Introduction: Scalp acupuncture has been widely used as a treatment for motor dysfunction in children with cerebral palsy (CP). Previous studies have not provided high-quality evidence to demonstrate the effectiveness of this treatment in children with CP. To date, no high-quality randomized controlled trials on scalp acupuncture have been reported. The present study aims to evaluate the effectiveness of Jiao's scalp acupuncture for the treatment of motor dysfunction in children with spastic CP. Methods: This was a randomized controlled trial. One hundred CP patients were randomly allocated to either the treatment or control group. The control group received conventional rehabilitation treatment, while the treatment group received both conventional rehabilitation treatment and Jiao's scalp acupuncture. Thirty-six treatment sessions were conducted over a 12-week period. Outcomes were assessed using the Gross Motor Function Measure (GMFM)-66 and the Fine Motor Function Measure (FMFM) at baseline, week 4, 8, 12 (post-treatment) and week 24 (follow-up). Results: Both groups showed significant improvements in motor function (p < 0.01), as assessed by the GMFM-66 and the FMFM. Compared to the control, the treatment group demonstrated a significantly greater improvement in both gross and fine motor function (p < 0.05). Conclusions: Acupuncture in the motor area of Jiao's scalp acupuncture significantly improved motor function in children with spastic CP. Scalp acupuncture treatment may serve as a beneficial adjunct to conventional rehabilitation for motor dysfunction in this population.

The lack of effective treatments for alleviating irreversible skeletal muscle atrophy caused by peripheral nerve dysfunction is a clinical problem. To identify therapeutic targets, signaling pathways in muscle cells activated by denervation have been explored, including the important roles of Cx43, a kind of protein that forms gap junctions, in other types of pathological process. The present study investigated the negative role of Cx43 in aggravated muscle cell degeneration following denervation. The blueberry extract was applied orally on mice models, and its protective effect against denervated skeletal muscle atrophy was found by wet weight measurement and tissue staining observation. Cx43/Akt pathway in denervated muscle cells was modulated by blueberry extract. In conclusion, the negative effects of Cx43 on denervated skeletal muscle atrophy were attenuated by blueberry extract by regulating the Akt pathway.

Purpose The management of a proximal interphalangeal (PIP) joint fracture dislocation becomes more challenging when the joint surface is damaged because of severe comminution or inadequate treatment in the acute phase. The purpose of this study was to evaluate the clinical outcomes of an osteochondral autograft for the reconstruction of the joint surface in patients with a partial PIP joint defect. Methods Twelve patients underwent osteochondral autograft surgery from May 2007 to July 2018. The average age at the time of surgery was 38 years (range, 21-67 years), and there were 10 men and 2 women. Plain radiographs and computed tomography scans showed a partial middle phalangeal base defect in all the cases. The surgeries were performed 2 weeks to 20 months after the fracture or a previous surgery. Partial hamate grafts were harvested to reconstruct volar lip (n = 7), middle portion (n = 2), and dorsal lip (n = 3) defects of the middle phalangeal base. Bone healing, postoperative range of motion, instability, and pain were evaluated. The average follow-up duration was 27.8 months (range, 12-53 months). Results Radiographic graft union was observed in all the patients 6-8weeks after the surgery. The deformity was corrected in 11 patients. The active range of motion of the involved PIP joint was improved from 28.3(degrees) (range, 0(degrees)-60(degrees)) to 75.0(degrees) (range, 25(degrees)-95(degrees)). Complications were observed during follow-up, including degenerative arthritis (n = 2), instability (n = 3), and stiffness (n = 5). Conclusions Various types of partial joint defects of the middle phalangeal base following a PIP fracture dislocation can be reconstructed using an osteochondral autograft from the hamate. The functional recovery is generally acceptable, with a well-restored joint architecture.

