BACKGROUND:Osteoporosis is a common systemic metabolic disease, leading to increased bone fragility and risk of fractures. Research has shown that Adenosine triphosphate (ATP) synthase, H+transporting, mitochondrial F1 complex, alpha subunit 1 (ATP5A1), a crucial component in ATP production, is inhibited in dexamethasone (DEX)-induced osteoblasts. Therefore, this study aimed to investigate the molecular mechanism underlying the inhibitory impact of DEX on osteogenic differentiation in rat bone marrow mesenchymal stem cells (BMSCs). METHODS:Rat BMSCs were treated with varying concentrations of DEX for 14 days, followed by subsequent analyses. The expression levels of calpastatin (CAST), calpain 1 (CAPN1), and ATP5A1 were assessed using quantitative reverse transcription polymerase chain reaction (qRT-PCR) and Western blotting analyses. Furthermore, osteogenic marker proteins and ATP activity were evaluated employing Western blotting analysis and enzyme-linked immunosorbent assay (ELISA). Moreover, to determine the regulatory role of DEX on the CAST-CAPN1 axis, overexpression plasmids for CAST (oe-CAST) and CAPN1 (oe-CAPN1) were constructed. Additionally, osteogenic differentiation and ATP activity in BMSCs were analyzed using qRT-PCR, Western blotting, Alizarin Red S staining, and ELISA. RESULTS:With increasing concentrations of DEX, the expression of the CAST-CAPN1-ATP5A1 axis in BMSCs was significantly altered (p < 0.05). DEX downregulated the levels of osteogenic markers, including Runt-Related Transcription Factor 2 (RUNX2), alkaline phosphatase (ALP), and osteopontin (OPN), while reducing ATP activity (p < 0.05). However, oe-CAST partially mitigated the inhibitory effects of DEX on osteogenic differentiation and ATP activity (p < 0.05). In contrast, oe-CAPN1 exacerbated the effects of DEX and reversed the regulatory impact of CAST (p < 0.05). CONCLUSION:DEX inhibits osteogenic differentiation and reduces ATP activity in BMSCs by modulating the CAST-CAPN1 axis.

BACKGROUND:It has been reported that Sirtuin 2 (SIRT2) prevents phosphoenolpyruvate carboxykinase 1 (PCK1) degradation, which can be involved in aging-induced osteoarthritis (OA), but the molecular mechanism of SIRT2/PCK1 in chondrocytes has not been clarified. Therefore, this study aims to explore the mechanism of SIRT2/PCK1 in chondrocyte inflammation. METHOD:To establish the OA model in vitro, chondrocytes cultured with interleukin-1β (IL-1β, 10 ng/mL) and manipulation of SIRT2 and PCK1 expression in the constructed cells to elucidate the interaction between the two genes. 1,9-Dimethyl-Methylene Blue (DMMB) was used to detect cellular glycosaminoglycan (GAG) content. Inflammatory factor levels were assessed using Enzyme-linked Immunosorbent Assay (ELISA). Apoptosis was detected by osmotic dye. The expression of B-cell lymphoma-2 (Bcl-2), Bcl-2 Associated X (Bax), Wnt Family Member 1 (Wnt1), catenin Beta 1 (β-catenin), Aggrecan, Collagen II, matrix metallopeptidase 13 (MMP-13) proteins in cells were analyzed using Western blot. RESULTS:PCK1 gained lower expressions in OA cell models. Overexpression of PCK1 or SIRT2 in the IL-1β chondrocyte model of inflammation promoted GAG content, inhibited apoptosis and Wnt/β-catenin protein expression, and lowered the levels of inflammatory factors. PCK1 silencing was proved to have the opposite effect. SIRT2 overexpression rescued the increased inflammation, MMP-13 expression, and apoptosis and the decreased Aggrecan and Collagen II expression caused by PCK1 silencing. PCK1 silencing also reversed the positive effects of SIRT2 overexpression on chondrocytes. CONCLUSION:SIRT2 inhibits articular chondrocyte extracellular matrix (ECM) degradation, inflammatory factor expression, and apoptosis via PCK1.

