Treatment of high ankle sprains with Suture-button elastic fixation assisted by arthroscopy / 中国组织工程研究

BACKGROUND:High ankle sprain is easily missed and leads to ankle dysfunction.Arthroscopy can detect hidden high ankle sprain.Suture-button elastic fixation can restore the biomechanical stability of the distal tibiofibular syndesmosis. OBJECTIVE:To explore the clinical efficacy of Suture-button elastic fixation for high ankle sprain under ankle arthroscopy. METHODS:A retrospective analysis was performed on 40 cases of high ankle sprain patients treated with Suture-button elastic fixation under ankle arthroscopy from August 2019 to August 2021 in the Department of Foot and Ankle Surgery,Wuhan Fourth Hospital.All patients underwent Suture-button elastic fixation.The American Orthopedic Foot and Ankle Society function score,Visual Analog Scale pain score,ankle range of motion,preoperative imaging data,and arthroscopic tibiofibular syndesmosis separation degree were recorded.Meislin criteria were used to evaluate the curative effect and postoperative complications were recorded. RESULTS AND CONCLUSION:(1)40 patients were followed up for 16-48 months after operation.(2)At the last follow-up,American Orthopedic Foot and Ankle Society score was(88.95±6.64 points).Visual Analog Scale score was(1.78±1.23 points).Ankle dorsiflexion range of motion was(33.50±5.79 degrees).Ankle plantarflexion range of motion was(34.50±5.97 degrees).There were statistically significant differences before and after surgery(P<0.05).(3)There was a low positive correlation between the radiographic separation index and the degree of arthroscopic separation(r=0.612,P<0.01).(4)The curative effect was evaluated by Meislin standard,with an excellent and good rate of 95%(38/40).Postoperative ankle joint pain was relieved,and ankle joint activities were significantly improved.(5)During the follow-up period,all patients had no nerve injury or incision infection.In 1 patient,the internal fixation was removed due to skin irritation and squatting sensation after operation.(6)It is concluded that Suture-button elastic fixation for high ankle sprain is effective under ankle arthroscopy in restoring ankle function and maintaining joint stability without the need for secondary removal,and it is worth clinical application.

Analysis of injury characteristics of peritalar dislocations using ankle models reconstructed with software Mimics / 中华创伤骨科杂志

Objective:To analyze the injury characteristics of peritalar dislocations using ankle models reconstructed with software Mimics.Methods:A retrospective study was conducted to analyze the medical records of 36 patients with peritalar dislocation who had been treated at Department of Orthopaedics, The Fourth Hospital of Wuhan from January 2008 to April 2022. There were 28 males and 8 females with an age of (46.0±14.6) years, and 16 left and 20 right limbs. Their CT data were imported into software Mimics to reconstruct ankle models to observe the fractures of the postero-medial process of the talus, the affiliated injuries to the surrounding bone structures outside the talus, and the complete or incomplete dislocations of the talonavicular articulation.Results:32 patients (88.9%, 32/36) had fracture of the postero-medial process of the talus, and 24 patients (66.7%, 24/36) a total of 33 affiliated injuries to the surrounding bone structures outside the talus, including 12 lateral malleolus ones, 4 medial malleolus ones, 7 scaphoid ones, 6 calcaneus ones, 3 fractures of the cuboid and 1 fracture of the fifth metatarsal. Sixteen patients were complicated with 1 affiliated injury, 7 patients with 2 affiliated injuries, and 1 patient with 3 affiliated injuries. The 8 patients with 2 or more affiliated injuries all had complete dislocation of the talonavicular articulation. Of the 36 patients, 26 had complete dislocation of the talonavicular articulation and 10 incomplete dislocation of the talonavicular articulation. The incidence of affiliated injuries [84.6% (22/26)] in the patients with complete dislocation of the talonavicular articulation was significantly higher than that [20.0% (2/10)] in those with incomplete dislocation of the talonavicular articulation ( P=0.001). Conclusions:Most of the peritalar dislocations are combined with the fracture of the postero-medial process of the talus. The incidence of complete dislocation of the talonavicular articulation is high. Patients with complete dislocation of the talonavicular articulation are more likely to have an affiliated injury, or even more than two injuries.