Objective : EID3 (EP300-interacting inhibitor of differentiation) was identified as a novel member of EID family and plays a pivotal role in colorectal cancer development. However, its role in glioma remained elusive. In current study, we identified EID3 as a novel oncogenic molecule in human glioma and is critical for glioma cell survival, proliferation and invasion.Methods : A total of five patients with glioma were recruited in present study and fresh glioma samples were removed from patients. Four weeks old male non-obese diabetic severe combined immune deficiency (NOD/SCID) mice were used as transplant recipient models. The subcutaneous tumor size was calculated and recorded every week with vernier caliper. EID3 and AMP-activated protein kinase α1 (AMPKα1) expression levels were confirmed by real-time polymerase chain reaction and Western blot assays. Colony formation assays were performed to evaluate cell proliferation. Methyl thiazolyl tetrazolium (MTT) assays were performed for cell viability assessment. Trypan blue staining approach was applied for cell death assessment. Cell Apoptosis DNA ELISA Detection Kit was used for apoptosis assessment.Results : EID3 was preferentially expressed in glioma tissues/cells, while undetectable in astrocytes, neuronal cells, or normal brain tissues. EID3 knocking down significantly hindered glioma cell proliferation and invasion, as well as induced reduction of cell viability, apoptosis and cell death. EID3 knocking down also greatly inhibited tumor growth in SCID mice. Knocking down of AMPKα1 could effectively rescue glioma cells from apoptosis and cell death caused by EID3 absence, indicating that AMPKα1 acted as a key downstream regulator of EID3 and mediated suppression effects caused by EID3 knocking down inhibition. These findings were confirmed in glioma cells generated patient-derived xenograft models. AMPKα1 protein levels were affected by MG132 treatment in glioma, which suggested EID3 might down regulate AMPKα1 through protein degradation.Conclusion : Collectively, our study demonstrated that EID3 promoted glioma cell proliferation and survival by inhibiting AMPKα1 expression. Targeting EID3 might represent a promising strategy for treating glioma.

Abstract Background: Dislocation or instability of the proximal tibiofibular joint is often obscure, difficult to diagnose, easily overlooked by clinicians, and may be the cause of some unexplained cases of common peroneal nerve compression. Moreover, the literature on proximal tibiofibular joint dislocation is very limited, with only a few case reports. This study aimed to evaluate the morphological characteristics and anatomic variation of tibiofibular joint through preoperative auxiliary examination and intraoperative exploration and to discuss its clinical significance.Methods: From October 2015 to July 2021, a common peroneal nerve palsy diagnosis was made for 243 patients in our institution, of whom 10 were diagnosed with unexplained common peroneal nerve palsy. We carefully compared the results of intraoperative exploration with anteroposterior and lateral radiographs of the patients’ lower limbs and CT of their lower limbs to investigate the presence of bony structural abnormalities. Results: In the examination of lower limb CT, we found that the anatomical relationship of tibiofibular joint was significantly abnormal in three patients, among whom the preoperative CT plain scan of the lower limbs indicated that the fibula position of the affected limb was 2 cm lower than that of the opposite side in one typical patient. In one of the three patients with abnormal CT results, high common peroneal tension was found even after releasing the thickened fibers at the fibula head. The compression factor of this patient was the anatomic variation of the tibiofibular joint, which led to the common peroneal nerve being pulled downward by the fibular head; thus, peroneal osteotomy was performed during the operation. After osteotomy, the common peroneal nerve was markedly reduced in tone.Conclusions: Anatomic abnormalities or dislocation of the proximal tibiofibular joint may result in the entrapment of the common peroneal nerve. Preoperative CT examination of these patients is required to determine the presence of common peroneal nerve compression due to bony structural abnormalities. If the patient has a definite bony structural abnormality, peroneal osteotomy may be required at the time of peroneal nerve release.