Olecranon osteotomy and paratricipital approaches were widely used in the treatment of type C distal humerus fracture but some disadvantages exist, so a combined medial and lateral approach was designed. The objective of this study was to investigate and compare the clinical outcomes of combined medial and lateral approach with the paratricipital approach in open reduction and internal fixation of type C distal humerus fractures.From May 2018 to April 2020, 37 patients with type C distal humerus fracture who accepted open reduction and internal fixation in our hospital were enrolled in this study. All cases were randomly divided into two groups according to the surgical approach: combined medial and lateral approach group (19 cases), paratricipital approach group (18 cases). All of the patients received open reduction and double vertical plates fixation. The operation and follow-up indexes, including operation time, blood loss, incision length, triceps muscle strength, flexion-extension arc of elbow and forearm rotation arc, were recorded and compared. Caja score was used to assess the quality of fractures reduction. Mayo Elbow Performance Score (MEPS) was used to evaluate the elbow function in the follow-up. Complications such as incision infection, ulnar nerve injury, degenerative osteoarthritis, and heterotopic ossification were analyzed.The differences in age, gender, and AO classification of fractures between two groups were not statistically significant (p > 0.05). The sum of medial and lateral incision length of combined approach group was longer than the midline incision of paratricipital approach group (15.4 ± 0.8 vs. 14.6 ± 0.8, p < 0.05), but there was no significant difference in operation time (103.5 ± 10.2 vs. 106.0 ± 8.8, p > 0.05), blood loss (71.3 ± 24.5 vs. 72.8 ± 24.6, p > 0.05), and Caja score (16.05 ± 5.67 vs. 15.56 ± 5.66, p > 0.05). During the follow-up, the MEPS of combined approach group was higher than that of paratricipital approach group at 3 months postoperatively (80.5 ± 5.7 vs. 68.9 ± 8.1, p < 0.05), but there was no significant difference in MEPS at 6 months postoperatively (83.9 ± 6.6 vs. 79.7 ± 7.0, p > 0.05) and at the last follow-up (86.8 ± 7.1 vs. 86.9 ± 7.7, p > 0.05) between the two groups. There was no significant difference in triceps muscle strength (p > 0.05), flexion-extension arc (126.8 ± 5.3 vs. 128.9 ± 6.0, p > 0.05), and forearm rotation arc (163.2 ± 5.3 vs. 163.6 ± 4.8, p > 0.05) at the last follow-up. Although the incidence of complication of combined approach group (15.8%) was lower than that of paratricipital approach group (22.2%), the difference was not statistically significant (p > 0.05).The combined medial and lateral approach was an effective and safe way of open reduction and internal fixation for type C distal humerus fractures. Compared with the paratricipital approach, the combined medial and lateral approach could restore the elbow function more quickly postoperatively, and the long-term results were comparable.

Objective:To compare the clinical efficacy between femoral neck system (FNS) and inverted cannulated compression screws (ICCS) in the fixation of adult femoral neck fracture.Methods:The clinical data were retrospectively analyzed of the 119 patients with femoral neck fracture who had received FNS or ICCS internal fixation at Department of Traumatic Orthopedics, West China Hospital from September 2019 to June 2020. They were divided into 2 groups according to their internal fixation methods. In the FNS group of 62 patients, there were 38 males and 24 females, with an age of (54.0±13.0) years, and 13 cases of type Ⅱ, 34 cases of type Ⅲ and 15 cases of type Ⅳ according to the Garden classification; in the ICCS group of 57 patients, there were 42 males and 15 females, with an age of (53.2±11.3) years, and 9 cases of type Ⅱ, 33 cases of type Ⅲ and 15 cases of type Ⅳ according to the Garden classification. The operation time, intraoperative blood loss, fluoroscopy frequency, hospitalization time, fracture healing time, Harris hip score and incidence of complications were compared between the 2 groups.Results:The 2 groups were comparable due to insignificant differences in their preoperative general data or follow-up duration ( P>0.05). There were significant differences between the FNS and ICCS groups in fluoroscopy frequency [(8.8±2.9) times versus (15.6±3.4) times], operation time [(45.2±10.1) min versus (51.8±11.7) min], fracture healing time [(3.2±0.4) months versus (4.0±0.6) months], Harris hip score at the last follow-up [(91.8±4.4) points versus (84.6±3.3) points], and femoral neck shortening at the last follow-up, favoring the FNS group (all P<0.05). There were no significant differences in follow-up time, hospitalization time, intraoperative blood loss or incidence of complications between the 2 groups ( P>0.05). Conclusions:In the fixation of adult femoral neck fractures, compared with ICCS, FNS can significantly reduce fluoroscopy frequency, shorten fracture healing and operation time, reduce risk of femoral neck shortening and hospitalization time, and promote functional recovery of the hip.

