Purpose We designed a prospective cohort study based on magnetic resonance angiography (MRA) to identify whether the degree of Kummell disease (KD) vertebral artery occlusion is more severe than that of simple vertebral compression fractures. Methods We enrolled elderly patients with VCFs who met the established criteria from January 2019. MRA was used to determine the degree of vertebral artery occlusion. We defined the lesion segmental occlusion rate (LSOR) as the sum of the ischemic values of the bilateral vertebral segmental arteries (0 means expedite, 1 means stenosis, 2 means occlusion; range from 0–4). The average LSOR is the sum of LSORs divided by the number of vertebrae. Follow-up outcomes included VAS and ODI scores after surgery. X-rays were re-examined at 1 year after surgery to determine whether the vertebral body had recollapsed. Results 25 cases of KD segments and 37 cases of non-KD segments were included. The average LSOR in KD segments was significantly higher than that in non-KD segments (1.44 vs 0.32, P<0.01). The recollapse rate of the KD segments after one year was significantly higher than that in non-KD segments (56% vs 27%, P=0.03). In non-KD segments, 57.1% of segments with a high LSOR (1–2) recollapsed, and 20% of segments with a low LSOR (0) recollapsed (P=0.045) Conclusions The degree of artery occlusion in the KD segment is more serious than that in the non-KD segment. KD segments or non-KD segments with a high degree of artery occlusion will have a higher recollapse rate.

(1) Introduction: The choices of the treatments for femoral neck fractures remain controversial. The purpose of this study is to evaluate the prognoses of the variable pitch fully threaded headless screws in the fixation of femoral neck fractures and to compare them with those of partially threaded cannulated screws. (2) Materials and Methods: Between 1st January 2012 and 31st December 2016, there were 89 patients with the main diagnose of femoral neck fracture who accepted the treatment of closed reduction cannulated screw fixation in Peking University People’s Hospital. 34 cases of partially threaded screws and 23 cases of fully threaded screws met the criterion. The characteristics, prognoses and the imaging changes of all cases were described and the differences between the two groups were compared. Statistical analyses were performed using SPSS version 23.0 (SPSS Inc., USA). Mann-Whitney U test, Analysis of Variance and Chi-square test were used. Statistical significance was defined as P value (two sided) less than 0.05. (3) Results: There was no significant difference in the general characteristics, fracture classifications and reduction quality between the two groups. The fully threaded group had a significant lower angle decrease rate (30.4% vs. 58.8%, P = 0.035), femoral neck shortening rate (26.1% vs. 52.9%, P = 0.044) and screw back-sliding rate (21.7% vs. 50.0%, P = 0.032), but a higher screw cut-out rate (21.7% vs. 0.0%, P = 0.008). No significant difference was found in the nonunion rate (8.7% vs. 0.0%, P = 0.159), avascular necrosis rate (17.4% vs. 23.5%, P = 0.744) and the good and excellent rate of Harris score (73.9% vs. 82.4%, P = 0.443). (4) Conclusion: Compared with the partially threaded screws, the variable pitch fully threaded headless screws had a lower screw back-sliding rate, femoral shortening rate, angle decrease rate and similar function score, but would result in more screw cut-outs and nonunions in Garden III-IV and Pauwels III fractures. As a conclusion, the variable pitch full threaded screws are recommended in stable undisplaced fractures rather than displaced unstable fractures. Further qualified investigations with a larger scale of patients and longer follow-up are needed in the future.

ABSTRACT Background: The peptidylarginine deiminase (PAD) family converts arginine into citrulline through protein citrullination. PAD2 and PAD4 inhibitors can improve survival in hemorrhagic shock (HS). However, the impact of isoform-specific PAD inhibition in improving survival has not been studied. In this study, we utilize selective Pad2−/− knockout mice to elucidate loss of function of PAD2 leads to pro-survival effect in HS. Methods: HS: Pad2 −/− and wild-type (WT) mice (n = 5/group) were subjected to lethal HS (55% volume hemorrhage). Survival was monitored over 7 days. Myocardial infarction (MI): Pad2 −/− and WT mice (n = 9/group) were subjected to MI by permanent LAD ligation to examine the effect of ischemia on the heart. After 24 h cardiac function and infarct size were measured. Results: HS: Pad2 −/− mice demonstrated 100% survival compared with 0% for WT mice (P = 0.002). In a sub-lethal HS model, cardiac β-catenin levels were higher in Pad2 −/− compared with WT after 24 h. MI: WT mice demonstrated larger MI (75%) compared with Pad2 −/− (60%) (P < 0.05). Pad2 −/− had significantly higher ejection fraction and fractional shortening compared with WT (P < 0.05). Conclusions: Pad2 −/− improves survival in lethal HS. Possible mechanisms by which loss of PAD2 function improves survival include the activation of cell survival pathways, improved tolerance of cardiac ischemia, and improved cardiac function during ischemia. PAD2 is promising as a future therapeutic target for the treatment of HS and cardiac ischemia.

