foot ulcers is an important determinant of insulin resistance at the onset of disease and induces macrophages to produce NF-κB, which regulates inflammation. It is thought that ADAM 15 contributes to angiogenic effects as a means of stimulating endothelial cells (Tab. 2, Fig. 3, Ref. 31).

Expression of matrix metalloproteinase-9 and tumour necrosis factor-alpha in the synovial cells of patients with meniscus tears.

BACKGROUND: A meniscus tear is a serious trauma that develops during swinging motion of the fixed foot. Meniscus tears may also be accompanied by divergence of the lateral ligaments of the knee joint. MATERIALS AND METHODS: We enrolled 45 males and 35 females with meniscal tears in the present study. Patients with local joint pain, swelling, difficulty climbing stairs, patellar creeping, difficulties with daily living activities, local pain on palpation, and walking and running complaints, were included. We performed preoperative magnetic resonance imaging. Synovial fluid (5 mL) was aspirated from the lateral suprapatellar pouch of each knee with meniscal pain with the patient in the supine position. Blood samples were taken and biochemical parameters were analysed. The Harris haematoxylin and eosin staining protocol was used to evaluate tissue samples, and the levels of anti-matrix metalloproteinase (MMP)-9 and anti-tumour necrosis factor alpha (TNF-α) antibodies were measured immunohistochemically. RESULTS: Increased numbers of lymphocytes and neutrophils, hyperplastic erythrocytes, and fibroblasts were observed in the joint fluid of females. In males, the fibroblast cells were hyperplastic and plasma cell numbers were increased. MMP-9 expression was elevated in plasma cells, fibroblasts, and neutrophils; and TNF-α expression was observed in lymphocytes and polymorphic nucleated cells. We suggest that increased fluid levels in inflamed joints with meniscal tears, and the associated inflammation, disrupt the cartilage matrix and elevate the production of cytokines such as TNF-α and MMP-9 via release from cells such as fibroblasts that synthesise these mediators. CONCLUSIONS: Anti-TNF-α treatment may prevent meniscal tears and prevent or slow the development of osteoarthritis.