目的 分析多层螺旋CT(MSCT)扫描对外伤性腕关节损伤患者临床诊治价值.方法 选取本院2017年2月至2018年5月收治的34例外伤性腕关节损伤患者作为研究对象,分析MSCT检查和X线对腕关节骨折或脱位的显示情况.结果 34例外伤性腕关节患者经MSCT检查共发现39处骨折或脱位,并经长期随访或手术证实.其中舟状骨骨折10处,头状骨骨折7例,三角骨骨折5例,豆状骨骨折5例,大多角骨骨折4例,月骨周围脱位8例;经X线检查共发现32处骨折或脱位,7处漏诊.34例患者中行开放复位术治疗患者7例,行手术复位术治疗患者23例,其余4例患者行单纯固定.结论 MSCT检查可有效提高外伤性腕关节损伤的诊断准确率,其三维重建技术能明确可疑骨折和脱位,可为临床医师手术方案的制定和选择提供可靠的依据.

Objective To investigate the factors, surgical treatment methods and clinical effect of internal fixation failure of intertrochanteric and subtrochanteric fractures. Methods From June 2015 to May 2019, arthroplasty and internal fixation revision were used to treat 18 cases of internal fixation failure of intertrochanteric and subtrochanteric fractures. There were 10 males and eight females, with an average age of 67.3 years (38–92 years). The 16 cases of initial intertrochanteric fractures were classified according to AO/OTA:13 cases of A2 and 3 cases of A3, the other 2 cases were subtrochanteric fractures (Seinsheimer type IV). The internal fixation failure was treated with total hip arthroplasty (6 cases), bipolar hemiarthroplasty (4 cases), revision with proximal femoral lockingplate (4 cases) and extend intramedullary nail (4 cases). Results All patients were followed up for an average of 24.7 months (range, 12 to 36 months). The average operative time was 111.4 min (range, 72 to 146 min) and the average intraoperative blood loss was 403.6 mL (range, 200 to 650 mL). The average time of fracture union was 6.9 months (range, 5 to 9 months) for cases of internal fixation revision. The operative time of the arthroplasty group was shorter than the revision group (P < 0.001), and the intraoperative blood loss of the arthroplasty group was less than the revision group (P = 0.001). The affected limb shortening of postoperative (0.21 ± 0.19 cm) was better than preoperative (2.01 ± 0.60 cm) (P < 0.001), while the limb shortening of the arthroplasty group (0.11 ± 0.21 cm) was less than the revision group (0.33 ± 0.09 cm) (P = 0.015). At the last follow‐up, all injured limbs regained walking function, and the Harris hip score was 81.3 ± 9.4 points. The Harris score of postoperative was better than preoperative (33.4 ± 5.9 points) (P < 0.001), while there were no significant differences between the arthroplasty group and the revision group at 3 months (76.5 ± 8.5 vs 71.1 ± 10.6, P = 0.249), 6 months (80.9 ± 7.9 vs 78.9 ± 12.9,P = 0.687) postoperative and the last follow‐up (80.5 ± 8.3 vs 82.3 ± 11.7, P = 0.716) respectively. Conclusion For internal fixation failure of peritrochanteric fractures, young patients could accept internal fixation revision to restore normal anatomical structure, correct varus deformity and autograft; while elderly patients and patients with damaged femoral head could be treated with arthroplasty to restore walking function.

Mesenchymal stem cells (MSCs) are a promising regenerative medicine. The roles of miRNAs in osteogenic differentiation of bone marrow MSCs (BM-MSCs) remained less reported. Forkhead Box O3 (FOXO3) and alkaline phosphatase (ALP) levels in the BM-MSCs were measured on 3, 7, and 14 days after osteogenic differentiation. After transfection of FOXO3 overexpression plasmids or siFOXO3 into BM-MSCs, factors related to osteogenic differentiation or cell autophagy were determined. Besides, 3-methyladenine or rapamycin, as well as miR-223-3p mimic or inhibitor were applied to further determine the effect of FOXO3 in BM-MSCs. FOXO3 and ALP levels were increased in a time-dependent manner with osteogenic differentiation, supported by Alizarin Red Staining. Furthermore, up-regulated FOXO3 increased levels of ALP and factors related to osteogenic differentiation by increasing levels of autophagy-related factors. FOXO3, targeted by miR-223-3p, reversed the effects of miR-223-3p on factors related to BM-MSC autophagy and osteogenic differentiation. Down-regulated miR-223-3p expression promoted osteogenic differentiation of BM-MSCs by enhancing autophagy via targeting FOXO3, suggesting the potential of miR-223-3p as a therapeutic target for enhancing bone functions.

