Effect of inflammatory response on joint function after hip fracture in elderly patients: A clinical study.

BACKGROUND: Excellent hip joint function facilitates limb recovery and improves the quality of survival. This study aimed to investigate the potential risk factors affecting postoperative joint functional activity and outcomes in elderly hip fractures patients and to provide evidence for patient rehabilitation and clinical management. AIM: To explore the relationship between inflammatory factors and hip function and the interaction between inflammation and health after hip fracture in elderly patients. METHODS: The elderly patients who had hip fracture surgery at our hospital between January 1, 2021, and December 31, 2022 were chosen for this retrospective clinical investigation. Patients with excellent and fair postoperative hip function had their clinical information and characteristics gathered and compared. Age, gender, fracture site, surgical technique, laboratory indices, and other variables that could have an impact on postoperative joint function were all included in a univariate study. To further identify independent risk factors affecting postoperative joint function in hip fractures, risk factors that showed statistical significance in the univariate analysis were then included in a multiple logistic regression analysis. In addition to this, we also compared other outcome variables such as visual analogue scale and length of hospital stay between the two groups. RESULTS: A total of 119 elderly patients with hip fractures were included in this study, of whom 37 were male and 82 were female. The results of univariate logistic regression analysis after excluding the interaction of various factors showed that there was a statistically significant difference in interleukin (IL)-6, IL-8, IL-10, C-reactive protein (CRP), and complement C1q (C1q) between the fair and excellent joint function groups (P < 0.05). The results of multiple logistic regression analysis showed that IL-6 > 20 pg/mL [(Odds ratio (OR) 3.070, 95%CI: 1.243-7.579], IL-8 > 21.4 pg/ mL (OR 3.827, 95%CI: 1.498-9.773), CRP > 10 mg/L (OR 2.142, 95%CI: 1.020-4.498) and C1q > 233 mg/L (OR 2.339, 95%CI: 1.094-5.004) were independent risk factors for poor joint function after hip fracture surgery (all P < 0.05). CONCLUSION: After hip fractures in older patients, inflammatory variables are risk factors for fair joint function; therefore, early intervention to address these markers is essential to enhance joint function and avoid consequences.

Positive or negative anteromedial cortical support of unstable pertrochanteric femoral fractures: A finite element analysis study.

OBJECTIVE: To explore the mechanical stability of unstable pertrochanteric fractures with proximal femoral nail anti-rotation (PFNA-Ⅱ) fixation under different anteromedial cortical support reduction patterns. METHODS: A 65-year-old healthy male volunteer with no history of hip or systemic disease was recruited. High-resolution computed tomography images with a slice thickness of 0.67 mm of his right femur were obtained. These images were used to establish three-dimensional (3D) models. The lesser trochanter and lateral femoral wall were cut off to create an AO Foundation/Orthopaedic Trauma Association type 31-A2 unstable pertrochanteric fracture model. PFNA-Ⅱ was used to simulate fixation. Nine different fracture reduction patterns, which included positive-positive, positive-neutral, positive-negative, neutral-positive, neutral-neutral, neutral-negative, negative-positive, negative-neutral, and negative-negative cortical support reductions, were simulated. A load of 700 N was applied to simulate a 70 kg elderly patient standing on one leg. The models were subjected to finite element analysis. The displacement and von Mises stress distributions were analyzed. RESULTS: The positive-positive cortical support reduction pattern showed minimal stress and the negative-negative reduction pattern showed maximal stress on the intramedullary nail. The stress was mainly concentrated at the junction of the helical blade and the main nail and at the site of the lateral aspect of the insertion point of the nail in the great trochanter. The positive cortical support reduction patterns seemed to have smaller maximum displacements of the entire fragment-implant assembly and relative displacements between the head-neck and shaft fragments. Meanwhile, the negative reduction patterns seemed to have larger displacements. CONCLUSION: The positive-positive support reduction pattern showed better mechanical stability for unstable pertrochanteric fractures. The negative-negative support reduction pattern was prone to fixation failure and should be avoided during an operation.

Multiplex analysis of serum hormone and cytokine in patients with cervical cOPLL: towards understanding the potential pathogenic mechanisms.

Cervical ossification of the posterior longitudinal ligament (cOPLL) is one of the major causes of myelopathy. However, the mechanism underlying remains elusive. In the present study, using MILLIPLEX magnetic bead panel, we investigated four serum hormones and six serum cytokines in cOPLL patients and healthy subjects. The results showed that tumor necrosis factore-α (TNF-α) were significantly increased, and DDK-1 was significantly decreased in the serum from male and female cOPLL patients compared with those from healthy controls, respectively. Osteopontin (OPN) and fibroblast growth factor-23 (FGF-23) were significantly increased in male cOPLL patients compared with that in healthy male controls. Further analysis showed that FGF-23 and OPN significantly increased, dickkopf-1 (DKK-1) decreased in the extensive cOPLL group. In addition, a significant positive correlation between the OPN and FGF-23 was observed in male cOPLL patients. The results are useful for understanding the mechanism underlying cOPLL.

Dynamic alterations of the levels of tumor necrosis factor-α, interleukin-6, and interleukin-1ß in rat primary motor cortex during transhemispheric functional reorganization after contralateral seventh cervical spinal nerve root transfer following brachial plexus avulsion injuries.

The transfer of a contralateral healthy seventh cervical spinal nerve root (cC7) to the recipient nerve in the injured side is considered a reliable and effective procedure for restoration of the physiological functions of an injured hand after brachial plexus root avulsion injury (BPAI). Growing evidence shows that the transhemispheric cortical reorganization is induced after cC7 nerve transfer surgery. However, little is known about the underlying molecular mechanism. Proinflammatory cytokines reportedly play an important role in the neural plasticity. We hypothesize that proinflammatory cytokines are involved in the transhemispheric functional reorganization after cC7 transfer. In the present study, we investigated the level of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-1ß (IL-1ß) in the rat primary motor cortex after cC7 transfer following BPAI by enzyme-linked immunosorbent assay. The results showed that, in the sham group, no statistical significance was observed between the level of TNF-α, IL-6, and IL-1ß at each time point after the operation compared with that at day 0, respectively. However, in the unrepaired and repaired groups, the level of TNF-α, IL-6, and IL-1ß changed dynamically. The study is the first to provide evidence for the involvement of proinflammatory cytokines in transhemispheric functional reorganization after cC7 transfer following BPAI, which are useful for understanding the underlying mechanism.