Objective To observe operative results of 2 posteromedial approaches in the treatment of posterior pilon fractures of Klammer type Ⅲ.Methods From January 2015 to December 2016,19 patients with posterior pilon fracture (Klammer type Ⅲ) were treated via the posteromedial approach.They were 12 men and 7 women,aged from 21 to 61 years (mean,37.4 years).Straight posteromedial incision was used in 11 cases and curved posteromedial incision in the other 8 cases.The 2 groups were compared in terms of postoperative wound complication,infection,bone union,visual analogue scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) scores.Results Follow-up ranged from 6 to 29 months (mean,11.8 months).All the fractures united after 6 to 15 months (mean,10.7 months).In the straight incision group,the VAS scores at the final follow-up ranged from 0 to 3 points,averaging 1.1 points;the AOFAS scores ranged from 83 to 100 points,averaging 90.8 points.In the curved incision group,the VAS scores at the final follow-up ranged from 0 to 3 points,averaging 1.3 points;the AOFAS scores ranged from 80 to 100 points,averaging 90.1 points.In one case in the curved incision group,the posteromedial wound failed to heal but scar healing was achieved after dressing change for 4 months.Conclusion The posteromedial approach,whether straight or curved,can provide good exposure for posterior pilon fractures of Klammer type Ⅲ,which is conductive to reduction and fixation of the fracture.

Despite progress in understanding the pathophysiology of peripheral nervous injury and regeneration, as well as advancements in different surgical techniques, peripheral nerve repair and functional reconstruction is still a major challenge for orthopedic surgeons. We proposed a new method to reconstruct peripheral nerve injury by using a new type of biodegradable biomaterial nerve tube. This tube is suited to maximize re-innervation of the regenerating proximal stump into the degenerating distal stump by providing a conduit for nerve guidance. The purpose of this prospective study was to investigate the long-term follow-up outcomes of different nerve repair technologies (biodegradable conduit small-gap tubulization and traditional epineurial suture) for the treatment of peripheral nerve injury. The nerve functional recovery conditions and electrophysiological studies were carried out at the 3-, 6-, 24- and 60-month after first surgery. Imageological diagnosis was carried out at the 60th month of the follow-up. Reconstruction images and related data along the injured nerves were compared with normal sides and correlated with electrophysiological neurography results. Complications were also recorded. The results showed that the clinical recovery effect of the injured nerves treated with biodegradable conduit small-gap (2 mm) tubulization was better than that treated with traditional epineurial neurorrhaphy in early period in this 5-year follow-up. Thus we conclude that biodegradable small-gap (2 mm) tubulization is an effective procedure in peripheral nerve injury treatment with an early good functional outcome, and presents potentially groundbreaking possibilities to help guide peripheral nerve reconstruction after injury in the future.

Objective: This study aims to evaluate the effects of standardization processes in improving severe trauma treatments in China. Methods: This study was conducted in 12 hospitals located in 12 geographically and industrially different cities in China. A standard process on severe trauma rescue was established as a general rule for staff training and patient treatment. A regional network (system) efficiently integrating pre-hospital rescue, emergency room treatments, and hospital specialist treatments was built under the rule for information sharing and improving severe trauma treatments. Treatment outcomes were compared between before and one year after the implementation of standardization processes. Results: The outcomes of a total of 74,615 and 12051 cases of severe trauma were collected from 12 hospitals before the implementation of standardization processes. Implementation of the standardization processes led to efficient cooperation and information sharing of different treatmen services. The emergency response time, pre-hospital transit time, emergency rescue time, consultation call time, and mortality rate of patients were 24.24±4.32、45.69±3.89、6.38±1.05、17.53±0.72 minutes, and 33.82±3.87%, n=441,respectively before the Implementation of the standardization and significantly reduced to 10.11±3.21、22.39±4.32、3.26±0.89、3.45±0.45 minutes, and20.49±3.11 %, seperatly, n=495, (P<0.05) after that. Conclusion: Staff training and standardization processes can significantly improve the treatment efficiency of severe trauma based on current personnel and organizations of severe trauma treatments in China.

