Traditional surgical options for releasing stiff elbows include open and arthroscopic techniques. The former involves long incisions and significant surgical trauma, while the latter is technique-demanding and carries a higher risk of nerve complications. This study was designed to (1) introduce a novel dual mediolateral mini-open releasing technique for elbow stiffness, (2) analyze the clinical outcomes of our proposed technique, and (3) investigate its advantages and limitations for surgical release of elbow contracture. Patients who underwent dual medial and lateral mini-open surgeries for elbow stiffness performed by our surgical team between January 2017 and May 2022, with a minimum follow-up of 24 months, were recruited. We recorded the maximum flexion and extension angles, range of motion (ROM), Mayo Elbow Performance scores, visual analogue scale (VAS) scores, presence of heterotopic ossification, and ulnar neuropathy at each visit. Differences at pre-operative, post-operative, and last follow-up were analyzed. The lengths of surgical incisions and complications were also recorded. A total of 21 patients (11 males and 10 females) with an average age of 36.47 ± 9.81 years at surgery were enrolled. The average follow-up period was 29.76 ± 7.31 months. Lateral and medial incisions averaged 4.1 ± 0.3 cm and 3.0 ± 0.2 cm, respectively. Preoperatively, the maximum extension, flexion angle, and ROM were 37.14 ± 13.24°, 99.05 ± 19.25°, and 61.90 ± 21.07°, respectively. By the latest follow-up, extension and flexion angles were 6.81 ± 6.78° and 138.33 ± 6.78°, and the ROM was 131.52 ± 10.77°. Significant improvement was also observed in Mayo Elbow Performance and VAS scores. Preoperatively, 13 patients exhibited sensory or motor deficits secondary to ulnar nerve entrapment. At discharge, 5 patients demonstrated persistent neuropathy, with one new-onset case. By final follow-up, 3 cases with pre-existing entrapment maintained residual symptoms. No revision surgeries were needed in our cohort by the latest follow-up. The dual mediolateral mini-open technique allows for a safe and effective release of stiff elbows through small incisions of 3–5 cm in length. With comparable improvements to those reported in traditional surgical approaches, this technique could serve as a reliable alternative to arthroscopic release procedures, aiming for smaller incisions and reduced surgical trauma. However, it is not indicated for patients with severe elbow joint deformities.

BACKGROUND:Bone nonunion is a major complication in fracture treatment. Despite considerable advancements in fracture care, 5-10% of fractures result in nonunion; This demonstrates the requirement for novel molecules to enhance fracture healing. Brain-derived neurotrophic factor (BDNF) has been increasingly recognized for its role in fracture healing; however, the underlying molecular mechanisms remain unclear. Osteoblast proliferation and migration are critical to this process. The nuclear casein kinase and cyclin-dependent kinase substrate 1 gene (NUCKS1), located on human chromosome 1 at 1q32.1, encodes a 27-kDa nuclear DNA-binding protein, which influences cell proliferation, migration, and apoptosis strongly. Although NUCKS1 is implicated in various diseases, its specific role in fracture healing remains unclear. Here, we explored whether NUCKS1 participates in the BDNF-mediated fracture-healing process. METHODS:We assessed NUCKS1 expression in MC3T3-E1 cells and callus from closed femoral fracture mice through quantitative reverse transcription polymerase chain reaction and Western blotting. NUCKS1 inhibition in MC3T3-E1 cells in terms of migration and proliferation changes was evaluated through transwell cell migration and Cell Counting Kit-8 assays. Fracture-healing status in mice was assessed through x-ray and micro-CT imaging 2 weeks after fracture. RESULTS:BDNF promoted NUCKS1 expression in both MC3T3-E1 cells and mouse callus tissues. NUCKS1 inhibition reduced MC3T3-E1 cell proliferation and migration and impaired fracture healing in mice. Finally, suppression of TrkB expression reduces both Akt phosphorylation and NUCKS1 expression, and inhibition of Akt phosphorylation reduces NUCKS1 expression. CONCLUSION:BDNF may enhance NUCKS1 expression through the TrkB-mediated Akt pathway, promoting osteoblast proliferation and migration and facilitating fracture healing.