Many children in the world suffer from cerebral palsy (CP), which is the leading cause of children’s disabilities, affecting their body movement and muscle coordination [18]. At present, the rehabilitation training of children with cerebral palsy has long relied on the physical therapist (PT) workforce. Our research wants to empower parents of children suffering from cerebral palsy to engage in simple training exercises themselves, supporting the rehabilitation process. We collaborate with physical therapists of a children’s hospital to design a system that uses pneumatic artificial muscles (PAMs) to help children with cerebral palsy train their plantar flexor muscles (Figure 1). We present an initial experimental prototype validated with physical therapists and doctors. We also show a feasibility test with patients with informed consent from parents and monitored by the physical therapists.

Brachial plexus (BP) root injury often results in disability of the upper extremities. Improvements in high-frequency ultrasonography have enabled the visualization of BP nerve roots. This study was aimed at quantifying the diagnostic accuracy of ultrasonography in BP root injury at different stages post-trauma. A consecutive series of 170 patients with BP root injury between 2015 and 2019 were studied retrospectively and divided into three groups on the basis of time between injury and ultrasound examination (<= 1 mo, 1-3 mo, >3 mo). Diagnosis of complete BP root injury under ultrasound was determined using a pre-defined criterion, including pseudomeningocele, retraction and rupture. Diagnostic accuracy was calculated based on surgical findings and intra-operative electrophysiological tests. Rates of detection of the cervical (C5-C8) and thoracic (T1) nerve roots under ultrasound were 99.4%, 99.4%, 99.4%, 95.9% and 79.4%, respectively. The sensitivity for complete BP root injury was 0.74, and the specificity was 0.91. No significant differences in sensitivity or specificity were observed across time stages. Ultrasound exhibited substantial consistency with surgical findings (k = 0.70) for complete BP root injury at any stage post-injury. Ultrasound can be an optional method of diagnosis of complete BP root injury at an early stage post-injury. (C) 2022 World Federation for Ultrasound in Medicine & Biology. All rights reserved.

PURPOSE:To evaluate whether gadolinium enhanced 3D SPACE STIR sequence technique increases the visualization of the lumbosacral plexus (LSP) and its small branches.METHODS:A retrospective study was performed on 24 patients who had underwent 3D SPACE STIR sequences scan with and without the administration of gadolinium contrast. In this study, we focused on the healthy sides of the LSP and its branches in each patient. The contrast ratio (CR), contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were objectively calculated by two experienced radiologists. The subjective visualization scores of the branches that were vitally important to therapeutic decision-making including femoral nerves, obturator nerves, lumbosacral trunks, superior gluteal and extra-pelvic sciatic nerves, were assessed using post-processing images.RESULTS:Of the 24 subjects, all LSP nerve roots, femoral nerves, lumbosacral trunks and sciatic nerves were illustrated on both contrast-enhanced and non-contrast images. The enhanced images were found to have higher nerve to vein CNRs compared to non-contrast images. Compared to non-contrast images, the CRs of nerves versus surrounding fat tissues, bones, veins and muscles were improved in contrast-enhanced images, while the SNRs were better but not significantly so. Targeted maximum intensity projection (MIP) nerves including femoral, obturator, superior gluteal and extra-pelvic sciatic nerves obtained significantly higher subjective scores when gadolinium was administered.CONCLUSIONS:The gadolinium enhanced 3D SPACE STIR sequence provided superior vascular suppression, resulting in increased conspicuity of LSP and its small branches. Altogether, this shows great potential for therapeutic decision-making in traumatic LSP lesions cases.