Postoperative deep vein thrombosis in patients after selective ankle or mid-hindfoot surgery / 中华创伤骨科杂志

Objective:To investigate the prevalence of deep vein thrombosis (DVT) in patients after selective ankle or mid-hindfoot surgery.Methods:A retrospective analysis was conducted of the 109 patients with ankle or mid-hindfoot disease who had been treated from January 2018 to December 2019 at Department of Orthopaedics, Wuhan Fourth Hospital. They were 65 males and 44 females, aged from 32 to 74 years (average, 49.0 years). Ultrasonography was performed at preoperative 1 day, postoperative 2 and 6 weeks to determine the occurrence, location and clinical symptoms of DVT. The patients were divided into an early DVT group, a late DVT group and a DVT-free group according to the occurrence and onset time of DVT. The 3 groups were compared in terms of gender, age, body mass index and tourniquet duration.Results:The incidence of postoperative lower limb DVT was 22.9% (25/109). All the thromboses were observed beyond the distal plane of the popliteal vein. 72.0% of the DVT patients were clinically asymptomatic. There was no significant difference in gender, age or body mass index between early DVT group ( n=17), late DVT group ( n=8) and DVT-free group ( n=84) ( P>0.05). The incidence was 68.0% (17/25) for early DVT and 32.0% (8/25) for late DVT. The intraoperative tourniquet duration for the early DVT group [(77.7±12.3) min] was significantly longer than that for the late DVT group [(66.8±11.2) min] and for the DVT-free group [(65.9±10.5) min] ( P<0.05). Conclusions:The majority of postoperative DVTs may be clinically asymptomatic in patients after selective ankle or mid-hindfoot surgery. Although DVT tends to occur within postoperative 2 weeks, its risk may continue after 2 weeks. Increased tourniquet duration may be associated with incidence of early DVT.

Emergent foot and ankle surgery in the epidemic of COVID-19 / 中华创伤骨科杂志

Objective:To report our experience in the emergent foot and ankle surgery in the epidemic of COVID-19.Methods:The data of 18 patients with acute foot and ankle injury were reviewed who had been admitted to the Department of Foot and Ankle Surgery, Wuhan Fourth Hospital from 20th January, 2020 to 26th February, 2020. They were 11 men and 7 women, aged from 18 to 70 years (average, 42.5 years). There were 5 cases of acute open injury and 13 ones of acute closed injury. COVID-19 infection was diagnosed or suspected in 5 cases but not in the other 13 cases. Emergency operation was carried out for 2 patients with open injury plus COVID-19 infection and one with complicated pilon fracture plus COVID-19 infection, one of whom received secondary operation. One patient with closed fracture of the left calcaneus plus COVID-19 infection was hospitalized from emergency department for secondary surgery, and another with closed fracture of the right lateral malleolus was referred to the isolation ward after emergency plaster fixation. Of the 10 patients with closed injury but without COVID-19 infection, 3 received conventional secondary surgery after admission and the others conservative treatment at the outpatient department. Recorded were COVID-19 infections in the patients after admission and in the medical staff. The measures taken and experience in control and prevention of COVID-19 infection after outbreak of the epidemic were reviewed.Results:Of the 11 patients who had been hospitalized for foot and ankle injury in emergency, 5 were definitely diagnosed of or suspected of COVID-19 infection and 6 free of COVID-19 infection. During hospitalization, COVID-19 infection was confirmed in the 5 cases and no COVID-19 infection occurred in the other 6 patients. No COVID-19 infection occurred in the medical staff; no cross infection was observed between the patients and the medical staff.Conclusions:Reasonable strategies are advised to balance the foot and ankle surgery and epidemic prevention. A simplified management is not advised for all the cases. The operative procedures in emergent foot and ankle surgery should be optimized in line with the epidemic control and prevention principles to facilitate functional rehabilitation for the patients.

Sinus tarsus mini incision approach with percutaneous reduction and fixation for Sanders Ⅱ、 Ⅲ calcaneal fractures / 中华骨科杂志