Quercetin (Que), one of the flavonoids, plays a role in fracture healing, while brain-derived neurotrophic factor (BDNF) and tyrosine kinase receptor kinase B (TrkB) have also been shown to be involved. Que and BDNF signaling pathways are interrelated in the nervous system, but their reciprocal regulatory mechanisms in fracture healing and osteoblast differentiation have not yet been studied. We conducted cellular experiments and fracture animal models to preliminarily clarify the roles and signaling mechanisms of Que and BDNF in osteoblast differentiation and fracture healing. Cellular experiments confirmed that low concentrations of Que (0.01-5 μM) promoted osteoblast differentiation and the expression of osteogenesis-related markers, including COL1A1, ALP and Runx2; activated EKR1/2 and promoted the expression of BDNF (P < 0.05); and that the combination of Que and exogenous BDNF had the strongest effect on promoting osteogenic differentiation (P < 0.05); further mechanistic studies revealed that, the ERK1/2-specific chemical inhibitor PD98059 significantly inhibited the expression of BDNF and osteogenic differentiation markers under the action of Que (P < 0.05), whereas the TrkB-specific chemical inhibitor K252a inhibited the activation of ERK1/2, the expression of BDNF, and the expression of osteoblast differentiation markers under the effect of Que (P < 0.05). In fracture animal models, Que (100 mg/kg) significantly promoted fracture healing and increased BDNF expression at the bone callus. Thus, low concentrations of Que promote osteogenic differentiation through the TrkB-ERK1/2-BDNF signaling pathway, which in turn affects fracture healing.

Objective:To explore the effect of intravenous tranexamic acid on postoperative drainage and elbow joint function after traumatic elbow stiffness release. Methods:The clinical data of 44 patients with elbow joint stiffness who were treated with release surgery between March 2022 and December 2023 and met the selection criteria were retrospectively analyzed. Among them, 20 patients were given intravenous infusion of 100 mL (1 g/100 mL, once a day) of tranexamic acid solution for 3 consecutive days after surgery (group A), and 24 patients were not treated with tranexamic acid after surgery (group B). There was no significant difference in baseline data such as gender, age, side, body mass index, initial injury, and preoperative hemoglobin, visual analogue scale (VAS) score, and Mayo elbow function score (MEPS), elbow flexion and extension activity between the two groups ( P>0.05). The drainage volume at 1 day and 3 days after operation, total drainage volume, drainage tube indwelling time, postoperative hospital stay, VAS score before operation and at 1, 2, and 3 days after operation, MEPS score before operation, at 3 months after operation, and at last follow-up, and elbow flexion and extension activity before operation and at last follow-up were recorded and compared between the two groups. Results:Both groups of patients successfully completed the operation, and there was no significant difference in operation time ( P>0.05). The drainage volume at 1 day and 3 days after operation, total drainage volume, drainage tube indwelling time, and postoperative hospital stay in group A were significantly less than those in group B ( P<0.05). Both groups of patients were followed up 6-12 months, with an average of 8.6 months. No complications such as wound infection, elbow joint varus and varus instability or dislocation, and pulmonary embolism or other thromboembolic events occurred in either group. The VAS scores of both groups were significantly higher at 1 day and 2 days after operation than before operation ( P<0.05); the VAS score of group A was significantly lower than that of group B ( P<0.05). The VAS scores of both groups decreased to the preoperative level at 3 months after operation, and there was no significant difference between the two groups ( P>0.05). At 3 months after operation and at last follow-up, the MEPS scores of both groups significantly improved when compared with those before operation ( P<0.05); there was no significant difference between the two groups ( P>0.05). At last follow-up, the postoperative elbow flexion and extension activity of the two groups significantly increased when compared with that before operation ( P<0.05); there was no significant difference in change of elbow flexion and extension activity between the two groups ( P>0.05). Conclusion:Intravenous tranexamic acid for 3 consecutive days after release of traumatic elbow stiffness can significantly reduce postoperative drainage volume, shorten drainage tube indwelling time and hospital stay, and relieve early postoperative pain, but it has no effect on the risk of thrombotic and embolic events and postoperative elbow function.

