Influence of ulnar bow sign on surgical treatment of missed Bado type I Monteggia fracture in children.

The present study aimed to explore the influence of ulnar bow on the surgical treatment of Bado type I missed Monteggia fracture in children. A retrospective review of 28 patients was conducted between November 2010 and June 2020. All patients were treated with open reduction of the radial head and ulnar opening wedge osteotomy without annular ligament reconstruction. Four months (range 1-12 months) was the mean interval between injury onset and surgery. The average age of patients at the time of surgery was 6.1 years old (range 2-10 years old). The maximum ulnar bow (MUB) and MUB position (P-MUB) via radiography were evaluated. The patients were divided into two groups according to P-MUB, as follows: middle group (A) included 17 cases, and the MUB was located at 40-60% of the distal ulna; and distal group (B) included 11 cases, and the MUB was located at 20-40% from the distal end of the ulna. The mean follow-up period was 33 months (range 6-102 months). At the last follow-up, all the children showed stable reduction of the radial head, and the flexion function of elbow joint improved after the operation (P < 0.05). Group A presented a larger ratio of maximum ulnar bow (R-MUB) and angle of ulnar osteotomy (OA) than group B (P < 0.05). The osteotomy angle was positively correlated with the R-MUB (R2 = 0.394, P = 0.038). The osteotomy angle was positively correlated with the P-MUB (R2 = 0.683, P = 0.000). The R-MUB was proportional to the P-MUB (R2 = 0.459, P < 0.0001). The regression equation of P-MUB and osteotomy angle was as follows: OA = 32.64* P-MUB + 7.206. If the ulnar bow was positioned at the middle ulna, then a stable reduction of radial head needed to be achieved through a large angle in the ulnar osteotomy. If the position of maximum ulnar bow (P-MUB) was closer to the middle of the ulna, or the ratio of maximum ulnar bow (R-MUB) was larger, then the osteotomy angle was larger.

Activation of the extracellular-signal-regulated kinase (ERK)/c-Jun N-terminal kinase (JNK) signal pathway and osteogenic factors in subchondral bone of patients with knee osteoarthritis.

BACKGROUND: The objectives of this study was to explore the activation of the extracellular-signal-regulated kinase (ERK) and c-Jun N-terminal kinase (JNK) signaling pathway and osteogenesis-related factors in the subchondral bone of patients with knee osteoarthritis (OA). METHODS: Ten patients with primary OA who underwent total knee arthroplasty in the Department of Arthritis Surgery of our hospital were enrolled, and subchondral bone tissue samples were obtained during the operation. He staining and saffron staining were used to observe the arrangement of chondrocytes in the patient tissues. The protein expression levels of JNK, p-JNK, ERK, p-ERK, Runx2 and OMD in subchondral bone were detected by Western Blot. Knee osteoarthritis mice were established. He staining was used to observe the arrangement of subchondral bone cells in the knee joint of mice. Cellular mineralized nodules were determined by alizarin red staining. RESULTS: Firstly, in general and staining, it was observed that the subchondral bone lesions of knee OA participants were obvious. Compared with normal knee joints, the levels of phosphorylation-c-Jun N-terminal kinase (P-JNK) and phosphorylation-extracellular-signal-regulated kinase (P-ERK) in the subchondral bone of knee arthritis participants were significantly increased (P<0.05). The level of osteomodulin (OMD) was significantly reduced (P<0.05). Secondly, compared with normal mice, the levels of JNK, P-JNK, OMD, ERK, and P-ERK in the model group were significantly different (P<0.05). At 2-8 weeks, the JNK and P-JNK levels in the mice model group increased significantly over time (P<0.05), and the OMD level decreased significantly over time (P<0.05). The levels of ERK and P-ERK fluctuated over time. Thirdly, osteoblasts were treated with different concentrations of anisomycin, and stained with alizarin red after continuous culture for 24 and 48 h, respectively. It was found that all the cells were stained with orange-red mineralized nodules. As the concentration of anisomycin was increased, the number of cell mineralization nodules was significantly larger, and the positive rate of chemical nodules increased. Different concentrations of anisomycin were given to interfere with the osteoblasts of mice. When anisomycin was administered at a dose of 25 ng, the OMD level reached the highest level. When the concentration of anisomycin was increased, the osteocalcin (OCN) level also showed an upward trend. CONCLUSIONS: The process by which the JNK signaling pathway regulates OMD may be closely related to the pathological changes of subchondral bone in patients with knee OA, and is involved in the occurrence and development of knee arthritis.

Case Report: Bosworth Fracture-Dislocation managed by Closed Reduction and Conservative Treatment.

Bosworth fracture-dislocation is a rare type of ankle injury, which in the typical radiologic are overlap of distal tibia and fibula in the anteroposterior view, posterior subluxation of the talus and syndesmosis dissociation in the lateral view, while in the CT scan, the fibula was displaced behind the posterior edge of the fibular notch (incisura tibiae), locked between the distal tibia and the displaced posterior malleolus fragment. Treatment can be challenging owing to the ignorance or failure of the initial reduction, resulting in an irreducible tibiotalar joint and tibiofibular syndesmosis reduction. To treat this complicated injury, emergent open surgery is always recommended for the first stage reduction to prevent adverse events. Successful closed reduction and conservative treatment of Bosworth fracture-dislocation is rare. This unique case presents a 25-year-old male with a Bosworth fracture-dislocation cured with closed reduction and U-shaped plaster splint. The patient was fully weight bearing and had no pain, and there were no limitations in the range of motion of the ankle and subtalar joints at 30 months of follow-up.

A new approach for surgical treatment of chronic Monteggia fracture in children.

PURPOSE: The aim of the study was to investigate the clinical outcomes of a combined anterior and posterior approach for the surgical treatment of chronic Monteggia fractures in children. MATERIALS AND METHODS: From November 2010 to January 2018, 33 patients (27 boys and 6 girls) with chronic Monteggia fracture who were treated surgically by one surgeon of our department were retrospectively analyzed. In the surgical procedure, open reduction and excision of fibrous scar were performed with the anterior Henry's approach, while ulnar osteotomy was carried out with a posterior approach. In cases of unstable radial head reduction, a trans-capitellar K wire was applied. Repair or reconstruction of the annular ligament (ALR) was not undertaken. RESULTS: The average follow-up of the patients was 33.8 months (range 8-87 months). At the last follow-up, Mayor Score and function of flexion and extension showed significant improvement compared to preoperative condition (p < 0.05). Two patients with palsy of the deep branch of the radial nerve with neurolysis recovered to normal over a 3-month follow-up. Redislocation occurred in two patients while subluxation occurred in one. One patient suffered a mild ischemic contracture but gradually recovered. Other severe complications, nerve injuries, heterotopic ossification, or synostosis, were not noted in the follow-up. CONCLUSION: A combined anterior and posterior approach for surgery resulted in a satisfactory outcome due to the advantages of better exposure, more convenient intraoperative management, and facilitate for radial nerve exploration. Our study provided a new approach for the surgery of chronic Monteggia fractures.