Objective To explore the methods and clinical effect of the sinus tarsus mini incision approach with percutaneous fixation technique in the treatment of Sanders Ⅱ,Ⅲ calcaneus fractures.Methods From January 2015 to May 2016,the clinical data of 64 cases with Sanders Ⅱ,Ⅲ calcaneus fractures who were treated by sinus tarsus mini incision approach with percutaneous reduction and fixation were analyzed retrospectively.The average age was 46.64±10.51 years (range,25-68) and 49 patients were males and 15 patients were females.According to Sander's classification,39 patients were Sanders Ⅱ and 25 were Sanders Ⅲ fracture.Calcaneal varus was corrected and the length,width and height of bone were reduced by sinus tarsus mini incision approach with percutaneous fixation technique.Calcaneal fracture was treated by calcaneal bone plate combined with percutaneous screw fixation.Complications and operation procedure were recorded post-operation.Anteroposterior,lateral and axial views of preoperative and postoperative X-ray and CT scan were taken to assess the classification,restoration and intertion status of fracture.Radiological assessment was performed using B(o)hler's angle and Gissane's angle.Functional outcome was assessed using the Maryland foot score (MFS).Results All of the sixty-four patients were followed up for 12-18 months (average,14.80± 2.03).After surgery,only 4 cases of superficial necrosis of the incision were found,and the incisions were all healed and no infection occurred after surgery.No tendon tenosynovitis was seen after surgery.There were no fracture displacement,internal fixation failure,and fracture deformity healing cases.The mean time of bone union was 9.44±1.38 weeks (8-12 weeks) without fracture deformity healing case.The mean time of bone union was 9.17±1.16 weeks for the 23 cases with bone graft.For the 41 cases without bone graft,the bone healing average time was 9.91 ± 1.62 weeks,and there is no statistically difference between cases with and without bone graft (t=1.936,P=0.061).B(o)hler's angle was 6.625°±4.904° (range,-5°-15°) preoperative,and improved to 31.031°± 4.660° (range,24°-40°),which had statistically significant difference (t=-28.863,P=0.000).Gissane's angle was from preoperative 76.094°±12.981° (range,55°-105°) to 127.328°±6.486° (range,115°-140°) at the time of the latest follow-up,and the difference had statistically significant (t=-28.246,P=0.000).Maryland Score:excellent 30 cases (22 cases of type Ⅱ,8 cases of type Ⅲ),good 27 cases (15 of type Ⅱ,12 of type Ⅲ),fair 7 cases (2 of type Ⅱ,5 of type Ⅲ).The overall good rate was 89.06％ (57/64).Conclusion The tarsal sinus minimally invasive small incision reduction and internal fixation combined with percutaneous reduction and fixation technique in the treatment of ealcaneal fractures,exerts the advantages of small trauma,clear surgical exposure for reduction,reliable fixation,and low incision complications,which is applicable to treat the Sanders Ⅱ,Ⅲ calcaneal fractures.

Comparison of retrograde intramedullary nailing versus locking plating for tibiotalocalcaneal arthrodesis / 中华创伤骨科杂志

Objective To compare the curative effects of retrograde intramedullary nailing versus locking plating for tibiotalocalcaneal arthrodesis. Methods A retrospective study was performed of the 47 patients who had undergone tibiotalocalcaneal arthrodesis from January 2012 through January 2017 at De-partment of Orthopaedics, Pu'Ai Hospital. Of them, 28 were treated by retrograde intramedullary nailing and 19 by locking plating. The 2 ways of fixation were compared in terms of bony union rate, bony union time, revision rate, complications, American Orthopaedic Foot and Ankle Society ( AOFAS ) Ankle-Hindfoot Scale and Short Form 36 ( SF-36 ) scores. Results The overall bony union rate was 80.9% ( 38/47 ) for the 47 patients; the bony union rate for the intramedullary nailing group ( 71.4%) was significantly lower than that for the locking plating group ( 94.7%) ( P ＜0.05 ). There were no significant differences between the 2 groups in revision rate due to nonunion [ 17.8% ( 5/28 ) versus 5.2% ( 1/19 ) ] , bony union time ( 5.0 ± 0.9 months versus 5.5 ± 1.1 months ) , AOFAS Ankle-Hindfoot Scale ( 80.6 ± 8.4 points versus 79.5 ± 5.7 points) or SF-36 scores ( 78.9 ± 7.1 points versus 88.9 ± 7.7 points ) ( P ＞ 0.05 ) . The locking plating group had a significantly higher incidence of wound complications ( 47.4%) than the intramedullary nailing group (17.9%) ( P ＜0.05), but there were no significant differences between the 2 groups in symptomatic hardware or nerve irritations. Conclusions Both retrograde intramedullary nailing and locking plating can lead to fine curative effects in tibiotalocalcaneal arthrodesis. Although locking plating may result in a higher union rate than retrograde intramedullary nailing, it may cause a higher rate of wound complications.

Effects of fluvastatin on ventricular remodeling and serum TNF-αexpression in elderly patients with acute myocardial infarction / 中国生化药物杂志

Objective To investigate the effect of fluvastatin on ventricular remodeling and serum tumor necrosis factor alpha(TNF-α)level in elderly patients with acute myocardial infarction.Methods 87 elderly patients with acute myocardial infarction were chosen in Jiande Hospital of Integrated Traditional Chinese and Western Medicine from October 2014 to October 2016,were randomly divided into control group(42 cases)and observation group(45 cases),the control group received aspirin,PI Gray chlorine and other conventional treatment,the observation group were given fluvastatinon the basis of the control group treatment.The changes of cardiac function and serum inflammatory factor TNF-α levels were observed before and after treatment.Results After the treatment,left ventricular weight index such asleft ventricular systolic volume index,left ventricular diastolic membrane membrane volume index,left ventricular ejection fraction in the two groups were improved in different degree,but the observation group improved significantly(P<0.05).In the control group,there was no significant improvement; and after treatment,the indexes of the observation group were significantly better than those of the control group(P<0.05).The effective rate in the observation groupwas 93.33％,was significantly higher than the control group(P<0.05).After treatment,the levels of serum TNF-α were significantly improved in the observation group,and the level of serum was significantly decreased compared with before treatment(P<0.05),and the observation group after the treatment was obviously lower than the control group(P<0.05).Conclusion For elderly patients with acute myocardial infarction with fluvastatin can better improve the patient's heart function,improve the body's inflammatory level,effectively improve the treatment effect,inhibit ventricular remodeling.