Background:. The fingertip is one of the most common sites of traumatic injuries faced by hand surgeons. In cases of lateral oblique amputation, only limited alternatives are available for reconstruction. This study introduced a new method involving rotation and use of an advancement pulp flap for covering lateral oblique defect and evaluated its outcome. Method:. A series of 12 patients with 14 lateral oblique fingertip defects were recruited in this study. All fingertips were unreplantable and were injured distal to the proximal one-third of nail bed, with phalanx exposed. All cases received surgical reconstruction using a triangular rotation and advancement pulp flap. Static 2-point discrimination, cold intolerance, pain, hypersensitivity, range of motion, and aesthetic satisfaction were evaluated 6 months to 12 months postoperation. Result:. Bone defect was noted in 7 cases. The area of defect was 10×7–20×12 mm2, and the angle of defect was 30–60 degrees. Mean follow-up was 14.3 months. No hook nail deformity, cold intolerance, and hypersensitivity were observed. One patient complained about pain postoperation, demanding a second operation. Static 2-point discrimination was between 5 and 8 mm in all cases. Range of motion of distal interphalangeal joint recovered to 20–45 degrees at the last follow-up. No stiffness was observed in the interphalangeal or metacarpophalangeal joints. All patients were satisfied with the appearance of the flap. Conclusion:. The triangular rotation and advancement pulp flap is simple, safe, and reliable for treating lateral oblique defect of fingertip, providing scope for anatomical reconstruction and fair sensation and aesthetic recovery.

Treatment options for denervated skeletal muscle atrophy are limited, in part because the underlying molecular mechanisms are not well understood. Unlike previous transcriptomics studies conducted in rodent models of peripheral nerve injury, in the present study, we performed high-throughput sequencing with denervated atrophic biceps muscle and normal (non-denervated) sternocleidomastoid muscle samples obtained from four brachial plexus injury (BPI) patients. We also investigated whether Ficus carica L. (FCL.) extract can suppress denervated muscle atrophy in a mouse model, along with the mechanism of action. We identified 1471 genes that were differentially expressed between clinical specimens of atrophic and normal muscle, including 771 that were downregulated and 700 that were upregulated. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses revealed that the differentially expressed genes were mainly enriched in the GO terms "structural constituent of muscle," "Z disc," "M band," and "striated muscle contraction," as well as "Cell adhesion molecules," "Glycolysis/Gluconeogenesis," "Peroxisome proliferator-activated receptor alpha (PPARα) signaling pathway," and "P53 signaling pathway." In experiments using mice, the reduction in wet weight and myofiber diameter in denervated muscle was improved by FCL. extract compared to saline administration, which was accompanied by downregulation of the proinflammatory cytokines interleukin (IL)-1β and IL-6. Moreover, although both denervated groups showed increased nuclear factor (NF)-κB activation and PPARα expression, the degree of NF-κB activation was lower while PPARα and inhibitor of NF-κB IκBα expression was higher in FCL. extract-treated mice. Thus, FCL. extract suppresses denervation-induced inflammation and attenuates muscle atrophy by enhancing PPARα expression and inhibiting NF-κB activation. These findings suggest that FCL. extract has therapeutic potential for preventing denervation-induced muscle atrophy caused by peripheral nerve injury or disease.

BACKGROUND Intra-articular malunion of the proximal interphalangeal joint is challenging. Multiple treatment options vary from arthrodesis to different types of osteotomy procedures. The aim of this study was to evaluate the effectiveness of intra-articular osteotomy in treating malunited proximal interphalangeal (PIP) joint fractures. MATERIALS AND METHODS Fifty-nine consecutive patients with chronic PIP joint fractures were presented to us from May 2007 to December 2017. Sixteen joints of 15 patients were malunited PIP fracture without severe cartilage damage and underwent intra-articular osteotomy. The average interval from injury to operation was 4 (1-48) months. The mean duration of follow-up was 9 (2-43) months. Radiographic evidence of bone healing, joint alignment, range of motion of PIP, and distal interphalangeal joints were documented and assessed. RESULT Fifteen patients underwent intra-articular osteotomy. The average age was 32 (15-54) years. Fourteen of them were males. Fractures affect 9 middle phalangeal bases and 7 proximal phalangeal heads. Bony union was obtained in all patients by 6 to 10 weeks after surgery. Pain was relieved in 14 patients and the deformity was corrected in 12 joints of 11 patients. The average arc of motion for involved PIP joints was improved from 30.3 (10.0-39.1) degrees to 68.4 (7.2-75.6) degrees. One patient arose painful degenerative arthritis after surgery. Ten patients were satisfied or very satisfied. CONCLUSIONS For malunited PIP joint fracture without severe cartilage damage, intra-articular osteotomy provides predictable functional recovery and minimal donor site sacrifice.