Objective:To analyze the effectiveness of binocular loupe assisted mini-lateral and medial incisions in lateral position for the release of elbow stiffness.Methods:The clinical data of 16 patients with elbow stiffness treated with binocular loupe assisted mini-internal and external incisions in lateral position release between January 2021 and December 2022 were retrospectively analyzed. There were 9 males and 7 females, aged from 19 to 57 years, with a median age of 33.5 years. Etiologies included olecranon fracture in 6 cases, elbow dislocation in 4 cases, medial epicondyle fracture in 2 cases, radial head fracture in 4 cases, terrible triad of elbow joint in 2 cases, supracondylar fracture of humerus in 1 case, coronoid process fracture of ulna in 1 case, and humerus fracture in 1 case, with 5 cases presenting a combination of two etiologies. The duration of symptoms ranged from 5 to 60 months, with a median of 8 months. Preoperatively, 12 cases had concomitant ulnar nerve numbness, and 6 cases exhibited ectopic ossification. The preoperative range of motion for elbow flexion and extension was (58.63±22.30)°, the visual analogue scale (VAS) score was 4.3±1.6, and the Mayo score was 71.9±7.5. Incision lengths for both lateral and medial approaches were recorded, as well as the occurrence of complications. Clinical outcomes were evaluated using Mayo scores, VAS scores, and elbow range of motion both preoperatively and postoperatively.Results:The lateral incision lengths for all patients ranged from 3.0 to 4.8 cm, with an average of 4.1 cm. The medial incision lengths ranged from 2.4 to 4.2 cm, with an average of 3.0 cm. The follow-up duration ranged from 6 to 19 months and a mean of 9.2 months. At last follow-up, 1 patient reported moderate elbow joint pain, and 3 cases exhibited residual mild ulnar nerve numbness. The other patients had no complications such as new heterotopic ossification and ulnar nerve paralysis, which hindered the movement of elbow joint. At last follow-up, the elbow range of motion was (130.44±9.75)°, the VAS score was 1.1±1.0, and the Mayo score was 99.1±3.8, which significantly improved when compared to the preoperative ones ( t=-12.418, P<0.001; t=6.419, P<0.001; t=-13.330, P<0.001).Conclusion:The binocular loupe assisted mini-lateral and medial incisions in lateral position integrated the advantages of traditional open and arthroscopic technique, which demonstrated satisfying safety and effectivity for the release of elbow contracture, but it is not indicated for patients with posterior medial heterolateral heterotopic ossification.

In the past decades,a dramatic development of navigation technology in orthopaedic surgery has been witnessed. By assisting the localization of surgical region,verification of target bony structure,preoperative planning of fixation,intraoperative identification of planned entry point and direction of instruments or even automated insertion of implants,its ability and potential to reduce operation time,intraoperative radiation,surgical trauma,and improve accuracy has been proved. However,in contrast to the widespread use of navigation technology in arthroplasty,orthopaedic tumor,and spine surgery,its application in orthopaedic trauma is relatively less. In this manuscript,the main purpose is to introduce the technical principles of navigation devices,outline the current clinical application of navigation systems in orthopaedic trauma,analyze the current challenges confronting its further application in clinical practice and its prospect in the future.

Objective Regular monitoring of serum potassium after a total joint arthroplasty (TJA) is a form of routine examination that can help detect abnormal serum potassium levels and reduce the incidences of adverse events that may occur on account of postoperative hypokalemia. Previous studies rarely discussed hypokalemia after joint replacement. In the present study, our primary goal was to investigate the incidence and possible risk factors of hypokalemia after a total hip and knee replacement procedure was performed. Methods This study included patients who underwent a unilateral total knee or hip arthroplasty in our department between April 2017 and March 2018. Serum potassium levels pre and post operation were collected and retrospectively analyzed. The differences in age, gender, body mass index (BMI), history of diseases, red blood cell (RBC), hemoglobin, hematocrit, glomerular filtration rate, ejection fraction, blood glucose, urine creatinine, urea nitrogen, intraoperative blood loss, operation time, drainage, preoperative potassium, surgery type, were compared between those patients diagnosed with hypokalemia and their non‐hypokalemia at different times post surgery. Thereafter, the risk factors of postoperative hypokalemia patients were analyzed using statistical procedure multiple logistic regression model. Results The risk of hypokalemia after TJA was 53.1%, while, that on the first, third, and fifth day after operation was 12.5%, 40.7%, and 9.6% respectively. The serum potassium level on the first, third, and fifth postoperative days was 3.84 ± 0.32, 3.59 ± 0.34, and 3.80 ± 0.32 mmol/l, respectively. However, the level on the third day appeared to be the lowest (p = 0.015) of them all. The independent risk factors for hypokalemia after a total hip and knee replacement were the level of preoperative serum potassium concentration (p = 0.011), preoperative red blood cells counts (p = 0.027), and history of diabetes (p = 0.007). Conclusion Regular monitoring of serum potassium concentration should be performed post TJA. We need to pay more attention to the patient's preoperative potassium levels along with their red blood cell counts especially in patients diagnosed with type 2 diabetes mellitus.