Comparison of locking compression plate distal ulna hook plate and cannulated screws for fractures of fifth metatarsal base at zones Ⅰ and Ⅱ / 中华创伤骨科杂志

Objective To compare the therapeutic effects of locking compression plate distal ulna hook plate (LCP-DUHP) and cannulated screws in the internal fixation for fractures of the fifth metatarsal base at zones Ⅰ and Ⅱ.Methods This retrospective study included 67 patients who had been treated for fractures of the fifth metatarsal base at zones Ⅰ and Ⅱ from July 2013 through December 2015.Of them,29 were treated by internal fixation with cannulated screws,including 17 men and 12 women with an average age of 46.6 years.There were 13 zone Ⅰ fractures and 16 zone Ⅱ fractures according to the Lawrence-Botte partition.The other 38 patients were treated by internal fixation with LCP-DUHP,including 20 men and 18 women with an average age of 33.7 years.There were 20 zone Ⅰ fractures and 18 zone Ⅱ fractures according to the Lawrence-Botte partition.The therapeutic effects were evaluated at the final follow-ups using visual analogue scale (VAS) for the affected feet,American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scoring system,and incidence of postoperative complications.Results All this series were followed up for 51 to 87 weeks (average,57weeks).There were no significant differences between the cannulated screws group and the LCP-DUHP group in terms of fracture healing time (13.9 ± 1.6 weeks versus 14.2 ± 1.8 weeks),VAS scores (4.9 ± 1.3 versus 4.8 ± 1.O) or AOFAS midfoot scores (87.9 ± 3.4 versus 88.6 ± 2.5) (P ＞ 0.05).Bony union was achieved in all.No implant failure was observed in this series.Conclusion Both LCP-DUHP and cannulated screws can lead to satisfactory therapeutic effects in the treatment of fractures of the fifth metatarsal base at zones Ⅰ and Ⅱ.

Joint distraction arthroplasty as an alternative treatment for ankle osteoarthritis / 中华骨科杂志

Objective To analyze the feasibility of Ilizarov apparatus for ankle joint distraction to treat post-traumatic ankle osteoarthritis(OA).Methods From March 2012 to May 2014,15 patients with moderate post-traumatic ankle OA treated with foot and ankle deformities,and combined with ankle distraction surgery simultaneously by Ilizarov apparatus.The average age of patients was (35.6±6.5) years (10 Males and 5 females).Selected cases were involved in unilateral ankle disease,including 9 cases with ankle fractures medical history and 6 cases with ankle sprain medical history.Distraction was carried out for 3 months during which full weight bearing was allowed.Results Joint mobility and radiographic joint space were preserved in all 15 cases.No patients had undergone either ankle arthrodesis or total ankle arthroplasty.Ankle osteoarthritis scale (AOS) score was (33.8 ± 7.95) points before operation,(55.4 ± 5.46) points in the first year follow-up,and increased to (71.4 ± 10.19) points in the second year after operation,medical outcomes study 36-item short-form health survey (SF-36) score was (37.2 ± 4.32) points before operation,and increased to (52.8 ± 3.42) and (59.2 ± 2.95) points at 1 year and 2 years after operation,respectively,the difference between the two groups was statistically significant.The results of ankle range of motion (ROM) indicated function improved which was similar at both 1 year and 2 year's follow-up.Radiology joint space width (JSW) assessment indicated that ankle gap was improved significantly in 11 patients (73.3％,11/15) in the first year and maintain successfully in the second year.For the rest 4 patients (26.7％,4/15),ankle joint gap did not improved significantly,AOS and SF-36 showed clinical symptoms improved.Conclusion Ilizarov apparatus for ankle joint distraction is a promising treatment for moderate post-traumatic ankle OA at early stage of treatment,at least delaying the need for a joint fusion or total ankle arthroplasty.