Objective: To explore a reliable predicator of surgical outcomes of carpal tunnel release (CTR) by exploring the changes of preoperative and intraoperative median nerve-abductor pollicis brevis compound muscle action potential (CMAP). Methods: Fifteen patients with carpal tunnel syndrome were involved in the study. Electrophysiology examination was carried out to record CMAP of abductor pollicis brevis muscle at following moments: before CTR; right after brachial plexus block; immediately after CTR and tourniquet release; 1 minute, 3 minutes, 5 minutes, and 7 minutes after tourniquet release. Statistics analysis was done to compare these parameters with preoperative values. Results: There were statistically significant changes in both amplitude and latency of the CMAP within 5 minutes after tourniquet release ( P < .05) while not much difference was seen after 5 minutes. Both the latency and amplitude of CMAP greatly improved ( P < .05). Moreover, the improvement of amplitude had more statistical significance ( P < .01). Conclusion: CMAP amplitude is a better predictor than CMAP latency to evaluate the effectiveness of median nerve decompression. It is more reliable to carry out electrophysiology examination at least 5 minutes after tourniquet release.

HypothesisChronic fractures affecting the PIP joint present a big challenge for hand surgeons. There is no classification for this problem. The purpose of the study is to classify this chronic fracture. We hypothesize that each stage of chronic PIP joint fractures have different appropriate treatment.MethodsConsecutive patients with chronic PIP joint fractures presented to our center from May 2007 to Dec 2014 were included in the study. Patients who were indicated for reconstructive surgery were divided into 5 different groups according to severity of the joint injuries, and received relevant reconstructive procedures. Outcome measurements included radiographic evidence of bone healing, joint alignment and/or collapse, ROM of PIP joint, and the donor site morbidity.ResultsThere were 36 patients with chronic PIP joint fractures presented to our center during the period. Among them, 23 patients received reconstructive surgery. The average age was 32 (15-54) years, with 21 males. These patients were divided into 5 groups: 2 cases of nonunion, 6 cases of malunion, 9 cases of partial osteochondral defect, 3 cases of posttraumatic arthritis, and 4 cases of joint collapse. Surgeries were performed 1 months to 3 years after the fracture or previous surgery. Following procedures were performed: ORIF + BG for nonunion, corrective osteotomy for malunion, osteochondral graft for partial osteochondral defect, vascularised joint transfer for posttraumatic arthritis, and vascularised joint transfer following distraction for joint collapse. The average arc of motion for the involved PIP joint was 79° (35°–95°). The distal interphalangeal (DIP) joint average arc of motion was 50° (0°-65°). Bony union was obtained in 22 patients. There was one painful degenerative arthritis after osteochondral bone graft and one refracture after vascularized joint transfer who converted to a revision surgery. Twenty-one patients had no pain, and 20 patients were satisfied with their function.Summary PointsView Large Image Figure ViewerDownload Hi-res image Download (PPT) HypothesisChronic fractures affecting the PIP joint present a big challenge for hand surgeons. There is no classification for this problem. The purpose of the study is to classify this chronic fracture. We hypothesize that each stage of chronic PIP joint fractures have different appropriate treatment. Chronic fractures affecting the PIP joint present a big challenge for hand surgeons. There is no classification for this problem. The purpose of the study is to classify this chronic fracture. We hypothesize that each stage of chronic PIP joint fractures have different appropriate treatment. MethodsConsecutive patients with chronic PIP joint fractures presented to our center from May 2007 to Dec 2014 were included in the study. Patients who were indicated for reconstructive surgery were divided into 5 different groups according to severity of the joint injuries, and received relevant reconstructive