Background The choice of treatment for scapular fractures is a topic worth discussing. The type of scapular fracture is often complex, and more and more scholars prefer surgical treatment to obtain better shoulder joint function. In addition, because of the rich blood supply and muscles of the scapula, some scholars believe that simple suspension can also achieve satisfactory clinical effects. The aim of this study was to investigate the curative effect and prognostic factors of patients with scapular fracture with indications for surgery after receiving conservative treatment. Methods Patients with scapular fracture who did not receive surgical treatment from July 2016 to May 2021 were recruited from the orthopedic trauma database of Nanjing Gulou Hospital, and the data from patients with indications for surgery were screened out for a retrospective analysis. The data were obtained from the database of orthopaedic trauma patients in Nanjing Drum Tower Hospital. The relevant data were recorded during telephone and video follow-up visits. Linear regression was used to analyze the factors associated with disabilities of the arm, shoulder and hand (DASH) score after receiving conservative treatment. Results A total of 21 patients were included in the final statistical analysis. All patients were followed up for 31.0±20.3 (range, 6–63) months, aged 52.9±12.7 (range, 27–71) years. All fractures had clinical healing with a 100% recovery satisfaction rate. Outcome measures of efficacy [both DASH scores and visual analogue scale (VAS) scores], were correlated with whether the fracture involved the superior border of the scapular, were not associated with the following variables: age (P=0.18), Injury Severity Score (ISS) score (P=0.10), the glenopolar angle (GPA) value (P=0.76), superior shoulder suspensory complex (SSSC) injury (P=0.82), and glenoid fracture (P=0.84). The range of motion of the affected shoulder was significantly reduced compared to the healthy shoulder (P<0.01), but the range of forward flexion and elevation was not significantly different from that of the healthy shoulder (P>0.05). Patients with fractures not involving the superior border of the scapula had a much lower range of motion in the affected shoulder than in the healthy shoulder during abduction (P<0.05). Conclusions The range of surgical indications for scapular fractures with scapular fractures involving the lower margin of the scapular can be appropriately narrowed. Some patients with scapular fracture who have surgical indications can regain satisfactory shoulder function after receiving conservative treatment.

Objective:To investigate the clinical characteristics and predisposing factors associated with preoperative anemia in adult femoral shaft fractures.Methods:A retrospective analysis of clinical data from 157 patients presenting with femoral shaft fractures admitted to the department of orthopedics at Nanjing Drum Tower Hospital between June 2018 and June 2022 was conducted. The study cohort comprised 106 males and 51 females, with an average age of 45.06 ± 14.32 years (range: 18-65 years). Based on hemoglobin levels measured within 2 days of admission, patients were stratified into two groups: anemia group (Hb<120 g/L in adult males and Hb<110 g/L in adult females) and non-anemia group. General demographic information, AO fracture types, and clinical characteristics, as well as the results of laboratory examinations for both groups were collected. Subsequently, univariate and multivariate logistic regression analyses were conducted.Results:Out of the 157 patients with femoral shaft fractures, 118 (75.2%) exhibited preoperative anemia (the anemia group). Among them, 75 cases were male, and 43 cases were female, with an average age of 45.84±14.23 years (range: 18-65 years). In terms of fracture AO type, 41 cases were classified as 32A, 19 as 32B, and 58 as 32C. Regarding fracture location, 14 were situated in the upper 1/3 of the femoral shaft, 67 in the middle 1/3, and 37 in the lower 1/3. The causes of injury included 63 cases of motor vehicle accidents, 5 cases of blunt trauma, 40 cases of falls, and 10 cases of other falls, with 65 cases involving multiple injuries. Conversely, 39 patients (24.8%) did not exhibit preoperative anemia (the non-anemia group). Of these, 31 were male, and 8 were female, with an average age of 42.72 ± 14.51 years (range: 19-65 years). In terms of fracture AO type, 24 cases were classified as 32A, 5 as 32B, and 10 as 32C. Regarding fracture location, 3 were situated in the upper 1/3 of the femoral shaft, 19 in the middle 1/3, and 17 in the lower 1/3. The causes of injury included 13 cases of motor vehicle accidents, 5 cases of blunt trauma, 20 cases of falls, and 1 other fall, with 8 cases involving multiple injuries. Univariate analysis revealed statistically significant differences between preoperative anemia and AO fracture type, mechanism of injury, multiple injuries, time from injury to hospital admission, albumin levels, and age ( P< 0.05). Multifactorial logistic regression analysis identified AO type 32C ( OR=3.12, P=0.020), blunt trauma injuries ( OR=0.13, P=0.021), reduced albumin levels ( OR=9.90, P=0.037), and multiple injuries ( OR=3.65, P=0.016) as risk factors for preoperative anemia. Multifactorial logistic regression further revealed that multiple injuries ( OR=5.20, P=0.004) and reduced albumin levels ( OR=5.47, P=0.001) were risk factors for the severity of anemia. Conclusion:AO type 32C fractures, blunt trauma injuries, reduced albumin levels, and multiple injuries were identified as potential contributors to the development of preoperative anemia, with multiple injuries and reduced albumin levels exacerbating the severity of anemia. Clinicians should be vigilant for the occurrence of preoperative anemia in adult femoral shaft fracture patients, particularly those with blunt trauma injuries, multiple injuries, hypoalbuminemia, and AO type 32C fractures.