OBJECTIVE:To evaluate the current condition of urban road traffic injuries (RTIs) according to Beijing Emergency Medical Center (BEMC) from Jan. 1, 2004 to Dec. 31, 2010, analyze the social characteristics and explore the possible methods for prevention and improvement.METHODS:Using data from the Beijing Emergency Medical Center, we collected 19 550 victims who were involved in RTIs in Beijing from Jan. 1, 2004 to Dec. 31, 2010. The personal information, time of the injury event, road user type and striking vehicle type, as well as the site and severity of injury, were analyzed using Excel 2007 and SPSS 17.0 software with ANOVA of variance and Chi-squared tests.RESULTS:The annual rate of RTIs was 120.0 per 100 000 people in Beijing, and the mortality rate was about 4.97 per 100 000 people. Male victims were more than female victims (11 737 persons vs. 7 618 persons).The mean age was (72.92 ± 5.67) years. Overall, RTIs in all the age groups happened in October commonly, and were inclined to daytime, especially at noon. But different age groups had their special hour distribution features of RTIs. Traffic collisions occurred most frequently in pedestrians and cyclists (7 588,38.81%;3 790,19.39%). Majorities of victims presented with head injuries and lower-limb injuries(8 343,42.68%; 6 828,34.93%). These collisions included car striking accidents (11 490, 58.77%). And most of the older adults were classified as medium in severity (11 718, 59.94%).CONCLUSION:The prevention and treatment of RTIs, should focus on targeted prevention solutions and standardized pre-hospital rescue, according to specific population, time interval and vehicle usage.

OBJECTIVE:To study clinical-related characteristics of sociology of postoperative distal radius fracture patients.METHODS:A multi-center retrospective research was conducted on the information of the case evaluation and follow-up, including the patients' gender, age, habits, history of chronic diseases, conditions of fracture, length of hospital stay and treatments. The epidemiology data were analyzed with SPSS15.0.RESULTS:Of the entire 143 patients, 52 were male (average age: 41), and 91 were female (average age: 61). The different gender and age groups had significant distinction in the characteristics of injury. The length of hospital stay was influenced by the energy of injury.CONCLUSION:To reduce the damage or incidence of distal radius fracture, we should avoid falling, strengthen protection awareness, treat internal medicine diseases or osteoporosis and so on. The knowledge of characteristics of sociology and injury of distal radius fracture is beneficial to the prevention and treatment.

OBJECTIVE:To investigate the surgical treatment results of implant failure after clavicular fracture open reduction and internal fixation (ORIF).METHODS:Fifteen cases from Jan. 2005 to Jan. 2013 were treated surgically according to fracture classification, time of implant failure and implant type. The fracture union, shoulder function and pain were evaluated postoperatively.RESULTS:All the patients had full follow-up for 5 to 101 months (mean: 43.8 months). All the fractures were united well. The constant scores to assess the shoulder function were 82 to 100 (mean: 93.3 in the fracture side) and were 85 to 100 (mean: 96.7 in the uninjured side); statistically significant difference of the constant scores between the two sides was found (P=0.02). Eight cases did not have shoulder pain in the fracture side, while the other 7 cases had mild pain, The visual analogue scale (VAS) scores to evaluate shoulder pain were 1 to 3 in the fracture side, which were statistically different from those in the uninjured side (P=0.03).CONCLUSION:Implant instability causes early implant failure after clavicular fracture ORIF and re-fixation with stable implant is effective. Fracture nonunion leads to late implant failure, and bridging fixation using locking plate associated with bony autograft with iliac crest is a successful method to treat atrophy clavicular nonunion. Surgical treatment can bring good results.