procedures. Outcome measurements included radiographic evidence of bone healing, joint alignment and/or collapse, ROM of PIP joint, and the donor site morbidity. Consecutive patients with chronic PIP joint fractures presented to our center from May 2007 to Dec 2014 were included in the study. Patients who were indicated for reconstructive surgery were divided into 5 different groups according to severity of the joint injuries, and received relevant reconstructive procedures. Outcome measurements included radiographic evidence of bone healing, joint alignment and/or collapse, ROM of PIP joint, and the donor site morbidity. ResultsThere were 36 patients with chronic PIP joint fractures presented to our center during the period. Among them, 23 patients received reconstructive surgery. The average age was 32 (15-54) years, with 21 males. These patients were divided into 5 groups: 2 cases of nonunion, 6 cases of malunion, 9 cases of partial osteochondral defect, 3 cases of posttraumatic arthritis, and 4 cases of joint collapse. Surgeries were performed 1 months to 3 years after the fracture or previous surgery. Following procedures were performed: ORIF + BG for nonunion, corrective osteotomy for malunion, osteochondral graft for partial osteochondral defect, vascularised joint transfer for posttraumatic arthritis, and vascularised joint transfer following distraction for joint collapse. The average arc of motion for the involved PIP joint was 79° (35°–95°). The distal interphalangeal (DIP) joint average arc of motion was 50° (0°-65°). Bony union was obtained in 22 patients. There was one painful degenerative arthritis after osteochondral bone graft and one refracture after vascularized joint transfer who converted to a revision surgery. Twenty-one patients had no pain, and 20 patients were satisfied with their function. There were 36 patients with chronic PIP joint fractures presented to our center during the period. Among them, 23 patients received reconstructive surgery. The average age was 32 (15-54) years, with 21 males. These patients were divided into 5 groups: 2 cases of nonunion, 6 cases of malunion, 9 cases of partial osteochondral defect, 3 cases of posttraumatic arthritis, and 4 cases of joint collapse. Surgeries were performed 1 months to 3 years after the fracture or previous surgery. Following procedures were performed: ORIF + BG for nonunion, corrective osteotomy for malunion, osteochondral graft for partial osteochondral defect, vascularised joint transfer for posttraumatic arthritis, and vascularised joint transfer following distraction for joint collapse. The average arc of motion for the involved PIP joint was 79° (35°–95°). The distal interphalangeal (DIP) joint average arc of motion was 50° (0°-65°). Bony union was obtained in 22 patients. There was one painful degenerative arthritis after osteochondral bone graft and one refracture after vascularized joint transfer who converted to a revision surgery. Twenty-one patients had no pain, and 20 patients were satisfied with their function. Summary Points

Total scalp avulsion is a rare but challenging surgical trauma to manage. This study reports 8 cases of total scalp avulsion between 2001 and 2008. In all these cases, the patients were subjected to vascular replantation of the scalp. Microvascular technique after the debridement was used for scalp replantation in all these patients. Study outcome was that between 2001 and 2004, only 1 case had shown major scalp revival and scalp survival whereas in 3 other cases, the scalp survival failed. This may be attributed to the poor microscopic anastomosis. However, between 2005 and 2008, scalp survival was reported in all the cases, which was chiefly due the advanced microsurgical method adopted. In this advanced microsurgical technique, the subcutaneous tissue was suspended by the tight suture of scalp tissue around the anastomotic stoma, which resulted in scalp survival in all the cases. Microsurgical scalp replantation is an effective treatment for scalp avulsion. The key to the successful scalp replantation is high-quality vascular anastomosis involving subcutaneous tissue suspension via the tight suture of scalp tissue around the anastomotic stoma careful debridement.

