Elastic stable intramedullary nail combined with Kirschner wire (E-K) technique for treating pediatric distal tibial diaphyseal metaphyseal junction (DTDMJ) fractures.

Objective: Elastic stable intramedullary nail (ESIN) is a commonly used method for treating diaphyseal fractures of the tibia, but its application in Distal Tibial Diaphyseal Metaphyseal Junction (DTDMJ) fractures has been a subject of controversy. This study aims to evaluate the clinical efficacy of the Elastic stable intramedullary nail-Kirschner wire (E-K) technique in treating pediatric DTDMJ fractures, providing better clinical decision-making for clinicians in diagnosing and treating such fractures. Methods: We conducted a retrospective analysis of patients aged 3-9 years who received treatment at our hospital from January 2019-January 2021 for distal tibial diaphyseal metaphyseal junction (DTDMJ) fractures. Based on their surgical procedures, they were categorized into the Elastic Stable Intramedullary Nail-Kirschner wire group (E-K) and the ESIN group. Demographic data, surgical duration, clinical outcomes, complications, and imaging data were recorded. Results: The study included a total of 57 patients, with 24 cases in the E-K group and 33 cases in the ESIN group. There were 30 males and 27 females. The average age was (6.25 ± 1.59) years in the E-K group and (6.27 ± 1.48) years in the ESIN group. There were no significant differences between the two groups in terms of gender, age, weight, time from injury to surgery, follow-up time, side of injury, associated injuries, nail site infection, deep infection, and nail removal time (P > 0.05). Neither group experienced nonunion or refracture. The E-K group exhibited significantly lower coronal and sagittal plane angular values at the final follow-up compared to the ESIN group (P < 0.001). In the E-K group, the final follow-up coronal plane angle was 2.67 (1.09)°, while in the ESIN group, it was 6.55 (2.05)°. The final follow-up sagittal plane angle was 3.12 (1.54)° in the E-K group and 7.58 (1.48)° in the ESIN group. Both groups showed good alignment in the initial postoperative x-rays, with no statistically significant differences. However, during clinical healing, the ESIN group exhibited significant displacement, whereas the E-K group had minimal displacement, demonstrating a significant statistical difference (P < 0.001). There was a statistically significant difference in the AOFAS joint function assessment between the two groups (P = 0.027). Conclusion: The E-K technique is a viable option for treating DTDMJ fractures in pediatric patients, with well-established clinical efficacy. Its advantages include a straightforward surgical procedure, safety, and a low incidence of severe complications.

TYROBP-positive endothelial cell-derived TWEAK as a promoter of osteosarcoma progression: insights from single-cell omics.

Background: Endothelial cells (ECs) play a vital role in promoting the progression of malignant cells, and they exhibit heterogeneity in their phenotypic characteristics. We aimed to explore the initiating cells of ECs in osteosarcoma (OS) and investigate their potential interaction with malignant cells. Method: We obtained scRNA-seq data from 6 OS patients, and datasets were batch-corrected to minimize variations among samples. Pseudotime analysis was performed to investigate the origin of differentiation of ECs. CellChat was employed to examine the potential communication between endothelial cells and malignant cells, and gene regulatory network analysis was performed to identify transcription factor activity changes during the conversion process. Importantly, we generated TYROBP-positive ECs in vitro and investigated its role in OS cell lines. Finally, we explored the prognosis of specific ECs cluster and their impact on the tumor microenvironment (TME) at the bulk transcriptome level. Results: The results showed that TYROBP-positive ECs may play a crucial role in initiating the differentiation of ECs. TYROBOP-positive endothelial cells (ECs) exhibited the strongest crosstalk with malignant cells, likely mediated by TWEAK, a multifunctional cytokine. TYROBP-positive ECs exhibited significant expression of TME-related genes, unique metabolic and immunological profiles. Importantly, OS patients with low enrichment of TYROBP-positive ECs had better prognoses and a lower risk of metastasis. Finally, vitro assays confirmed that TWEAK was significantly increased in ECs-conditioned medium (ECs-CM) when TYROBP was over-expressed in EC cells, and could promote the proliferation and migration of OS cells. Conclusion: We concluded that TYROBP-positive ECs may be the initiating cells and play a crucial role in the promotion of malignant cell progression. TYROBP-positive ECs have a unique metabolic and immunological profile and may interact with malignant cells through the secretion of TWEAK.

Application of 3D navigation for osteotomy of DDH in children: A systematic review and meta-analysis.