OBJECTIVE:To establish a stable animal model for studying the effect of traumatic brain injury on bone fracture healing.METHODS:Eighty adult male Sprague-Dawley rats were randomly divided into fracture combined brain injury group (A) and simple fracture group (B). Animals of the two groups were killed 6 hours, 1 week, 2 weeks, 1 month and 2 months after trauma, respectively. Their brain histopathology changes were observed and neurological severity scores (NSS, 0 through 25 from no injury to severe injury) determined to measure the brain injury after head trauma, and fracture-healing was assessed by measuring callus volume and X ray examination at the scheduled time points after trauma. The callus volumes were compared between the groups using independent-samples t test 1 week, 2 weeks, 1 month and 2 months after trauma respectively. A value of P<0.05 was considered statistically significant.RESULTS:Ninety percent of the rats of group A presented with hemiplegia and the mortality rate was 10% (4/40) . The survived rats developed decorticated flexion deformity of the forelimbs, with behavioral depression, and lost some reflexes and muscle tone. The NSS were 10.83±1.94, 9.33±0.82, 8.17±1.17, 7.83±0.75 and 8.07±0.82 with 6 hours, 1 week, 2 weeks, 1 month and 2 months after trauma, respectively. It showed that the animals received moderate head injury, which tended to be stable from 2 weeks after trauma. Brain pathology showed that blood brain barrier was destroyed, and neurons were degenerative and necrotic at and around the trauma sites. The callus volumes(unit: mm(3)) of the two groups 1 week, 2 weeks, 1 month and 2 months after trauma were 60.03±28.05 and 32.80±11.04, 78.54±15.16 and 51.36±23.02, 93.01±10.65 and 72.38±20.38, 115.26±40.00 and 60.30±13.34, respectively. The callus volumes of the two groups 2 weeks, 1 month and 2 months after trauma were statistically and significantly different (P values were 0.036, 0.006 and 0.01 respectively), and there was no difference 1 week after trauma (P=0.065).CONCLUSION:This model is capable of producing accurately quantified brain injury. The animal model is credible, stable and reproducible, so it is an effective platform for studying the effect of traumatic brain injury on fracture.

OBJECTIVE:To investigate the treatment effect of open arthrolysis for elbow stiffness.METHODS:From Aug. 2007 to Apr. 2012, 17 cases of elbow stiffness were treated with open arthrolysis,in which, 11 were post-traumatic stiffness and 6 elbow stiffness resulted from rheumatoid arthritis and osteoarthritis. The preoperative Mayo elbow score was 65.1±16.4. Posterior middle approach was applied for 15 cases, and primary lateral approach for 2 cases. The ulnar nerve release and antedisplacement were performed for 12 cases with series limited flexion. The mobile hinged fixator were applied for 2 cases of unstable elbow after debridement of series hero ossification.RESULTS:With follow-up time for 6 to 41 months (average 13.1 months), all the patients acquired the follow-up and evaluation. According to Mayo elbow score of the last follow-up, the score was 87.5±16.7, and compared with the preoperation, the difference was significant: 9 cases were excellent, 6 good, 1 fair, and 1 poor, and the total excellent and good rate was 88.23%. The active range of motion (ROM) of flexion-extension was 110.6°±27.5°. However, 1 case developed chronic infection, and 1 ulnar nerve symptom.CONCLUSION:In applying open arthrolysis to treat elbow stiffness, as long as we release completely and assure stable elbow and early postoperative motion, we can get satisfying results.