Objective To explore the compensatory mechanisms after severing the C7 nerve root by studying the morphological changes of motor end-plate in target muscles.Methods Forty-two male SD rats were randomly divided into 7 groups,with 6 each.C7 nerve root on the right side was transected while that on the left side was left intact.At 1,2,4,6,8,and 12 weeks after C7 nerve root transection,the triceps brachii,latissimus dorsi and extensor digitorum communis muscles of the experimental side and the normal side were harvested and subjected to acetylcholinesterase staining,silver-acetylcholinesterase staining,immunofluorescence staining and electron microscopy.The morphological changes of the motor end-plate in these muscles were recorded and analyzed.SPSS 17.0 software was used to calculate the mean,standard deviation and analysis of variance.Results Within 1 to 3 weeks of C7 transection,there were no significant morphological changes of the motor end-plate in target muscles.Between 4 to 8 weeks post transection,a small number of abnormal motor end-plates with features of larger area,lighter acetylcholinesterase staining and severe ultrastructural degeneration under electron microscopy emerged sparsely in some spots in the target muscles.The morphology of motor endplate returned to normal status 12 weeks following C7 transection.Multiple small specialized postsynaptic membrane aggregations appeared in the neighborhood of the original nerve terminal to form new motor end-plates.Conclusion Morphological changes of the motor end-plate happened in target muscles after C7 nerve root transection.These changes returned to normal in 12 weeks.Axonal sprouting derived from adjacent healthy nerve fibers could be the main mechanism of compensation in C7 nerve transfer.

Background: There is no consensus on the effects of operative versus nonoperative treatment on the outcomes of midshaft clavicular fractures in adults. We conducted a meta-analysis of randomized clinical studies.Materials and methods: We searched the literature and included studies that investigated the effects of operative versus nonoperative intervention on the outcome of midshaft clavicular fractures. Patient data were pooled by use of standard meta-analytic approaches. For the continuous variables, the weighted mean difference was used. For dichotomous data, the relative risk was calculated.Results: Seven studies reported in 8 publications were eligible for data extraction. The pooled analyses showed that, compared with nonoperative treatment, operative treatment led to significantly lower incidences of nonunion and fewer symptomatic malunions. Subgroup analysis indicated that these advantages could be ascribed to plate fixation. Furthermore, surgery with plates resulted in significantly fewer complications. Patients undergoing surgery had better Disabilities of the Arm, Shoulder and Hand and Constant scores and lower dissatisfaction with their appearance.Conclusion: In the management of midshaft clavicular fractures, surgery is superior to nonoperative treatment. Surgery with plates results in lower incidences of nonunion, fewer total complications, and fewer symptomatic malunions compared with nonoperative treatment. (C) 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.

Introduction Mallet finger injuries are common and involve disruption of the terminal extensor mechanism overlying the distal interphalangeal joint. Many operative techniques have been advocated. The pull-in suture technique is a useful surgical procedure for the treatment of mallet finger. Although this procedure allows accurate realignment of the tendon-bone, it has limitations. Purpose To eliminate these limitations, we present here a modification of the pull-in suture technique. Material and Methods From January 2008 to October 2009, 10 mallet fingers treated using this modification were included in this prospective study. Of the patients, 6 were men and 4 were women. Their ages at surgery ranged from 19 to 41 years, with a mean of 29.7 years. Of these, 1 involved the thumb; 2, the index finger; 2, the middle finger; 3, the ring finger; and 2, the little finger. The length of time from the injury to surgery ranged from 1 to 20 days (mean, 6.3 days). According to Doyle’s classification, there were 1 type II, 4 type III, and 5 type IVb cases. Results At a mean follow-up of 15.4 (range, 13–22) months, all patients were pain free. The average final active range of motion of the distal interphalangeal joint was 60 degrees (range, 50–70 degrees). Using Crawford’s criteria, 2 patients were graded as excellent, 7 as good, and 1 was graded as fair. Neither pin tract infections nor skin compressive ulcers occurred. Conclusion The modification eliminated or reduced the incidence of complications when compared with the original method. This technique should be considered when treatment of a mallet deformity using the pull-in suture technique is planned.

