Outcomes after ORIF are similar in young and elderly patients with tibial plateau fractures: A minimum 2-year follow-up study.

BACKGROUND: This study aimed to compare the outcomes of open reduction internal fixation in young and elderly patients with tibial plateau fractures. METHODS: A total of 224 patients with tibial plateau fractures treated with open reduction internal fixation at a level I trauma center from 2014 to 2019 were reviewed. The patients with a minimum follow-up of 2 years were divided into two groups, with those aged 60 years and older divided into the elderly group and those under 60 years divided into the young group. The mean follow-up time was 55 months (range: 24-80), and the primary outcomes were quality of reduction and function. The secondary outcomes included complications, fracture healing time, and conversion to total knee arthroplasty. RESULTS: The elderly group had a higher proportion of women than the young group (61.1% vs. 23.9%, p < 0.001). Diabetes was more prevalent in the elderly cohort than in the young cohort (18.9% vs. 9.0%, p = 0.030). The rate of bone grafts was higher in the elderly group (57.8% vs. 41.8%, p = 0.019), but no significant differences were found between the groups regarding fracture characteristics, the operative time or intraoperative blood loss. The reduction quality, knee function, postoperative complications, healing time, and total knee arthroplasty conversion rate were not significantly different (p > 0.05) between the groups. CONCLUSIONS: Open reduction internal fixation remains a satisfactory technique to treat tibial plateau fractures in the elderly. Although the rate of bone grafts is higher in elderly patients, they had comparable outcomes compared with their younger counterparts.

Microbial production of vitamin B5: current status and prospects.

Vitamin B5, also called D-pantothenic acid (D-PA), is a necessary micronutrient that plays an essential role in maintaining the physiological function of an organism. It is widely used in: food, medicine, feed, cosmetics, and other fields. Currently, the production of D-PA in industry heavily relies on chemical processes and enzymatic catalysis. With an increasing demand on the market, replacing chemical-based production of D-PA with microbial fermentation utilizing renewable resources is necessary. In this review, the physiological role and applications of D-PA were firstly introduced, after which the biosynthesis pathways and enzymes will be summarized. Subsequently, a series of cell factory development strategies for excessive D-PA production are analyzed and discussed. Finally, the prospect of microbial production of D-PA production has been prospected.

EZH2 regulates pancreatic cancer cells through E2F1, GLI1, CDK3, and Mcm4.

Pancreatic cancer (PC) is one of the most common malignant tumors in digestive tract. To explore the role of epigenetic factor EZH2 in the malignant proliferation of PC, so as to provide effective medical help in PC. Sixty paraffin sections of PC were collected and the expression of EZH2 in PC tissues was detected by immunohistochemical assay. Three normal pancreas tissue samples were used as controls. The regulation of EZH2 gene on proliferation and migration of normal pancreatic cell and PC cell were determined by MTS, colony forming, Ki-67 antibody, scratch and Transwell assays. Through differential gene annotation and differential gene signaling pathway analysis, differentially expressed genes related to cell proliferation were selected and verified by RT-qPCR. EZH2 is mainly expressed in the nuclei of pancreatic tumor cells, but not in normal pancreatic cells. The results of cell function experiments showed that EZH2 overexpression could enhance the proliferation and migration ability of PC cell BXPC-3. Cell proliferation ability increased by 38% compared to the control group. EZH2 knockdown resulted in reduced proliferation and migration ability of cells. Compared with control, proliferation ability of cells reduced by 16%-40%. The results of bioinformatics analysis of transcriptome data and RT-qPCR demonstrated that EZH2 could regulate the expression of E2F1, GLI1, CDK3 and Mcm4 in normal and PC cells. The results revealed that EZH2 might regulate the proliferation of normal pancreatic cell and PC cell through E2F1, GLI1, CDK3 and Mcm4.

Proximal tibia osteotomy with absorbable spacer combined with fibular osteotomy versus high tibial osteotomy for medial compartmental knee osteoarthritis.