Objective: To systematically review the current articles to compare the efficacy and safety of 3D navigation-assisted osteotomy of DDH with conventional osteotomy of DDH in children. Study design Databases such as PubMed, Embase, Cochrane Library were searched, from inception to April, 2022, for studies applying 3D navigation-assisted osteotomy in DDH children. Methods: There were 626 articles identified. According to the search strategy and inclusion criteria, 7 studies were finally included, with a total of 288 cases. Study screening, data extraction, and quality assessment were conducted by two reviewers independently. Data analyses were performed using RevMan 5.4 software. Results: There were 7 retrospective cohort studies included. Meta-analysis showed that 3D navigation-assisted DDH osteotomy resulted in shorter duration of surgery [I 2 = 88%, REM, MD = 22.86, 95%CI (-27.29, -18.43), p < 0.00001], less radiation exposure during surgery [I 2 = 53%, REM, MD = 2.76, 95%CI (-3.15, -2.37), p < 0.00001], and less intraoperative bleeding [I 2 = 94%, REM, MD = 26.83, 95%CI (-39.24, -14.41), p < 0.0001], compared with conventional DDH osteotomy. There was a significant difference in the number of patients with McKay clinical function graded as poor between the two groups [I 2 = 0%, FEM, RR = 0.20, 95%CI (0.05, 0.74), p = 0.02], whereas there were no significantly statistical differences in the corrected acetabular index angle, postoperative leg length discrepancy, and number of patients with Severin x-ray graded as poor between the two groups (p > 0.05). Conclusion: 3D navigation-assisted pelvis and thighbone osteotomy for DDH children could shorten duration of surgery and reduce intraoperative bleeding and x-ray exposure, presenting definite therapeutic effect. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier: CRD42022333767.

Clinical analysis of 60 children with pelvic fracture and associated injuries: an observational study.

BACKGROUND: The injury mechanism of a pelvic fracture is primarily high-energy injury, and it is easily combined with injuries to other tissues and organs. This study aimed to investigate the clinical effectiveness of early diagnosis and treatment of pelvic fractures and associated injuries in children. METHODS: The diagnosis and treatment of 60 children with pelvic fractures and associated injuries who were admitted to our hospital from January 2005 to December 2016 were retrospectively analyzed. Among these patients, 36 were male, and 24 were female. The patients' ages ranged within 2-15 years, with an average of 7.6 years old. The pelvic fractures were classified based on the Torode and Zieg classification; among the patients, 12 had type I, 16 had type II, 20 had type III, and 12 had type IV. All patients received early diagnosis, immediate anti-shock measures, aggressive treatment of associated injuries, and early reduction and fixation of the pelvic fractures after admission. RESULTS: Of the 60 patients, 28 had injuries caused by traffic accidents, 26 had injuries caused by falling from high places, and 16 had injuries caused by compressing or crushing. Eight patients had unilateral pubic bone fracture or pubic symphysis separation that involved posterior pelvic fracture or sacroiliac joint separation, and two had fractures that affected the anterior ring or acetabulum. Moreover, 26 patients had hemorrhagic shock, 18 had traumatic brain injury, 14 had fractures at other sites, 8 had pelvic large vessel injuries, 8 had ipsilateral femoral and proximal femoral fractures, 8 had retroperitoneal hematoma, 8 had urinary system injury, 6 had perineal laceration and vaginal trauma, 6 had spinal cord injury, 4 had intestinal injuries, 4 had soft tissue contusions, and 4 had sacral nerve injury. During the follow-up (average: 48 months), six children died. The evaluation results of the curative effect were excellent in 32 children, good in 18, and poor in 4; the 'excellent' and 'good' rate was 92.5% (50/54). CONCLUSION: Early diagnosis, reduction, and fixation and timely treatment of associated injuries might achieve better clinical efficacy and are worthy of clinical promotion. KEY WORDS: Associated Injuries, Childhood, Diagnosis, Fracture, Pelvic, Treatment.

Ultrasound features predicting the 3-week outcome of Pavlik harness treatment for developmental hip dysplasia.

BACKGROUND: The treatment protocol for children with developmental dysplasia of the hip (DDH) is routinely adjusted by assessing the hip reduction after 3 weeks of Pavlik harness treatment. However, there is a high risk of failure and complications in the treatment adjustment. The aim of this study was to explore the value of ultrasound features in predicting the treatment outcome of Pavlik harness after 3 weeks in DDH children. METHODS: A total of 215 DDH children were recruited and the demographics and the changes of ultrasound features [α and ß angle and femoral head coverage (FHC)] during the Pavlik harness treatment were recorded. The children were divided into the success group and the failure group according to the reduction outcome after 3 weeks. Univariate and multivariate analyses were performed to analyze the independent predictors for the treatment outcome. Repeated-measures analysis of variance was used to compare the changes of ultrasound features between the two groups during the treatment. Receiver operating characteristic (ROC) curves were plotted to analyze the predictive accuracy of the ultrasound features. RESULTS: Graf type III (P=0.036), bilateral dislocation (P=0.031), and age at diagnosis (P=0.021) were associated with an increased risk of Pavlik harness failure in the multivariate analysis. The changes in α and ß angle and FHC were generally greater in the success group than in the failure group. The α angle and FHC were larger in the success group, while the ß angle was larger in the failure group (P<0.05). Each ultrasound parameter (α and ß angle and FHC) alone could not accurately predict the treatment outcome within 3 weeks. However, the combined ultrasonic features at the second week could accurately predict the outcome of Pavlik harness treatment after the third week. The combination of the ultrasound features at the first week and the influencing factors (Graf classification, age at diagnosis, and side of pathology) could accurately predict the outcome at the first week [area under curve (AUC) =0.931, sensitivity =82.14%, specificity =97.86%]. CONCLUSIONS: The combined model of ultrasonic features at the second week could accurately predict the reduction outcome of Pavlik harness after the third week. The combined model including independent predictors and ultrasonic features could accurately predict the reduction outcome at the first week.