Objective To investigate the protein expression changes in rat triceps muscle after C7 nerve root rhizotomy by two way fluorescence differential gel electrophoresis (2D-DICE),and to study the molecular mechanism of the triceps muscle's functional compensation. Methods C7 nerve root rhizotomy model was created on one side of the SD rats.The contralateral side did not undergo surgery and served as control.Equal amounts of triceps muscle were harvested from both sides after 1,2,3,6 and 12 weeks.The total proteins from the C7 rhizotomy side and from the normal side were examined by the 2D-DIGE technique.One way ANOVA was used to screen protein spots that differentiated with statistical significance.These protein spots were then identified by MALDI-TOF-MS or MS/MS. Results At different time points following C7 rhizotomy there were 38 protein spots detected with significant change.Among them 27 proteins were identified by MALDI-TOF-MS or MS/MS.11proteins belonged to functional groups associated with the energy metabolism of muscles.One week after rat C7 nerve root rhizotomy,5 protein spots of anaerobic metabolism enzyme down-regulated,then displayed an upregulation in their relative expression levels from 3rd to 12th week postoperatively.However 6 protein spots of aerobic oxidation enzymes down-regulated together with mitochondrial elongation factor Tu from 6th to 12th week.Conclusion The functional compensation of triceps after rat C7 nerve root rhizotomy may be associated with the changes in muscle fiber types,and the regulation of such a change may occur in the level of protein translation ofenergy metabolism enzyme.

Objective To study the effect and mechanism of transplanting spinal fetal neural stem cells (NSCs) into the peripheral nerve for delaying muscle denervation atrophy. Methods Spinal. fetal NSCs were separated from spinal cord of enceinte 10 to 12 days SD rats, cultured and purified. After three passages, the formed NSC spheres were blew into single cell suspension ( 106/μl×5 μl) and transplanted into the distal part of the transected tibial nerve. 5 μl of cell culture medium was injected into the distal tibial nerve in the control group. Three and 5 months after the transplantation, the distal part of the tibial nerve and the triceps suraes were harvested and identified with specific markers, by means of indirect immunofluorescent staining to evaluate survival and differentiation of transplanted NSCs in the nerve, and to observe the neuromuscular junctions.Results Compare to the control group, atrophy of the triceps suraes muscle was less severe 3 and 5 months after NSCs transplantation. Postsynaptic membrane was also better preserved in NSCs transplanted group. Five months after NSCs transplantation, new synapses (neuromuscular junction) formed in the denervated muscle.Conclusion NSCs transplantation can delay atrophy denervated muscles. NSCs transplantation can not only maintain the structure of postsynaptic membrane, but also form new synapse with the denervated muscle.

Objective To compare the stress,contact area and pressure change between pre-and post four-comer atthrodesls.To study the effect of four-comer arthrodesis to the stress in raaiocarpal joint.Methods Eight fresh-frozen forearm specimens were used in this investigation.The specimen were placed in a specialjig,150 N load was distributed to tendons passing through the wrist according to a certain proportion.Place and maintain the wrist in different positions,the prescale film was encapsulated and inserted into the radiocarpal joint.Then performed a simulated four-comer arthrodesis.did the same process and gained the corresponding results.Compare the three indexes between pre-and post four-comer arthrodesis.Results In norlnal radioearpal joint,the contact areais 3%to 43%in scaphoid fossa and 6%to 30%inlunatefossa,afterfour-comer arthrodesis,it change to 0%to 30%in seaphoid fossa and 7%to 32%in lunate fossa,all the three indexes were changed according to the position of the wrist.In the normal joint,the stress change mild and gradually,post four-comer arthrodesis,the stress change is intense and rigid.Conclusion The stress,contact area and pressure in the seaphoid and lunate fossa are different and change according to the position of the wrist.The change in the maiocarpal joint after four-comer arthrodesis is acute and hard,which will perhaps interfere the cartilage in the long run.