Objective To observe the effectiveness of locking compression hook plate in treatment of humeral greater tuberosity fractures. Methods Between March 2014 and September 2017, 16 patients with isolated humeral greater tuberosity fractures were terated with open reduction and internal fixation with locking compression hook plates. There were 11 males and 5 females, with an average age of 38.4 years (range, 22-67 years). The cause of injury was falling injury in 13 cases and sport injury in 3 cases. All patients were closed fractures. Of all patients, 14 patients accompanied with shoulder joint dislocations. CT scan showed the average displacement of fragment was 12.6 mm (range, 8-21 mm) after reduction. All patients began passive functional exercise at 3 days after operation. Results Primary healing of the incisons achieved in all patients, without complications such as infection and nerve injury. All patients were followed up 12-20 months (mean, 15.3 months). At 3 months after operation, X-ray film showed that all fractures achieved bone union, all of which met the imaging anatomical reduction standard. According to the Neer scoring criteria, 11 cases were excellent and 5 cases were good at last follow-up. One patint presented slight pain of shoulder joint and mild activity limitation, which relieved after 1 year. Conclusion The method of open reduction and locking compression hook plate internal fixation for isolated humeral greater tuberosity fractures has advantages, such as less intraoperative hemorrhage, mild postoperative pain, firm fixation, and allowing patients to perform functional exercise earlier, which is conducive to shoulder functional recovery and obtain satisfactory effectiveness.

Background: Though several systematic reviews concerned have been published, controversy still exists. The current systematic review was designed to clarify the detailed advantages and disadvantages of the negative pressure wound therapy (NPWT) in treatment of open fractures in comparison with the conventional wound dressings. Methods: A systematic search was performed in Pubmed, Cochrane Library, Embase, and Google Scholar for the published relevant clinical studies. Unpublished studies were searched in Clinicaltrials, ICTRP and ISRCTN. The outcome measures included presence of infection, wound healing process, length of the patient hospital stay, flap issues, frequency of amputation, and patient life quality. Results: In the 8 randomized controlled trials (RCTs) (421 patients) and the 6 retrospective cohort studies (488 patients), NPWT resulted in a significantly lower infection rate, significantly shorter wound coverage time, wound healing time and hospital stay length, and the lower amputation rate. However, no statistically significant difference was found in the need for flap surgery, the proportion of free flaps, the flap failure rate or the fracture non-union rate. Only 1 RCT was reported to have a higher physical component score of short form 36 in the infected patients. Conclusion: NPWT can significantly reduce the risk of infection in treatment of open fractures and accelerate their wound healing process. Some but not much evidence suggests that NPWT may possibly help reduce the severity of the limb injury and therefore provide a chance for the limb to avoid amputation. Use of NPWT in the flap area is probably safe, but should be carried out with caution. The advantage of NPWT over the conventional wound dressings still requires to be confirmed in the other aspects.

Submit Manuscript | http://medcraveonline.com Abbreviations: RoBANS: Risk of Bias Assessment Tool for Non-Randomized Studies; MIN: Intramedullary Nailing; LISS: Less Invasive Stabilization System; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis; WHO: World Health Organization; ICTRP: International Clinical Trials Registry Platform; ISRCTN: International Standard Randomized Controlled Trial Number; OR: Odds Ratio; SPSS: Statistical Package for the Social Sciences

Objective: The aim of this study was to investigate the optimal timing for the resection of heterotopic ossification (HO) of the elbow. Methods: We retrospectively reviewed 42 patients who were treated operatively for heterotopic ossification of the elbow from March 2010 to December 2014 at our institution. The patients were divided into early (before 12 months) and late (after 12 months) excision groups. In the early excision group (17 patients), the average time from the initial injury to HO excision was 7.4 (3-11) months, and in the late excision group (25 patients), the average time was 33.5 (12-240) months. Every patient was evaluated by range of motion (ROM), the Mayo Elbow Performance Score (MEPS), postoperative complications and HO recurrence. Results: The preoperative mean ROM in the late excision group was greater than that of the early excision group, suggesting that the ROM is expected to increase even without surgery. Both early and late surgery increased ROM and MEPS, but early surgery improved ROM and MEPS more than late surgery did (p < .05). Conclusions: Early excision of HO can provide better elbow function, as indicated by ROM and MEPS. Considering that there were no notable differences in postoperative ROM and MEPS, HO recurrence, or postoperative complications, we concluded that early excision is safe and that the time from an elbow injury to surgery may be shortened. (c) 2017 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V.