Objective: The purpose of this study was to retrospectively evaluate patients who had open reduction, external fixation and bone cement implantation of open calcaneal fractures. Methods: The records of 14 patients with open calcaneus fractures from January 2015 to January 2019 were reviewed retrospectively. Clinical evaluations consisting of AOFAS, MFS and EQ-5D VAS scores and radiological evaluations consisting of the height, width and length of the calcaneus as well as Bohler's and Gissane angle performed at 3 months, 1 year and the last follow-up postoperatively. Time to surgery, wound complications were recorded. Results: Our study sample consisted of 9 males and 5 females with a mean age of 38.5 +/- 9.8 years and a mean follow-up of 31.4 +/- 7.7 months. The mean period from injury to surgery was 5.4 +/- 1.9 days and the mean duration of hospitalization was 13.2 +/- 4.5 days. The AOFAS, MFS and EQ-5D VAS scores were 92.5 +/- 10.3, 84.1 +/- 9.7 and 86.4 +/- 15.1 respectively at the final follow-up. The Bohler's angle increased from (12.9 +/- 3.1)degrees preoperatively to (28.5 +/- 6.3)degrees at the final follow-up (P < 0.001), with the Gissane's angle from (104.5 +/- 9.7)degrees to (116.4 +/- 8.9)degrees (P < 0.001). One patients (7.1%) developed pin infections and one patient (7.1%) suffered from dorso-lateral hindfoot hypoaesthesia. There was complete fracture healing without secondary loss of reduction in all cases. Conclusion: External fixation with bone cement implantation is a valid alternative treatment for the management of displaced open calcaneal fractures with a low rate of complications. Level of evidence: IV, retrospective case series. (C) 2021 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

OBJECTIVE:To explore the risk factors of limb fracture complicated with pleural effusion, and to provide reference for the prevention of pleural effusion.METHODS:From January 2010 to December 2019, 137 patients with multiple limb fractures were treated surgically, including 102 males and 35 females, aged 16 to 92(48.34±15.85) years. Multiple limb fractures were defined as more than two limb fractures in the whole body, so the selected patients had complete clinical, impact and laboratory examination data before operation, including preoperative chest CT, gender, age, body mass index(BMI), hematocrit(HCT), American Society of Anesthesiologists(ASA), injury severity score (ISS), smoking history of operation, history of diabetes, history of hypertension, admission to operation time, fracture site, platelet count, albumin, C-reactive protein and D-dimer. Whether the patient was complicated with pleural effusion, calculate the amount of pleural effusion were recorded, and the relevant risk factors were statistically analyzed.RESULTS:All limb fractures received surgical treatment. The incision healed well after operation, and there were no complications such as wound infection, acute lung injury or acute respiratory distress syndrome. Multivariate regression analysis showed that ISS higher than 16(P=0.000), smoking history(P=0.001) and rib fracture(P=0.000) were the risk factors of multiple limb fractures complicated with pleural effusion. Multivariate linear regression analysis showed that smoking history, ISS and rib fracture were the risk factors for the increase of pleural effusion in multiple limb fractures.CONCLUSION:Multiple fractures of limbs combined with pleural effusion are related to ISS, smoking history and rib fracture;the amount of pleural effusion was related to smoking history, ISS and rib fracture. Patients with multiple fractures with ISS greater than 16, smoking history or rib fracture should be vigilant and intervene as soon as possible to reduce the risk of pleural effusion.

