Size and fixation options of dorsoulnar fragments in distal radius fractures.

PURPOSE: This study aimed to investigate the influence of size and fixation options of dorsoulnar fragments on the clinical outcomes of distal radius fractures (DRFs). METHODS: This retrospective analysis was performed on 94 patients with DFR accompanied by dorsoulnar fragments, spanning the period from October 2018 to November 2022. Mean follow-up was 15.5 (range, 12-20) months. Patients were divided into small- (<5 %, n = 28), middle- (5-15 %, n = 50), and large- (>15 %, n = 16) sized groups according to articular involvement of dorsoulnar fragments determined by three-dimensional (3D) computed tomography (CT) modeling. Subdivision also took place for the presence of postoperative fragment displacement (>2 mm) and fixation methods including volar locking plate (VLP), VLP combined with dorsal hollow compression screw (VDS), and VLP combined with dorsal low-profile mini plate (VDP). The radiographic parameters (volar tilt, radial inclination, and radial height) and functional outcome measures of wrist range of motion, wrist function (DASH, PRWE), and wrist pain (VAS) were evaluated and compared between groups. RESULTS: Fracture healing was observed in all patients at final follow-up. No instances of dorsoulnar fragment displacement were observed in patients undergoing VDS and VDP treatment and the incidence of the dorsoulnar fragment displacement was 35 % (n = 8) in small-sized group, 21 % (n = 7) in middle-sized group, and 7 % (n = 1) in large-sized group when patients were treated with VLP. In small-sized group, no significant differences were found between patients with and without dorsoulnar fragment displacement in dorsiflexion restriction (10.6 ± 2.8°, 9.1 ± 2.3°, P = 0.159), pronosupination restriction (9.6 ± 2.1°, 8.6 ± 1.7°, P = 0.188), DASH (11.5 ± 4.1, 10.7 ± 3.2, P = 0.562), PRWE (11.9 ± 4.2, 10.6 ± 3.6, P = 0.425), and VAS (1.1 ± 1.1, 0.9 ± 1.0, P = 0.528). In middle-sized combined with large-sized group, the functional outcome measures of dorsiflexion restriction (12.5 ± 3.7°, 9.8 ± 2.9°, P = 0.022), DASH (14.6 ± 5.2, 11.4 ± 3.7, P = 0.030), and PRWE (15.0 ± 4.5, 11.3 ± 3.9, P = 0.016) were superior in patients without dorsoulnar fragment displacement. In patients treated with VLPs, no significant differences were found in dorsiflexion restriction (9.8 ± 2.5°, 10.8 ± 3.5°, 9.4 ± 2.5°, P = 0.299), pronosupination restriction (9.2 ± 1.9°, 10.1 ± 2.8°, 8.9 ± 1.5°, P = 0.200), DASH (11.1 ± 3.5, 12.9 ± 4.3, 11.1 ± 3.6, P = 0.162), PRWE (11.1 ± 3.9, 12.8 ± 4.2, 10.8 ± 3.9, P = 0.188), and VAS (1.0 ± 1.0, 1.4 ± 1.1, 0.9 ± 0.9, P = 0.151) between small-sized, middle-sized, and large-sized groups. In middle-sized group, no significant differences were found in dorsiflexion restriction (10.8 ± 3.5°, 9.4 ± 2.2°, 9.4 ± 2.4°, P = 0.316); pronosupination restriction (10.1 ± 2.8°, 8.8 ± 1.9°, 9.0 ± 2.5°, P = 0.314), DASH (12.9 ± 4.3, 10.3 ± 3.7, 10.5 ± 3.7, P = 0.133), PRWE (12.8 ± 4.2, 10.4 ± 3.8, 10.6 ± 4.1, P = 0.199), and VAS (1.4 ± 1.1, 0.8 ± 0.7, 1.0 ± 1.1, P = 0.201) between subgroups of VLP, VDS, and VDP. No significant differences were found in radiographic parameters between all groups compared. CONCLUSION: This study indicated that the strict reduction and fixation of a dorsoulnar fragment might be not essential when its articular involvement was less than 5 %. The volar locking plate (VLP) fixation was commonly effective in treating distal radius fractures accompanied by a dorsoulnar fragment involving over 15 % of the articular surface. Additionally, the use of an additional dorsal hollow compression screw or a dorsal low-profile mini plate can get good wrist function in the early-term follow-up when the dorsoulnar fragment involve 5-15 % of the articular surface.