The relationship between plasma homocysteine and acute cerebral infarction and the effect of folic acid and VitB12 / 中国生化药物杂志

Objective To study the relationship between plasma homocysteine and acute cerebral infarction and the effect of folic acid and VITB12.Methods74 cases of cerebral infarction patients in Jiande Hospital of Integrated Chinese and Western Medicine from December 2015 to December 2016 were selected as the observation group, 42healthy patients who received physical examination at the same stage were selected as the control group.All the researchers are using fluorescence polarization immunoassay to measure the plasma levels of homocysteine.47 patients with hyperhomocysteinemia in patients with acute cerebral infarction, then according to the classification method of randomly divided into the treatment group(n=23) and non treatment group(n=24).The treatment group was treated with folic acid and vitamin B12, while those in the non treatment group were not treated with these drugs, the effect of the intervention was compared.ResultsThe level of plasma homocysteine in the observation group was significantly higher than that in the control group, the difference was statistically significant (P<0.05).The levels of plasma HCY in the treatment group were significantly decreased after treatment with folic acid and vitamin B12,compared with non treatment group, the difference was statistically significant (P<0.05).ConclusionIn patients with acute cerebral infarction and the plasma homocysteine level was significantly higher than normal, so it needs to be controlled in a reasonable range, folic acid and vitamin B12 can reduce plasma HCY of the patient's body, and keep it in a more reasonable range, for the prevention of acute cerebral infarction is significant, it is worthy of clinical application.

Tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail with a valgus curve / 中华创伤骨科杂志

Objective To investigate the clinical effects of tibiotalocalcaneal arthrodesis (TTCA) using a retrograde intramedullary nail with a valgus curve.Methods At our department,22 patients underwent TTCA using a retrograde intramedullary nail with a valgus curve from June 2009 to January 2014 and were available for complete follow-up.They were 12 men and 10 women,aged from 46 to 79 years (average,62.2 years).There were 3 cases of primary ankle osteoarthritis,9 ones of traumatic arthritis,one of ankle arthritis secondary to severe talar avascular necrosis,3 ones of progressive subtalar arthritis following failed ankle replacement,5 ones of progressive subtalar arthritis following failed ankle arthrodesis,and one of arthritis secondary to equinovarus.The outcome measurements included the American Foot and Ankle Society (AOFAS) ankle-hindfoot scale,EQ-5DTM functional score,radiologic assessment and clinical examination.Results The mean follow-up was 21.3 months (range,from 14 to 38 months).A plantigrade foot and bony union were achieved in all the patients after a mean time of 3.9 months (range,from 2.4 to 6.2 months).Postoperative radiologic results showed a good hindfoot alignment in all the patients.Superficial infection occurred in one patient and loosening of the distal screw in another who asked for removal.The mean postoperative EQ-5DTM functional score and AOFAS ankle-hindfoot score were 69.3 (range,from 20 to 90) and 69.9 (range,from 45 to 85),respectively.Conclusion TTCA using a retrograde curved intramedullary nail may lead to solid fusion and good hindfoot alignment.

Effects of Captopril in renal ischemia reperfusion injury / 中国小儿急救医学

Objective To explore therapeutic mechanism of angiotensin-converting enzyme inhibitor (Captopril) in renal ischemia reperfusion (I/R) injury.Methods Wistar rats were randomly divided into sham operation group (Sham group),ischemia-reperfusion group (I/R group),captopril-treated group (CAP group),I/R model was made through ligating one side renal vessel.Renal function indexes including SCr and BUN were detected through biochemical analysis.Changes of renal tissue were observed by pathological section.ELISA detection was used to determine inflammatory cytokines such as IL-6,IL-8 and TNF-α.Activation of MAPK signaling pathway were analyzed by Western blot.Results After captopril treatment,SCr,BUN levels of the I/R group and the CAP group were higher than those of Sham group(P ＜ 0.05),Scr,BUN concentrations of CAP group were lower than those of I/R group(P ＜ 0.05).After captopril treatment,IL-6,IL-8,TNF-α concentrations of I/R group were higher than those of the Sham group(P ＜0.05);IL-6,IL-8,TNF-α concentrations of CAP group were lower than those of I/R group(P ＜ 0.05).Renal tissue c-jun N-terminal kinase,extracellular signal-regulated protein kinases,P38 in I/R group and CAP group were phosphorylated,and there were no significant differences between the two groups.Conclusion Captopril couldimprove renal function to some degree,and reduce expression of inflammatory cytokines rather than MAPK inflammatory signaling pathway.

Postoperative radiographic and clinical assessment of the treatment of posterior tibial plafond fractures using a posterior lateral incisional approach.

The purpose of the present study was to evaluate the postoperative radiographic and functional outcomes of reduction and fixation of a posterior plafond fracture using a posterolateral approach. We included 38 patients with a tibial plafond fracture. Fixation was most commonly performed using screws, T plates, or meta plates. The average follow-up period was 38 (range 25 to 72) months. The clinical outcomes of these patients were evaluated using the American Orthopaedic Foot Ankle Society score. The radiographs of the included patients were evaluated twice within 2 months by 3 experienced orthopedic trauma surgeons, who performed the retrospective radiographic review. Articular step off measures included the radiographic appearance of the reduction using picture archiving and communication system measurement tools. All 32 patients showed radiologic evidence of bony union at the follow-up visit; 6 patients were lost to follow-up. The American Orthopaedic Foot Ankle Society average score was 92 points; 21 patients (93.7%) had excellent scores (90 to 100 points), 9 patients (28.1%) had good scores (80 to 89 points), and 2 patients (6.2%) had fair scores (<80 points). Excellent to good outcomes were noted in 93.7% of the patients. One patient developed a superficial infection. Another patient experienced a sural cutaneous nerve injury. The radiographic articular step off was measured as 1 mm or less in 29 patients (90.6%) and 1 to 2 mm in 3 patients (9.4%). One patient (3.1%) developed symptomatic post-traumatic arthritis. The posterolateral approach allowed for good exposure and buttress fixation of the posterior plafond fractures with few local complications. The anatomic repositioning and stable fixation resulted in good functional and subjective outcomes.