目的 探索基于三柱构成理念的改良髋臼骨折分型的可信度与可重复性.方法 本研究纳入2016年8月至2020年8月南京鼓楼医院高淳分院收治的108例髋臼骨折患者的临床病例资料,其中男58例,女50例;年龄18～60岁,平均(39.45±10.24)岁.由4名从事临床工作5年以上的骨科医生根据患者X线、三维CT资料对髋臼骨折进行Letournel-Judet分型以及改良髋臼骨折分型,3个月后进行第二次分型,通过一致性Kappa检验分析这两种分型方法的可信度与可重复性.结果 使用改良髋臼骨折分型可以全部纳入108例髋臼骨折,而使用Letournel-Judet分型有平均7.25例无法纳入.改良髋臼骨折分型,不同医生同一时间点的可信度检验的Kappa平均值为0.891,相同医师不同时间点可重复性的Kappa值为0.938;而Letournel-Judet分型的可信度平均值为0.857,可重复性为0.897.改良髋臼骨折分型的可信度与可重复性略高于Letournel-Judet分型,同时两种分型方法的可信度与可重复性都达到优等级.结论 基于三柱构成理念的改良髋臼骨折分型具有较高的可信度与可重复性,且能更好地覆盖各种髋臼骨折类型,在临床中可更好地帮助医师对髋臼骨折进行分型及制定治疗方案.

Objective:To analysis the risk factors for calcaneal fracture combined with vertebral fracture.Methods:A retrospective study was performed of the 745 calcaneal fractures which had been surgically treated from May, 2005 to September, 2020 in Nanjing Drum Tower Hospital Affiliated to Medical School, Nanjing University. There were 651 males and 94 females, aged from 11 to 89 years (mean, 43.8 years). The incidence of calcaneal fracture combined with vertebral fracture was recorded. The risk factors were screened out by univariate analysis from gender, age, body mass index, unilateral or bilateral calcaneal fractures, injury severity score (ISS), cause of injury, fall height, classifications of calcaneal and number of vertebral fracture; binary logistic regression analysis was used to determine independent risk factors from the rtsk factors with P<0.05. Results:Vertebral fracture occurred in 70 of the 745 patients with calcaneal fracture (9.40%). Univariate analysis showed significant differences in gender, body mass index, unilateral or bilateral calcaneal fractures, ISS and fall height between patients with simple calcaneal fracture and patients with calcaneal fracture combined with vertebral fracture ( P<0.05); Binary logistic regression analysis showed that gender ( OR=0.225, 95% CI:0.095~0.532, P=0.001), unilateral or bilateral calcaneal fractures ( OR=3.582, 95% CI:1.705~7.526, P=0.001), ISS ( OR=5.229, 95% CI:1.605~17.035, P=0.006), and fall height ( OR=49.820, 95% CI:23.068~107.597, P<0.001) were the independent risk factors for calcaneal fracture combined with vertebral fracture. Conclusion:A more likely combined vertebral fracture should be taken into consideration in male patient with bilateral calcaneal fractures, a falling height > 3 m, or a high ISS.

Background Volar locking plating remains a popular method for the surgical management of distal radius fractures. Dorsal metaphyseal comminution (DMC) is a common fracture pattern which weakens the stability during fracture fixation. In this study, we aimed to compare the radiographic and functional outcome of the intra- and extra-articular distal radius fractures with DMC following single volar locking plate fixation. Materials and methods Patients suffered from a distal radius fracture with DMC were reviewed in the clinical database of the authors’ institution between Jan 2016 and Jan 2020. The included patients were classified into the extra-articular (A3) group or the intra-articular (C2 and C3) group according to the AO/OTA system. The radiological parameters, wrist range of motion, and functional outcomes were evaluated following open reduction and volar locking plate fixation. Results A total of 130 patients were included in this study with a mean follow-up length of 17.2 months. Compared with the A3 fracture group, no significant fracture re-displacement or reduced wrist ROMs was observed in the C2 fractures after 12-month’s follow-up. However, significantly decreased volar tilt ( P = 0.003) as well as the extension/flexion ROMs were observed in the C3 fractures comparing to the A3 fractures. Most of the patients achieved an excellent (n = 75) or good (n = 51) Gartland and Werley wrist score. Four patients with C3 fractures resulted in a fair functional outcome due to a significant loss of volar tilt during follow-up. Conclusions The single volar locking plate fixation provided sufficient stability for distal radius fractures with DMC, and resulted in similar radiological and functional outcomes in the intra-articular distal radius fractures with a simple articular component (C2 fractures) as those in the extra-articular fractures. Considering the intra-articular fractures with multifragmentary articular component (C3 fracture), despite of the subsequent loss of volar tilt, the majority of the patients achieved good to excellent wrist function following single volar locking plating. Trial registration This study has been registered on the ClinicalTrials.gov.

