Low osteotomy cut of Dega procedure for older children with developmental dysplasia of the hip.

The effect on acetabular management in developmental dysplasia of the hip (DDH) patients aged 7 or older with modified low Dega osteotomy procedure was evaluated. Patients between 7 and 14 years old were managed with modified low Dega osteotomy and open reduction and concomitant procedures to evaluate whether low level osteotomy improved the clinical and radiologic outcomes after treatment. Clinical status was assessed using the modified McKay's criteria; radiologic evaluations were assessed for the modified Severin classification, the mean acetabular index (AI), Sharp angle and center-edge (CE) angle. And occurrence of triradiate cartilage injury and complications was recorded. Forty-two DDH patients (57 hips) between 7 and 14 years old were managed with modified low Dega osteotomy. The results demonstrated the latest follow-up 43 hips (75.4%) were rated excellent and 10 hips (17.5%) rated good according to the modified McKay criteria and 41 hips (71.9%) were rated excellent and 11 hips (19.3%) rated good according to Modified Severin classification, respectively. The mean Hip Score improved from 69.53 ±â€…7.14 before the operation to 93.17 ±â€…8.43 at the final follow-up. The mean AI changed from 31.9° to 20.2°, mean Sharp angle decreased from 59.3° to 38.8° and mean CE angle increased from -10.9° to 35.2°, preoperatively and at latest follow-up, respectively. The modified low Dega osteotomy combined with open reduction and concomitant procedures were found to be adequate in improving instant and sustained clinical and radiographic outcomes for the late detected pediatric walking DDH patients.

Identification of differentially expressed genes in hip cartilage with femoral head necrosis, based on genome­wide expression profiles.

Necrosis of the femoral head (NFH), a severe orthopedic disease in adults, involves the collapse of the femoral head. The pathophysiological mechanisms underlying NFH are yet to be fully investigated. The aim of the present study was to identify potentially important genes and signaling pathways involved in NFH and investigate their molecular mechanisms. Gene expression profiles of patients with NFH and healthy controls were compared using the Gene Expression Omnibus (GEO) database repository of the National Center of Biotechnology Information. GSE74089 from the GEO database included 4 patients with NFH and 4 healthy individuals. A total of 1,191 differentially expressed genes (DEGs) were identified between the patients with NFH and controls, including 743 upregulated and 448 downregulated DEGs. Then, Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis revealed that upregulated DEGs were mainly involved in the phosphoinositide 3­kinase/protein kinase B signaling pathway, focal adhesion and extracellular matrix­receptor interactions. Additionally, protein­protein interaction (PPI) analysis identified the most central DEGs as vascular endothelial growth factor A, Jun proto­oncogene, cyclin D1, fibroblast growth factor 2, HECT domain and ankyrin repeat­containing E3 ubiquitin protein ligase 1, protein kinase Cα, bone morphogenetic protein 2 and prostaglandin­endoperoxide synthase 2. PPI analysis also identified guanine nucleotide­binding protein, γ13 as the most commonly downregulated gene based on different centrality. The results of the present study may provide novel insight into the genes and associated pathways involved in NFH, and aid the identification of novel therapeutic targets and biomarkers in the treatment of NFH.

Identification of differentially expressed genes in synovial tissue of rheumatoid arthritis and osteoarthritis in patients.

Rheumatoid arthritis (RA) and osteoarthritis (OA) are the common joints disorder in the world. Although they have showed the analogous clinical manifestation and overlapping cellular and molecular foundation, the pathogenesis of RA and OA were different. The pathophysiologic mechanisms of arthritis in RA and OA have not been investigated thoroughly. Thus, the aim of study is to identify the potential crucial genes and pathways associated with RA and OA and further analyze the molecular mechanisms implicated in genesis. First, we compared gene expression profiles in synovial tissue between RA and OA from the National Center of Biotechnology Information (NCBI) Gene Expression Omnibus (GEO) database. Gene Expression Series (GSE) 1919, GSE55235, and GSE36700 were downloaded from the GEO database, including 20 patients of OA and 21 patients of RA. Differentially expressed genes (DEGs) including "CXCL13," "CD247," "CCL5," "GZMB," "IGKC," "IL7R," "UBD///GABBR1," "ADAMDEC1," "BTC," "AIM2," "SHANK2," "CCL18," "LAMP3," "CR1," and "IL32." Second, Gene Ontology analyses revealed that DEGs were significantly enriched in integral component of extracellular space, extracellular region, and plasma membrane in the molecular function group. Signaling pathway analyses indicated that DEGs had common pathways in chemokine signaling pathway, cytokine-cytokine receptor interaction, and cytosolic DNA-sensing pathway. Third, DEGs showed the complex DEGs protein-protein interaction network with the Coexpression of 83.22%, Shared protein domains of 8.40%, Colocalization of 4.76%, Predicted of 2.87%, and Genetic interactions of 0.75%. In conclusion, the novel DEGs and pathways between RA and OA identified in this study may provide new insight into the underlying molecular mechanisms of RA.