[Objective] To compare clinical outcomes of antegrade locked intramedullary nailing versus dynamic compression plating for the primary surgical fixation of humeral shaft fractures.[Methods] An electronic search was conducted using the databases including the Cochrane library,Medline,Embase and CNKI.A literature search was performed for all the studies published in the all languages from the earliest records to December 2016 regarding to antegrade locked intramedullary nailing versus dynamic compression plating for humeral shaft fractures.After meticulous data extraction,a meta-analysis was performed were performed using Review Manager Software 5.0.[Results] At the initial search 472 articles were sought out.Only 8 articles met to the criteria after a review were included into this study.There were 373 patients including 187 with the nail and 186 with the plate for treatment of humeral shaft fractures.The antegrade locked intramedullary nailing had significantly lower postoperative infection compared to dynamic compression plating [OR=0.34,95％ CI (0.12,0,98),P=0,05],however,the former got the increased incidence of shoulder impairment and reoperation over the latter [OR=7.81,95％ CI (2.51,24.33),P=0.0004;OR=2.61,95％ CI (1.19,5.72),P=0,02].There were no significant differences in incidences of nonunion,radial nerve palsy between the two techniques.[Conclusion] On the basis of current evidence,both antegrade locked intramedullary nailing and dynamic compression plating have similar risk of nonunion and radial nerve palsy.However the nailing increases the chance of shoulder impairment and reoperation,conversely decrease postoperative infection compared with the plating.

Objective To evaluate the safety of conversion from external fixation to internal fixation for open tibia fractures. Methods Between January 2010 and December 2014, 94 patients (98 limbs) with open tibia fractures were initially treated with external fixators at the first stage, and the clinical data were retrospectively analyzed. In 29 cases (31 limbs), the external fixators were changed to internal fixation for discomfort, pin tract response, Schantz pin loosening, delayed union or non-union after complete wound healing and normal or close to normal levels of erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and the leucocyte count as well as the neutrophil ratio (trial group); in 65 cases (67 limbs), the external fixators were used as the ultimate treatment in the control group. There was no significant difference in gender, age, side of the limbs, interval from injury to the first debridement, initial pathogenic bacteria, the limbs that skin grafting or flap transferring for skin and soft tissue defect between the two groups ( P>0.05). The incidence of Gustilo type III fractures in the control group was significantly higher than that in the trial group ( P=0.000). The overall incidence of infection was calculated respectively in the two groups. The incidence of infection according to different fracture types and whether skin grafting or flap transferring was compared between the two groups. The information of the pathogenic bacteria was recorded in the infected patients, and it was compared with the results of the initial culture. The incidence of infection in the patients of the trial group using different internal fixation instruments was recorded. Results The overall incidences of infection for the trial and control groups were 9.7% (3/31) and 9.0% (6/67) respectively, showing no significant difference ( χ2=0.013, P=0.909). No infection occurred in Gustilo type I and type II patients. The incidence of infection for Gustilo type IIIA patients in the trial group and the control group were 14.3% (1/7) and 6.3% (2/32) respectively, showing no significant difference ( χ2=0.509, P=0.476); the incidence of infection for type IIIB patients in the two groups were 50.0% (2/4) and 14.3% (2/14) respectively, showing no significant difference ( χ2=2.168, P=0.141); and the incidence of infection for type IIIC patients in the two groups were 0 and 16.7% (2/12) respectively, showing no significant difference ( χ2=0.361, P=0.548). Of all the infected limbs, only 1 limb in the trial group had the same Staphylococcus Aureus as the result of the initial culture. In the patients who underwent skin grafting or flap transferring, the incidence of infection in the trial and control groups were 33.3% (2/6) and 13.3% (2/15) respectively, showing no significant difference ( χ2=1.059, P=0.303). After conversion to internal fixation, no infection occurred in the cases that fixed with nails (11 limbs), and infection occurred in 4 of 20 limbs that fixed with plates, with an incidence of infection of 20%. Conclusion Conversion from external fixation to internal fixation for open tibia fractures is safe in most cases. However, for open tibia fractures with extensive and severe soft tissue injury, especially Gustilo type III patients who achieved wound heal after flap transfer or skin grafting, the choice of secondary conversion to internal fixation should carried out cautiously. Careful pre-operative evaluation of soft tissue status, cautious choice of fixation instrument and meticulous intra-operative soft tissue protection are essential for its safety.