Ectopic osteogenesis in vivo using bone morphogenetic protein-2 derived peptide loaded biodegradable hydrogel / 生物医学工程学杂志

We investigated the development of an injectable, biodegradable hydrogel composite of poly(trimethylene carbonate)-F127-poly(trimethylene carbonate)(PTMC11-F127-PTMC11 )loaded with bone morphogenetic protein-2 (BMP-2) derived peptide P24 for ectopic bone formation in vivo and evaluated its release kinetics in vitro. Then we evaluated P24 peptide release kinetics from different concentration of PTMC11-F127-PTMC11 hydrogel in vitro using bicinchoninic acid (BCA)assay. P24/ PTMC11-F127-PTMC11 hydrogel was implanted into each rat's erector muscle of spine and ectopic bone formation of the implanted gel in vivo was detected by hematoxylin and eosin stain (HE). PTMC11-F127-PTMC11 hydrogel with concentration more than 20 percent showed sustained slow release for one month after the initial burst release. Bone trabeculae surround the P24/ PTMC11-F127-PTMC11 hydrogel was shown at the end of six weeks by hematoxylin and eosin stain. These results indicated that encapsulated bone morphogenetic protein (BMP-2) derived peptide P24 remained viable in vivo, thus suggesting the potential of PTMC11-F127-PT- MC11 composite hydrogels as part of a novel strategy for localized delivery of bioactive molecules.

Weil osteotomy for metastatic metatarsalgia after hallux valgus surgery / 中华骨科杂志

Objective To investigate the cause of metastatic metatarsalgia after hallux valgus surgery and the clinical outcomes of Weil osteotomy for metastatic metatarsalgia after hallux valgus surgery. Methods From July 2009 to Janurary 2012, data of 27 patients (27 feet) with metastatic metatarsalgia of 2nd to 4th head of metatarsal bone after hallux valgus surgery who had been treated by Weil osteotomy were retrospectively analyzed. There were 1 male and 26 females with an average age of 51 years (range, 28-73 years). Metatarsalgia occurred 6-24 months after operation for hallux valgus. 13 feet underwent mini-invasive cervi-cal wedge osteotomy of the first metatarsal, 7 with Chevron procedure, 5 with Akin procedure, and 2 with Lapidus procedure. No shortening in first metatarsal was found in 5 feet with Akin osteotomy, while there were varying degrees of shortening in first meta-tarsal in the remaining 22 feet. The clinical results were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores. The preoperative and postoperative plantar pressure changes were tested by plantar pressure tester. Results 25 Patients were followed up for 12-42 months (average, 24 months). Among these 25 cases, the metatarsalgia of 23 cases were completely disappeared. The metatarsal plantar lateral metastatic pain occurred in the remaining 2 cases (2 feet) and 1 was relieved by the foot pad, 1 was cured by re-Weil osteotomy. AOFAS score was 46.82 ± 6.13 before surgery and 90.63 ± 1.65 after surgery. The VAS score was 7.5 (6, 7) before surgery and 0.5 (0, 1.0) after surgery. The last follow-up, according to the score of AOFAS toe metatarsophalangeal-interphalangeal joint, of which 23 cases were excellent, 1 good, 1 poor;the excellent and good rate was 96%(24/25). Preoperative pressure under 2nd to 5th metatarsal head were 3.12±1.62 Pa, 5.81±1.92 Pa, 4.63± 2.10 Pa, 3.37±1.57 Pa, 1.67±1.20 Pa and postoperative were 3.33±1.35 Pa, 3.89±1.08 Pa, 3.65±1.96 Pa, 2.25±1.23, (1.48±1.11) Pa. Postoperative pressure under 2nd to 5th metatarsal head were significantly decreased. Conclusion Weil osteotomy can effec-tively adjust the length of the metatarsal and the height of metatarsal head, thus effectively improve the pressure under the metatar-sal head, so it could reach a good effect in the treatment of metastatic metatarsalgia after hallux valgus surgery.

Lateral malleolus hook plate for comminuted Weber A and B fractures: A retrospective study.