Biomechanical analysis between Orthofix® external fixator and different K-wire configurations for pediatric supracondylar humerus fractures.

BACKGROUND: Closed reduction and percutaneous fixation are considered as the optional treatments for displaced supracondylar humerus fractures. However, there was no published report about the biomechanical analysis in Orthofix® external fixator. In this study, we developed a model of supracondylar humerus fractures and compared the biomechanical analysis of external fixator and different K-wires configurations in order to evaluate the stability of external fixator in supracondylar humerus fractures. METHODS: We developed an anatomic humerus model by third-generation synthetic composite, and 60 synthetic humeris were osteotomized to simulate the humeral transverse supracondylar fracture. Those fractures were reduced and fixed by external fixator or K-wires, and then biomechanical analysis was performed in extension, varus, valgus, and internal and external rotation loading. A paired-sample t test was used to evaluate the distance at the fracture site between the external fixator and K-wire configurations. RESULTS: During all direction loading, there was a significant statistical difference between external fixator and K-wires (P < 0.001 for all pairwise comparisons). In extension and internal rotation loading, the external fixator and three crossed K-wires had no comparable stiffness values (P = 0.572; P = 0.795), and both were significantly greater than two crossed and lateral K-wires (P < 0.05). In external rotation loading, there was no significance between the external fixator and K-wire configurations except two lateral K-wires (P > 0.05). In valgus loading, the stability of the external fixator was less than that of three crossed K-wires (P = 0.001) but was not significantly different with those of two crossed or three lateral K-wires (P = 0.126; P = 0.564). In varus loading, the stability of the external fixator was larger than those of two and three lateral K-wires (P = 0.000; P = 007). CONCLUSIONS: External fixator could provide enough stability for pediatric supracondylar humerus fractures without the injury of the ulnar nerve. Besides, it could enhance the rotational stiffness of the construct in rotation loading to avoid the complication of cubitus varus.

Lateral shelf acetabuloplasty for severe Legg-Calvé-Perthes disease in patients older than 8 years: A mean eleven-year follow-up.

The natural history of Legg-Calvé-Perthes disease (LCPD) in children older than 8 years is usually poor without treatment. The treatment goal is to prevent deformity and incongruity of the hip by achieving a stable spherical femoral head in a deep, congruent, sharp-edged acetabulum, with a good range of hip movement at skeletal maturity. Lateral shelf acetabuloplasty in LCPD can increase the coverage of the femoral head, benefiting the remodeling of the femoral head and acetabulum. The aim of this study was to evaluate the efficacy of lateral shelf acetabuloplasty for severe LCPD in patients older than 8 years.We evaluated 51 patients with severe LCPD who underwent shelf acetabuloplasty between 1994 and 2005. Clinical and radiological examinations were evaluated preoperatively and over a mean follow-up of 132.35 months (range 102-183 months). According to the Catterall classification, the LCPD was classified as grade II in 11 (21.6%) patients, grade III in 15 (29.4%), and grade IV in 25 (49.0%). According to the Herring classification, there were 12 (23.5%) patients in grade B, 24 (47.1%) in grade B/C, and 15 (29.4%) in grade C. The mean ages at the onset of signs and at surgery were 103.39 months and 110.78 months, respectively.By the end of follow-up, all patients had a normal passive range of hip movement without pain. The mean Iowa hip score was improved from 69.5 ±â€Š7.28 to 91.6 ±â€Š5.14 (P < 0.001). According to the Stulberg classification, 11 (21.6%) hips were classified as grade 1, 19 (37.3%) hips as grade 2, 14 (27.5%) hips as grade 3, and 7 (13.7%) hips as grade 4. The CE angle, Sharp angle, medial joint space ratio, epiphysis height ratio, and percentage of acetabular coverage were significantly improved by shelf acetabuloplasty (P < 0.001).We recommend shelf acetabuloplasty for severe LCPD in patients older than 8 years. The procedure yields a favorable clinical outcome and Stulberg outcome for the hip. Shelf acetabuloplasty can improve femoral head coverage and reduce subluxation of the hip, with a benefit to the biological remodeling of the femoral head within the acetabulum.