Diabetic foot is a kind of limb- and life-threatening complication that is difficult to treat with conventional therapy, especially when accompanied with peripheral arterial insufficiency and severe infection. We present a diabetic patient with a postamputation wound infected by multidrug-resistant Acinetobacter baumannii/haemolyticus, which was resistant to almost all antibiotics. As the clinical response to antimicrobial therapy was poor, antibiotic was discontinued. Autologous platelet-rich gel with anticoagulation, negative pressure wound therapy, and improvement of microcirculation were used successfully to eradicate infection of the superbug and achieve final wound closure.

Endothelial progenitor cells (EPC) derived from the circulation may be used to enhance neovascularization. Since the combination of granulocyte colony-stimulating factor (GCSF) and CXCR4 antagonist AMD3100 efficiently mobilizes hematopoietic stem cells into peripheral circulation, it may increase the pool of endogenously circulating EPC. We tested this hypothesis by administering GCSF and AMD3100 to adult rabbits and rats, isolating mononuclear cells from peripheral blood by Ficoll density gradient centrifugation, and characterizing the blood-derived EPC based on morphology, immunophenotyping, gene expression and other functional analyses. These EPC showed clonal growth similar to that of human umbilical vein endothelial cells when cultured in complete EGM-2 medium on collagen I-precoated culture plates. The EPC exhibited a typical cobblestone-like morphology and were relatively homogeneous by the third passage. The cells expressed the typical endothelial marker CD31 based on flow cytometry and fluorescence microscopy, formed capillary-like structures when cultured in Matrigel, internalized DiI-acetylated low-density lipoprotein, bound Ulex europaeus agglutinin-1, and expressed CD31 and several other endothelial markers (VEGFR2, VE-cadherin, Tie-2, eNOS, vWF) at significantly higher levels than bone marrow-derived mesenchymal stem cells. These results suggest that the combination of GCSF and AMD3100 can efficiently release stem cells into peripheral circulation and generate EPC that show the desired morphological, immunophenotypic and functional characteristics. This minimally invasive approach may be useful for autologous cell transplantation for postnatal neovasculogenesis and tissue repair.

ObjectiveTo explore the flap combined with VSD sexual selection in the calf segmental destroyed the value of soft tissue defect.MethodsFrom January 2010 to December 2014,Total calf segmental destructive injury treated 25 cases of patients with soft tissue defect,the wound skin flap to repair and/or in combination with the VSD continuous seal negative pressure drainage technology,free skin graft to repair.ResultsAll the 25 patients were followed up for 3~56 months,25 cases of calf segmental destructive injury with soft tissue defect,there were 8 cases excellent (32%),13 cases good(52%),3 cases acceptable(12%),and 1 case poor(4%).ConclusionThe skin flap with VSD should comprehensive use,in order to best shape function,for the purpose of the least damage as reference. Soft tissue defect wound only cover,pure skin graft;Serious deep infection to myocutaneous flap to repair damaged,to the merger, the part can use the VSD optimization wound,simplified as skin grafts or fascia flap repair. The VSD drainage granulation repair of tendon scar adhesion can be avoided,and partial choice of drainage can be avoided and the direct skin flap is repaired.