Objective To analyze the injury characteristics in 2004-2009 road traffic accidents (RTAS) of 0-25 years old adolescents treated in Beijing "120" Emergency Center so as to provide scientific basis for making effective measures in prevention and control of RTAs. Methods The data of all the adolescents with traffic injuries treated in Beijing "120" Medical Emergency Center were collected for a retrospective analysis on sex,age,traffic injury time,wound regions,injury characteristics and death condition of the injured adolescents. Results ( 1 ) There were 17 232 injuries and 259 deaths according to the traffic reports from 2004 to 2009. Among the total injury cases,there were 4 229 cases of 0-25 years old adolescents (24.5％),at (20.13 ± 4.43 ) years of age.The injury number showed a significant rising trend with the increase of age and the injury number of 20 years old group were obvious more than that of other age groups.(2) There were 2 252 males and 1 677 females,with ratio of males to females for 1.5:1 ( P ＜ 0.05 ).( 3 ) Total number of patients was decreased yearly.The high incidence of adolescent RTAs could be seen in September,October and May in one year; Friday,Saturday and Sunday in one week; and between 8:00 am and 11:00 pm in one day.The low incidence of adolescent RTAs could be seen in Tuesday in one week,and 3:00-6:00 am in one day (P ＜0.05).(4) Cases of limb and arthrosis wounds (53.4％) were more than those of head and neck wounds (35％).Most of the cases were pedestrians (49.1％ ).(5) There were 38 deaths,including 28 males and 10 females,at ageof (19.29 ± 5.30) years.The death were mainly resulted from craniocerebral injuries (87％),which mainly concentrated in July ( 13.2％ ) and August ( 15.8％ ). Conclusions The present condition ofadolescent traffic injuries is not good enough.We should strengthen traffic security education,increase executive powers in the traffic rush and promote cooperation and communication in pre-hospital emergency,as may be beneficial for decreasing adolescent RTA.

OBJECTIVE:To establish an area by generating a surface model located a certain distance inside the scaphoid bone by computer analysis of three-dimensional reconstructions of computed tomography images, and define the central zone of the scaphoid.METHODS:Twenty cases of three-dimensional computed tomography reconstructions of normal scaphoids in a computerized operation planning and simulation system (Vxwork software) were obtained. The scaphoid surface model was shrunk by using the function "erode" in the software until the waist portion became the one third size of the original waist portion of the scaphoid, and then another 1.5 mm shrinkage was made to get the central zone. Geometry and size of the central zone were evaluated and measured.RESULTS:Geometry of all central zones was similar, as irregular as the scaphoid. The central zone could be divided into distal pole, waist portion and proximal pole. The narrowest part in the central zone was the waist portion, whose diameter ranged from 0.8-1.2 mm. Based on irregularity and size of the central zone, a screw axis could only be possibly contained completely either in the proximal, waist or distal central zone area, as it was very difficult to place the screw centrally in the whole scaphoid.CONCLUSION:The establishment of the central zone of the scaphoid three-dimensional computed tomography images could provide a baseline for discussion of central placement for scaphoid screw.

Objective To discuss the indications, methods and treatment outcomes of double plate internal fixation of comminuted distal radius fractures via a dorsal approach. Methods Ten patients of type C comminuted distal radius fractures were treated by dorsal approach reduction, bone graft and double plate internal fixation. Among them, 2 were male and 8 were female. The average age of the patients was 72 years. Results Postoperatively the patients were followed up for 6 to 26 month, with an average of 14 months. The mean Garland and Werley score was 2 (range 0 to 12). Results were considered excellent in 5 cases, good in 4 cases and fair in 1 case. Conclusion Dorsal double plate fixation for comminuted distal radius fracture is technically challenging. However dorsal reduction, bone grafting and fixation is more in line with the anatomy of distal radius and the injury mechanism. It is one of the most effective methods for treating this type of complex fractures.

OBJECTIVES:To investigate the clinical features of femoral neck fractures and analyze related causes. METHODS:The clinical data of patients with femoral neck fractures from June 2002 to August 2009 were retrospectively analyzed. The gender, age, fracture side, fracture type, basic social data, activities before injury, injury causes and treatment were analyzed. RESULTS:A total of 219 patients (106 male and 113 female) was analyzed. All patients were divided into children group (age < 16 years), adult group (age ranged from 16 to 60 years) and older group (> 60 years). There were 5 patients (2.3%) in the children group, 81 patients (37.0%) in the adult group and 133 patients (60.7%) in the older group. There were 11 patients (5.0%) with Garden I fractures, 32 patients (14.6%) with Garden II fractures, 90 patients (41.1%) with Garden III fractures and 86 patients (39.3%) with Garden IV fractures. Fall damage and traffic injury were the main injury types. Home and public place were the main injury sites. CONCLUSIONS:The incidence of femoral neck fracture shows the highest in the old persons. The male patients with femoral neck fractures are more than female patients in children and adult group, while the male patients with femoral neck fractures are less than female patients in older group. The dominant fractures type according to Garden classification is Garden III fractures in children and adult groups, but Garden IV fractures in older group. Fall damage and traffic injury are the main injury types. Home and public place are the main injury sites.