Is reduction or arthrodesis in situ the optimal choice for adolescent spondylolisthesis?-a systematic review and meta-analysis.

BACKGROUND: Controversy remains about the choice of reduction or arthrodesis in situ for surgical management of adolescent spondylolisthesis, while no systematic review and meta-analysis were performed to determine which one is the optimal surgical choice. The study aims to compare outcomes of the two surgical strategies for adolescent spondylolisthesis. METHODS: A comprehensive search was performed through PubMed, Web of Science, Cochrane Library, Embase, OVID/MEDLINE, CBM, CNKI, and Wanfang with a cutoff date of May 21st, 2021. Search terms included "spondylolisthesis", "in situ" and "reduction". Included studies had following characteristics: (I) participants: adolescents with spondylolisthesis. (II) Intervention: reduction following arthrodesis. (III) Control: arthrodesis in situ. (IV) Outcomes: postoperative clinical and/or radiographic results. (V) Study design: randomized controlled trial (RCT), cohort or case-control study. Data were analyzed with Review Manager 5.4, and risk of bias assessment of studies was assessed via Newcastle-Ottawa quality assessment scale (NOS). RESULTS: Six cohort studies were included, with NOS scores of all ≥6. There were no significant differences regarding operative time [mean difference (MD) =152.62; 95% [confidence interval (CI)]: -54.02 to 359.26; I2=96%; P=0.15], blood loss (MD =786.61; 95% CI: -646.82 to 2,220.04; I2=90%; P=0.28), patient satisfaction (MD =1.98; 95% CI: 0.72 to 5.43; I2=0%; P=0.18), neurological complications (MD =1.02; 95% CI: 0.25 to 4.18; I2=0%; P=0.98), or total complications (MD =0.59; 95% CI: 0.29 to 1.19; I2=0%; P=0.14). However, patients undergoing reduction achieved better radiographic results: fusion rate (MD =3.09; 95% CI: 1.22 to 7.84; I2=40%; P=0.02), postoperative pseudarthrosis (MD =0.35; 95% CI: 0.15 to 0.79; I2=24%; P=0.01), percentage of slippage (MD =-20.58; 95% CI: -26.32 to -14.84; I2=0%; P<0.00001), and slipping angle (MD =-10.05; 95% CI: -14.55 to -5.54; I2=0%; P<0.0001). And no overt publication bias was found in the studies. DISCUSSION: Both reduction and arthrodesis in situ in adolescent spondylolisthesis are safe and demonstrate good clinical outcomes. However, reduction showed better radiographic results and was associated with less pseudarthrosis, better relief of disability, and improvements in self-image. In conclusion, reduction may be the optimal choice compared with arthrodesis in situ, but further verification of these findings is recommended using RCTs.

Aberrant Expression of PAFAH1B3 Affects Proliferation and Apoptosis in Osteosarcoma.

Osteosarcoma is a major malignant tumor of bone and soft tissue, which is presenting with early metastasis and a high mortality rate. Platelet activating factor acetylhydrolase 1B3 (PAFAH1B3), a cancer-relevant molecular, was found to play a vital role in tumorigenesis and aggressiveness in several cancer types. However, the roles and the regulating mechanisms of PAFAH1B3 in osteosarcoma progression remain unclear. PAFAH1B3 expression was detected by immunohistochemistry in 83 osteosarcoma tissues and 44 paired adjacent normal bone tissues. In vitro, loss-of-function assay was performed to explore the role of PAFAH1B3 in osteosarcoma cells. Tumor xenograft growth assay was used to verify the effect of PAFAH1B3 knockdown on osteosarcoma growth in vivo. Chip assay was carried out to investigate the mechanism in osteosarcoma proliferation regulated by PAFAH1B3. PAFAH1B3 was overexpressed in osteosarcoma tissues and cell lines. Moreover, PAFAH1B3 knockdown inhibited osteosarcoma cell proliferation and promoted apoptosis in vitro, and also suppressed osteosarcoma growth in vivo. Furthermore, the proliferative effect of PAFAH1B3 in osteosarcoma was related to the regulation of the expression of EIF4EBP1, MYC, PTGS2 and RPS6KB1. This study demonstrated the biological function of PAFAH1B3 on osteosarcoma proliferation. This research suggested that PAFAH1B3 could be a novel therapeutic target for osteosarcoma patients.