OBJECTIVETo investigate the application and technical essentials of computer-assisted navigation in the surgical management of periacetabular fractures and pelvic fractures.METHODSBetween May 2010 and May 2011, 39 patients with periacetabular or anterior and posterior pelvic ring fractures were treated by minimally invasive fixation under computer-assisted navigation and were followed up more than 2 years, and the clinical data were analyzed retrospectively. There were 21 males and 18 females, aged 15-64 years (mean, 36 years). Fractures were caused by traffic accident in 23 cases, crush injury in 6 cases, and falling from height in 10 cases. Of them, 6 cases had acetabular fractures; 6 cases had femoral neck fractures; 18 cases had dislocation of sacroiliac joint; and 15 cases had anterior pelvic ring injuries. All patients were treated with closed or limited open reduction and screw fixations assisted with navigation.RESULTSEighty-nine screws were inserted during operation, including 8 in the acetabulum, 18 in the neck of the femur, 33 in the sacroiliac joint, and 30 in the symphysis pubis and pubic rami. The mean time of screw implanted was 20 minutes (range, 11-38 minutes), and the average blood loss volume was 20 mL (range, 10-50 mL). The postoperative pelvic X-ray and three dimensional CT scan showed good reduction of fractures and good position of the screws. No incision infection, neurovascular injury, or implant failure occurred. All patients were followed up 27-33 months with an average of 29.6 months. The patients could walk with full weight loading at 6-12 weeks after operation (mean, 8 weeks); at last follow-up, the patients could walk on the flat ground, stand with one leg, and squat down, and they recovered well enough to do their job and to live a normal life.CONCLUSIONMinimally invasive fixation under computer-assisted navigation may be an excellent method to treat some specific types of periacetabular and anterior and posterior pelvic ring fractures because it has the advantages of less trauma and blood loss, lower complication incidence, and faster recovery.

OBJECTIVE:To investigate the application of lateral malleolus hook-plate for the treatment of stage II supination-adduction type medial malleolus fractures.METHODS:Between January 2011 and June 2013, 21 patients with stage II supination-adduction type ankle fractures were treated with lateral malleolus hook-plate, including 12 males and 9 females with an average age of 55.5 years (range, 27-65 years). The injury causes were sprain in 17 cases and traffic accident in 4 cases. The mean time between injury and admission was 12.4 hours (range, 2-72 hours). The tibial distal medial articular surface collapse was found in 7 cases by CT examination and in 3 cases by X-ray film. Of 21 cases, there were 12 cases of low transverse fractures of lateral malleolus, 7 cases of short oblique fractures of lateral malleolus, and 2 cases of ankle joint lateral collateral ligament injury without fractures of lateral malleolus. After operation, the clinical outcome was evaluated according to the talus-leg angle, the recovery of Coin-sign continuity, inside-outside and top ankle gap, talus slope, American Orthopedic Foot and Ankle Society (AOFAS) score, Olerud-Molander score, Kofoed evaluation standards, and patient satisfaction.RESULTS:Seventeen cases were followed up 18.7 months on average (range, 12-25 months). Primary healing was obtained in 16 cases except 1 case of delayed healing. Fracture healed at an average of 14.6 weeks (range, 12-16 weeks). All cases achieved anatomical reduction, the continuity of Coin-sign, and consistency of inside and outside joint gap; no talus tilt occurred. There was no complication of reduction loss, loosening or breakage of internal fixation, or osteoarthritis during follow-up. The talus-leg angle of the affected side was significantly improved to (83.4 ± 1.8)° at 1 week after operation from preoperative (74.8 ± 7.1)° (t = 5.370, P = 0.000), but no significant difference was found when compared with normal side (83.8 ± 2.3)° (t = 0.676, P = 0.509). The AOFAS score, Olerud-Molander score, and range of motion at 1 week, 3 months, and 1 year after operation were significantly improved when compared with preoperative ones (P < 0.05). According to Kofoed evaluation standard, the outcome was excellent in 15 cases and good in 2 cases; the excellent and good rate was 100%. According to patient satisfaction, the outcome was excellent in 13 cases, good in 3 cases, and poor in 1 case; the excellent and good rate was 94.1%.CONCLUSION:The use of lateral malleolus hook-plate for fixation of stage II supination-adduction type medial malleolus fracture not only can effectively maintain anatomical reduction and supporting function, but also can prevent re-collapsing of the reset joint surface. The surgical method can not increase soft tissue complication, so it is a safe and effective method.

通过回顾近年来国内外采用的组织工程双相支架修复软骨及软骨下骨缺损的文献,比较不同双相支架修复软骨及软骨下骨效果差别,分析其优势及存在的主要问题,并初步探讨软骨修复的合理方式和发展趋势.研究结果表明,以双相支架作为载体材料一体化修复软骨及软骨下骨缺损,较之传统方式以及其他组织工程修复途径有着不可比拟的优越性,而复合理想的种子细胞及合适生长因子后,更能促进修复效果.由此可见,双相支架有利于修复骨软骨缺损,而构建仿生化多相支架是未来研究的趋势.