BACKGROUND: The goal of managing the comminuted fracture of lateral malleolus is to restore length, rotation and alignment which might be more challenging with extensive comminution around the area of the distal tip. The common osteosynthesis techniques such as the one-third tubular plate, tension band wiring, K-wires, screws, or intramedullary nail may be insufficient in cases with a comminuted lateral malleolus. The anatomical hook plate is an alternative implant in such cases. We present our results of the comminuted lateral malleolar fractures (Weber A, B), managed by open reduction and internal fixation (ORIF) with an anatomical hook plate of lateral malleolus (Königsee Implant Company, Germany). MATERIALS AND METHODS: We retrospectively reviewed 20 patients of comminuted fracture of distal lateral malleolus between 2008 and 2010. There were 12 males and 8 females, right side was involved in 18 patients and left in 2. The mean age was 51.9 years (range 18-75 years). The fractures were categorized by Denis-Weber classification type A (n=1), B1 (n=1), B2 (n=13) and B3 (n=5). Nineteen cases were of closed injury and one of open injury (Gustilo Anderson type II). These patients underwent ORIF with a lateral malleolus anatomical hook plate. Followup including radiographs and clinical examinations were performed. The American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scores were documented at followups. RESULTS: The mean followup was 21.4 months (range 16-27 months). The average AOFAS score was 94.3 (range 78-100) points. A stable anatomic reduction and bony union were obtained in all the cases. The average time was 3.1 months (range 2.5-4 months). Four cases had complications like posttraumatic osteoarthritis, hardware impingement and superficial wound infection. CONCLUSION: A reasonably good stability can be obtained in distal most comminuted fractures of lateral malleolus with a lateral malleolus anatomical hook plate. We believe this method to be a reasonable treatment option for a distal lateral comminuted malleolar fracture when other common fixations are insufficient to fix the fragments.

Preparation and ectopic osteogenesis in vivo of scaffold based on new synthetic biodegradable hydrogel loaded with synthetic BMP-2-derived peptide / 国际生物医学工程杂志

Objective To prepare P24/PTMC11-F127-PTMC11 hydrogel,to study the in vitro release profile and to observe ectopic bone formation in p24 peptide incorporated PTMC11-F127-PTMC11 hydrogel.Methods Corresponding weight powder of p24 peptide was infunded into tubes of PTMC11-F127-PTMC11 solution with concentrations of 16％,20％ and 25％.Release profiles of P24 peptide in different concentration PTMC11-F127-PTMC11 hydrogel were measured in vitro by BCA assay.P24/PTMC11-F127-PTMC11 hydrogel was implanted into each rat's erector muscle of spine,and the implanted gel was detected by hematoxylin and eosin stain (HE).Results PTMC11-F127-PTMC11 hydrogel showed sustained slow release for the whole process after the initial burst release.With the increase of concentration in PTMC11-F127-PTMC.hydrogel,the initial burst release was reduced significantly.Ectopic bone formation was observed by computed tomography in p24 peptide incorporated PTMC11-F127-PTMC11 hydrogel after four weeks.Bone trabeculae surround the P24/PTMC11-F127-PTMC11 hydrogel was observed at forth week by hematoxylin and eosin stain.The bone trabeculae became thicker from sixth week.Conclusion Delayed release of peptide from the hydrogel was mainly controlled by disintegration of hydrogel and a satisfactory release profile was observed.These results suggest that the p24-loaded PTMC11-F127-PTMC11 hydrogel remmns active of p24 at the implanted site,continuously induce differentiation of osteoblast precursor cells into osteoblasts,and activate osteoblasts to promote ectopic calcification.

Clinical outcome of lateral malleolar's anatomical hook-plate for unstable distal fibular fracture / 中华骨科杂志

Objective To evaluate the clinical outcome of lateral malleolar's anatomical hook-plate in treating ankle fracture including distal fibular fracture. Methods Nineteen patients of ankle fracture including distal fibular fracture were treated from January 2006 to January 2009. There were 12 males and 7 females with an average age of 36 years (range, 18-72 years). The fractures were classified by Danis-Weber system. There were A type in 8 cases, B type in 11 cases. The average time of duration between injury and operation was 6 days (ranged from 6 hours to 16 days). The distal fibular fracture were treated with lateral malleolar's anatomical hook-plate. The medial malleolus was fixed with cancellous bone screw. The posterior malleolus was fixed with screw or plate according to the pattern of fracture. Results The mean follow-up period was 18.8 months with a range from 6 to 32 months. No obvious fracture line could be seen on the radiographs 4-6 weeks after operation. Bone healing was achieved in 10 cases 12 weeks after operation and in 9 cases 20 weeks after operation. All surgical incisions healed adequately. There were no instances of infection, instability of ankle and other complications. According to Mazur ankle joint scoring scale system, the fiual result was scored from 67 to 92 (average 86.3). There were excellent in 12 cases, good in 4, fair in 2,and poor in 1 case. The excellent and good rate was 84.2%. Conclusion The lateral malleolar's anatomical hook-plate represents a definite biomechanical superiority in treating fracture of the external malleolus, with advantage of restoring anatomic structure, joint activity effectively and firm fixation.