The Periosteal Autografts Transplantation for Cartilage Defects of the Hip in Older Children With Developmental Dysplasia as an Adjunctive Procedure.

Cartilage lesions are at a high prevalence in dysplastic hips and may relate to arthritic changes and hip joint dysfunction. To date, the effectiveness of repair of articular cartilage defects in the dysplastic hips has not yet been thoroughly evaluated. Here we retrospectively reviewed the effects of acetabuloplasty procedures with/without concomitant autologous tibial periosteal transplantation (ATPT) for articular cartilage defects of the hip in older children with developmental dysplasia of the hip (DDH).Older DDH children with focal cartilage defects of the acetabular or femoral cartilage or both in the hip joint were treated by acetabuloplasty procedures with (Group I) or without (Group II) concomitant ATPT to evaluate the improvements in range of motion (ROM), pain relief of hip, walking tolerability (WL), radiologic evaluations, and outcomes in the long-term follow-up.More satisfactory functional outcome is readily achieved among patients treated with combined acetabuloplasty and ATPT, evidenced by marked pain relief and improved ROM and WL. The latest favorable radiologic evaluation was 70.6% in Group I and 60.0% in Group II, respectively. More hips exhibited congruency between the femoral head and the shell, with less deformity of femoral head and acetabulum or narrowed joint space in Group I. Few major complications were recorded in Group I.Application of periosteal autograft for repair of cartilage defects within the hip joint might be an effective adjunctive treatment for acetabuloplasty in preventing stiffness, reducing pain, and improving ROM and outcomes in hip rehabilitation in the long-term follow-up in older children with DDH.

Electroacupuncture ST36 prevents postoperative intra-abdominal adhesions formation.

BACKGROUND: We have recently proved electroacupuncture (EA) ST36 exerted an anti-inflammatory effect in the early phase of intra-abdominal adhesion formation. Evidences indicate that the anti-inflammatory effect of EA ST36 involves a cholinergic anti-inflammatory pathway-dependent mechanism via the vagus nerve. However, the exact effects and accurate vagal modulation of acupuncture in prevention of postoperative intra-abdominal adhesion formation has not been thoroughly evaluated. MATERIALS AND METHODS: Sprague-Dawley rats subjected to abdominal adhesion lesions operation at the cecum and abdominal wall were randomly divided into six groups as follows: (a) EAN: EA non-channel acupoints; (b) EA: EA ST36 after abdominal lesions; (c) VGX/EA: vagotomy (VGX) after abdominal lesions, then EA ST36; (d) VGX/EAN: VGX after abdominal lesions, then EAN; (e) α-BGT/EA: intraperitoneal injection of α-bungarotoxin (α-BGT, an antagonist of α7 subunit of cholinergic nicotinic receptor) before EA ST36, and (f) α-BGT/EAN group: α-BGT injection before EAN. Seven days after abdominal surgical lesions, the levels of tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF) in the adhesive tissue were evaluated, macroscopic observation and histopathologic evaluation of adhesion formation and assessment of angiogenesis by immunohistochemical staining of platelet endothelial cell adhesion molecule-1 (CD31) were performed. RESULTS: EA ST36 reduced TNF-α and VEGF levels in adhesive tissue homogenates 7 d after surgery, whereas vagotomy or intraperitoneal injection of α-BGT before EA ST36 reversed its suppressive effects. EA at non-channel acupoints with or without vagotomy or intraperitoneal injection of α-BGT before EA had no suppressive effects on TNF-α and VEGF levels. EA ST36 alleviated the adhesion formation, with both of macroscopic and histopathologic adhesion scores significantly lower than those of the EAN group (1.56 ± 0.29 versus 3.00 ± 0.82, 1.35 ± 0.4 versus 3.91 ± 0.8, respectively, both P < 0.05). Compared with the EAN group, EA ST36 significantly decreased angiogenesis evidenced by reduced CD31 positive microvessel density in adhesive tissue. CONCLUSIONS: EA ST36 might reduce the postoperative local inflammatory response, attenuate the angiogenesis, and alleviate the adhesion formation partly via activating the cholinergic anti-inflammatory mechanism.