Background: Volar locking plating remains a popular method for the surgical management of distal radius fractures. Dorsal metaphyseal comminution (DMC) is a common fracture pattern which weakens the stability during fracture fixation. In this study, we aimed to compare the radiographic and functional outcome of the intra- and extra-articular distal radius fractures with DMC following volar locking plate fixation.Materials and methods: Patients suffered from a distal radius fracture with DMC were reviewed in the clinical database of the authors’ institution between Jan 2016 and Jan 2020. The included patients were classified into the extra-articular (A3) group or the intra-articular (C2 and C3) group according to the AO/OTA system. The radiological parameters, wrist range of motion, and functional outcomes were evaluated following open reduction and volar locking plate fixation.Results: A total of 130 patients were included in this study with a mean follow-up length of 17.2 months. Compared with the A3 fracture group, no significant fracture re-displacement or reduced wrist ROMs was observed in the C2 fractures after 12-month’s follow-up. However, significantly decreased volar tilt (P = 0.003) as well as the extension/flexion ROMs were observed in the C3 fractures comparing to the A3 fractures. Most of the patients achieved an excellent (n = 75) or good (n = 51) Gartland and Werley wrist score. Four patients with C3 fractures resulted in a fair functional outcome due to a significant loss of volar tilt during follow-up.Conclusions: The volar locking plate fixation provided sufficient stability for distal radius fractures with DMC, and resulted in similar radiological and functional outcomes in the intra-articular distal radius fractures with a simple articular component (C2 fractures) as those in the extra-articular fractures. Considering the intra-articular fractures with multifragmentary articular component (C3 fracture), despite of the subsequent loss of volar tilt, the majority of the patients achieved good to excellent wrist function following volar locking plating.Trial registration: Not applicable because the design of the study is retrospective.

Background: The timely and accurate diagnosis of infected nonunion is challenging, and there is a need for more efficient biomarkers. Previous studies have shown that fibrinogen plays an important role in mediating inflammation in bacterial infections and, therefore, could be a valuable biomarker for infected nonunion. The purpose of this study was to evaluate and compare the performance of plasma fibrinogen and other traditional blood markers for the diagnosis of infected nonunion. Materials and Methods: We retrospectively studied 146 patients who underwent surgery for primary nonunion between January 2018 and January 2020. The patients were divided into those with infected nonunion (n = 55) and those with aseptic nonunion (n = 91). The preoperatively analyzed parameters were plasma fibrinogen, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and white blood cell (WBC) count. Receiver operating characteristic (ROC) curve analysis was used to assess the sensitivity and specificity of the biomarkers, and Youden's index was calculated to determine their optimal cut-off values. Results: The plasma fibrinogen values were significantly higher (p < 0.001) in the patients with infected nonunion than in those with aseptic nonunion. ROC curve analysis showed that plasma fibrinogen had a high value of area under the curve (0.816), which indicated that it had good diagnostic ability. Further, at the optimal threshold value of 2.75 g/L, plasma fibrinogen had the highest sensitivity (78.2%; 95% CI = 64.6-87.8) and good specificity (82.4%; 95% CI, 72.7-89.3). Conclusion: In comparison to the traditional markers of infection, plasma fibrinogen showed good diagnostic ability for the detection of infected nonunion. It may have potential as a practical and cost-efficient biomarker for the diagnosis of infected nonunion.

Brain‐derived neurotrophic factor (BDNF) has been reported to participate in fracture healing, whereas the mechanism is still unclear. Since osteoblast migration is important for fracture healing, investigating effects of BDNF on osteoblasts migration may help to reveal its mechanism. Here, MC3T3‐E1 cells were used in vitro while closed femur fracture mice were applied in vivo. Cells migration was assessed with Transwell assay. The protein expression was analysed by immunoblotting. X‐ray and Micro‐CT were performed at different time after fracture. Our results showed that BDNF promoted MC3T3‐E1 cells migration, integrin β1 expression and ERK1/2 and AKT phosphorylation. K252a, a specific inhibitor for TrkB, suppressed BDNF‐induced migration, integrin β1 expression and activation of ERK1/2 and AKT. PD98059 (an ERK1/2 inhibitor) and LY294002 (an AKT inhibitor) both inhibited BDNF‐induced migration and integrin β1 expression while integrin β1 blocking antibody only suppressed cell migration. X‐ray and Micro‐CT analyses showed that the adenoviral carried integrin β1 shRNA group had slower fracture healing at 7 and 21 days, but not 35 days compared to the control group. Thus, we proposed that BDNF stimulated MC3T3‐E1 cells migration by up‐regulating integrin β1 via TrkB mediated ERK1/2 and AKT signalling, and this may help to enhance the fracture healing.