Lengthening osteotomy of the fibula in treatment of treating lateral malleolar malunon / 中华骨科杂志

Objective To investigate the therapeutic effect of lengthening and rotational osteotomy of the fibula for lateral malleolar malunion. Methods Twenty-three patients who had suffering from the traumatic arthritis of ankle were due to lateral malleolar malunion treated with lengthening and rotational osteotomy from October 2005 to July 2008. Special radiographs were use to fully detect the extent of shortening and rotation of the fibula. The Lengthening and rotational osteotomy could be conducted with a special compression/distraction device and bone graft. The function of the ankles was evaluated by the American Orthopedic Foot Ankle Society (AOFAS) scoring system. Serial radiographs of the ankle were made to assess the bone healing and changes of posttraumatic osteoarthritis. Results Seventeen of 23 patients were followed up, with a mean 29.1 months (12-45 months). All the fractures were healed. The mean bone healing time was 13.3 weeks (11-16 weeks) and the mean time of total weight-bearing was 12.1 weeks (11-15 weeks). The ankle function score had improved from 29 (21-47) preoperatively to 81 (56-91)12 months after the operation. There was 5 in excellent, 8 in good, 3 in mild, 1 in poor, and the rate of good outcomes was 76.5%. After the operation, 1 patient had a skin necrosis around the wound which healed by conservative treatment. A slightly aggravated degeneration of the ankle joint was seen in 2 patients who responded to conservative managements. No failure of the internal fixation was noted in this group. Conclusion The outcomes demonstrate that reconstructive lengthening osteotomy is well worthwhile when there is absent or minimal osteoarthritic change, regardless the time from the original injury. Lengthening of the fibula is an important step in the treatment of the painful ankle when the fibula become shorter after injury, even when degenerative changes of the joint are already present. The lengthening of the fibula could lead to a good outcome in ankle with lateral malleolar malunion.

Effects of pulsed electromagnetic fields on the differentiation of mouse bone marrow mesenchymal stem cells into osteoblasts in vitro / 中国组织工程研究

BACKGROUND: The proliferation and differentiation of mesenchymal stem cells (MSCs) lack of regulatory functions. Following combining with suitable vectors, MSCs cannot highly effectively proliferate and differentiate, which are keys to prevent MSCs entering the clinic. It is of great importance to effectively regulate the differentiation of stem cells into osteoblasts using pulse electromagnetic field.OBJECTIVE: To investigate the differentiation of mouse MSCs into osteoblasts in vitro following stimulation of pulse electromagnetic field.DESIGN, TIME AND SETTING: The cytological in vitro controlled study was conducted at the Laboratory of Department of Orthopaedics, Puai Hospital of Tongji Medical College, Huazhong University of Science and Technology from May 2004 to October 2007.MATEIRALS: Totally 20 BALB/C mice were supplied by the Experimental Animal Center of Tongji Medical College. Pulse electromagnetic field deviser was designed and made by the Department of Electric Machine, Naval University of Engineering.METHODS: Mouse bilateral femur was sterilely isolated. BMSCs were harvested by the Percoll density gradient centrifugation,and purified and proliferated by the adherent method. Cells at the third passage (2×10~7/L) were incubated in a 6-well plate, and then divided into 4 groups. Cells in the blank control group were incubated in the complete medium. Cells in the pulse electromagnetic field underwent pulse electromagnetic field radiation of 50 Hz, sinusoidal wave, and 1 mT, twice a day, once 30 minutes, with an interval of 12 hours, totally 10 days. Cells in the osteogenic induction group were incubated in the complete medium, supplemented with dexamethasone, sodium glycerophosphate and VitC. Cells in the pulse electromagnetic field + osteogenic induction group were subjected to the same pulse electromagnetic field radiation and then incubated in the complete medium.MAIN OUTCOME MEASURES: The differentiation of BMSCs was measured.RESULTS: Results of alkaline phosphatase staining showed that cells were negative in the blank control group, but weakly positive in the pulse electromagnetic field group, positive in the osteogenic induction group, and strongly positive in the pulse electromagnetic field + osteogenic induction group 10 days following intervention. Compared with the blank control group,absorbance value of type I collagen immunohistochemistry was significantly greater in the osteogenic induction group, pulse electromagnetic field + osteogenic induction group (P < 0.05, P < 0.01).CONCLUSION: Pulsed electromagnetism fields of 50 Hz, waves of sine, with the intensity of 1 mT could promote alkaline phosphatase and type I collagen expression and enhance the differentiation of mouse BMSCs into osteoblasts in vitro.