Comparison of Kirschner wires and AO cannulated screw internal fixation for displaced lateral humeral condyle fracture in children.

PURPOSE: This retrospective study compares Kirschner wires versus 3.5-mm diameter AO cannulated screw internal fixation in treatment for the displaced lateral humeral condyle fractures. METHODS: The study included 62 patients (42 boys, 20 girls; mean age 6.93 years; age range two to 14 years) with displaced lateral humeral condyle fractures. All patients were treated by open reduction and Kirschner wires or cannulated screw fixation. The clinical outcomes were evaluated according to the criteria of Hardacre et al. The mean follow-up period was 39.4 months (range 21-95 months). RESULTS: There was no statistically significant difference in clinical outcome between these two groups (P > 0.05). Five patients (16.7%) developed skin infection around K-wires, while no infection occurred in fracture with screws. An obvious lateral prominence occurred in 11 (36.7%) patients with K-wires and four (12.5%) patients with screws. Nine (30%) patients with K-wires and two (6.3%) patients with screws had a lack of 10° of extension of the elbow compared with the other side. CONCLUSION: Both K-wires and cannulated screw fixation are effective in treatment for displaced lateral humeral condyle fracture. K-wires can pass through the ossific nucleus of capitulum without damaging it, but a longer period of external fixation and local skin care will be required. The screws can reduce the possibility of lateral prominence and promote the function of elbow by continuously stabilising the fracture, but a second operation is need for screw removal.

A modified Ponseti method for the treatment of idiopathic clubfoot: a preliminary report.

BACKGROUND: The regular Ponseti method for the treatment of idiopathic clubfoot requires a series of manipulations and castings at weekly intervals. It is not known whether the correction could be achieved in a shorter period of time with multiple manipulations and castings per week. This study was designed to evaluate the outcome of a modified treatment program with manipulation and casting offered twice a week. METHODS: The study included the modified group (26 patients with 40 idiopathic clubfeet treated with the Ponseti method twice a week) and the regular group (20 patients with 32 idiopathic clubfeet treated once a week). The average age of the patients at the time of treatment was 63.05 days in the regular group and 92.7 days in the modified group. RESULTS: All aspects of the deformity with the exception of the equinus were corrected in 20.61 days in the modified group and in 35.35 days in the regular group (P=0.0001). There were no differences between the 2 groups in the average number of casts (P=0.61). Percutaneous Achilles tenotomy was performed in 87.5% (35 of 40) of those in the modified group and 87.5% (28 of 32) of those in the regular group (P=0.47). A corrective surgery for a complete correction of the deformity was performed in 4 feet in the modified group (10%; 2 posteromedial releases; 2 posterior releases) and 3 feet in the regular group (10%; 2 posteromedial releases; 1 posterior release). CONCLUSIONS: The modified Ponseti method with the treatment program twice a week is safe and effective. It significantly shortens the timeframe for the treatment. LEVEL OF EVIDENCE: The study of therapeutic studies investigating the results of the treatment is level II.

Slotted acetabular augmentation with concurrent open reduction for developmental dysplasia of the hip in older children.

BACKGROUND: The slotted acetabular augmentation procedure can never achieve a concentric and congruous reduction of the femoral head. The aim of this study was to review the results of the slotted acetabular augmentation procedure performed at the time of open reduction for developmental dysplasia of the hip in older children. METHODS: Twenty-two patients with 27 hips underwent open reduction with concurrent slotted acetabular augmentation. The average age at the time of surgery was 8.5 years. The average follow-up was 8.3 years. RESULTS: Using modified McKay clinical criteria, 16 hips were classified as excellent, 8 hips as good, and 3 hips as fair. Using modified Severin radiographic criteria, 15 hips gave excellent results and 12 hips gave good results. CONCLUSIONS: Slotted acetabular augmentation with concurrent open reduction can be an effective procedure for developmental dysplasia of the hip in older children. LEVEL OF EVIDENCE: The study of therapeutic studies investigating the results of the treatment is level II.