目的 探讨采用含抗生素骨水泥填充治疗骨折内固定术后晚期感染并干骺端骨缺损的效果.方法 回顾性分析自2016-03-2017-10采用彻底清创、取出内固定、抗生素骨水泥填充一期手术治疗的8例骨折内固定术后晚期感染并干骺端骨缺损.结果 本组6例术中深部组织细菌培养阳性,均为金黄色葡萄球菌,其中2例为耐甲氧西林阳性;2例细菌培养结果为阴性.1例出现切口延迟愈合,经加强换药后顺利愈合.本组住院时间9～30 d,平均18.9 d.8例均获得随访,随访时间平均21.1(13～32)个月.末次随访时所有患者无明显疼痛,可以负重行走,无感染复发,无再骨折发生,影像学检查显示骨水泥周围无明显骨吸收.结论 抗生素骨水泥用于骨折内固定术后晚期感染并干骺端骨缺损患者的终末治疗,其优点是避免二次手术、减少患者的痛苦及治疗费用;同时对于部分骨缺损比较大或者骨折未完全愈合的患者,可以提供力学支撑,无需采用外固定.

PURPOSE:Infected nonunion after open reduction internal fixation (ORIF) is a serious complication. The aim of this study was to evaluate the usefulness of serum D-dimer for preoperative diagnosis of infected nonunion. PATIENTS AND METHODS:Patients undergoing debridement and external fixation for infected nonunion (n=32) and replacement of internal fixation due to aseptic failure (n=34) were enrolled and compared in this retrospective study. The optimum cutoff value of D-dimer for identification of infected nonunion was determined by calculating the Youden J statistic. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of four preoperative laboratory parameters-serum D-dimer level, white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP)-for diagnosis of infected nonunion were compared. RESULTS:Serum D-dimer level was significantly higher in patients with infected nonunion than in patients with aseptic nonunion: 2.62 mg/mL (range, 0.13-11.90 mg/mL) vs 0.35 mg/mL (range, 0.07-6.46 mg/mL; p<0.001). WBC count, CRP, and ESR demonstrated sensitivity of 12.5% (95% CI: 4.08-29.93), 40.6% (95% CI: 24.22-59.21), and 56.3% (95% CI: 37.88-73.16), respectively, and specificity of 94.1% (95% CI: 78.94-98.97), 88.2% (95% CI: 71.61-96.16), and 85.3% (95% CI: 68.17-94.46), respectively. Using the Youden index, 1.70 mg/mL was determined as the optimal threshold value for serum D-dimer for the diagnosis of infected nonunion. The sensitivity and specificity of serum D-dimer (>1.70 mg/mL) were 75.0% (95% CI: 56.25-87.87) and 91.2% (95% CI: 75.19-97.69). CONCLUSIONS:Serum D-dimer level may be useful for preoperative prediction of infected nonunion in patients after ORIF.

Objective This study was performed to investigate the incidence of and risk factors for asymptomatic heterotopic ossification (HO) after open reduction and internal fixation of elbow fractures. Methods This retrospective analysis involved 197 patients with elbow fractures treated operatively from 2014 to 2017 at our institution. Patient-related and clinical variables were recorded. Univariate analysis and multivariate logistic regression were performed to reveal independent risk factors for postoperative HO. In addition, a receiver operating characteristic (ROC) curve was performed to assess the ability of risk factors to predict the development of postoperative HO. Results The overall rate of asymptomatic HO after surgery was 18.78%. The incidence was highest in terrible triad injuries and lowest in capitellum fractures. Independent predictors of asymptomatic HO identified by the multivariate analysis were underlying diseases, fracture dislocation, and a prolonged operative time. The area under the ROC curve for underlying diseases, fracture dislocation, and a prolonged operative time were 0.593, 0.596, and 0.694, respectively. Conclusions The incidence of postoperative asymptomatic HO in patients with elbow fractures is high. Clinicians should employ prophylaxis to avoid HO when treating patients with elbow fractures who have underlying diseases, fracture dislocation, or a prolonged operative time.