PURPOSE: The study aimed to compare the perioperative complications, short-term clinical outcomes, patient-reported outcomes, and radiographic parameters of tibiofibular proximal osteotomy combined with absorbable spacer insertion (TPOASI) and open-wedge high tibial osteotomy (OWHTO) in a two year postoperative time period. METHODS: A total of 160 patients with Kellgren-Lawrence classification grade 3 medial compartmental knee OA were randomized to receive either TPOASI (n = 82) or OWHTO (n = 78). The primary and secondary outcomes were measured preoperatively, postoperatively, and at each follow-up examination. The primary outcomes were the between-group change in the Western Ontario and McMaster Universities Global score (WOMAC). Secondary measures included visual analog scale (VAS), radiographic parameters, American Knee Society Score (KSS), operation time, blood loss, length of incision, hospital stay, and relevant complications. Postoperative radiographic parameters, including the femorotibial angle (FTA), varus angle (VA), and joint line convergence angle (JLCA), were measured to evaluate the correction of varus deformity. RESULTS: No significant differences were found in the baseline data between the two groups. Both methods improved functional status and pain postoperatively. For primary outcomes of both groups, statistical difference was observed in WOMAC scores at the 6-month follow-up (P < 0.001). For secondary outcomes, no statistical difference was observed between the groups during the 2-year follow-up (P > 0.05). For TPOASI vs. OWHTO, the mean hospital stay (6.6 ± 1.3 days vs. 7.8 ± 2.1 days) was shorter (P < 0.001), and both blood loss (70.56 ± 35.58 vs. 174.00 ± 66.33 mL) and complication rate (3.7% vs. 12.8%) were significantly lower (P < 0.005 for both). CONCLUSIONS: Both approaches showed satisfactory functional outcomes and alleviated pain. However, TPOASI is a simple, feasible method with few complications, and it could be widely used.

Contra-Thermodynamic Positional Isomerization of Olefins.

A light-driven method for the contra-thermodynamic positional isomerization of olefins is described. In this work, stepwise PCET activation of a more substituted and more thermodynamically stable olefin substrate is mediated by an excited-state oxidant and a Brønsted base to afford an allylic radical that is captured by a Cr(II) cocatalyst to furnish an allylchromium(III) intermediate. In situ protodemetalation of this allylchromium complex by methanol is highly regioselective and affords an isomerized and less thermodynamically stable alkene product. The higher oxidation potential of the less substituted olefin isomer renders it inert to further oxidation by the excited-state oxidant, enabling it to accumulate in solution over the course of the reaction. A broad range of isopropylidene substrates are accommodated, including enol ethers, enamides, styrenes, 1,3-dienes, and tetrasubstituted alkyl olefins. Mechanistic investigations of the protodemetalation step are also presented.

Self-adjusting inverse design method for nanophotonic devices.

Nanophotonic devices, which consist of multiple cell structures of the same size, are easy to manufacture. To avoid the optical proximity effect in the ultraviolet lithography process, the cell structures must be maintained at a distance from one another. In the inverse design process, the distance is maintained by limiting the optimized range of the location. However, this implementation can weaken the performance of the devices designed during transmission. To solve this problem, a self-adjusting inverse design method based on the adjoint variable method is developed. By introducing artificial potential field method, the location of one cell structure is modified only when the distances between this cell structure and other cell structures are smaller than a threshold. In this case, the range of the location can be expanded, and thus the performance of the designed devices can be improved. A wavelength demultiplexer with a channel spacing of 1.6 nm is designed to verify the performance of the proposed method. The experiment reveals that the transmission of the designed devices can be improved by 20%, and the self-adjusting inverse design process is 100 times faster than the inverse-design process based on the genetic algorithm.

Advances in microbial production of feed amino acid.

Feed amino acids have numerous applications, and the market demand for them is likely to grow. Microbial cell factories promise the sustainable production of feed amino acids; however, their performance is significantly affected by the availability of precursors, carbon metabolic flux, and transporter systems. To circumvent these potential roadblocks, high-performance microbial cell factories have been constructed by strengthening the supply of precursors, increasing metabolic pathway flux, and engineering transporters. In this review, limiting factors and recent technical advances affecting the production of feed amino acids in microbial cell factories are discussed. In addition, existing challenges and potential strategies for increasing the output of these amino acids are described.

Cryogenic Scintillation Performance of Cs4PbI6 Perovskite Single Crystals.

All-inorganic Cs4PbI6 single crystals (SCs) is emerging scintillators for radiation detection. In this study, we report on the X-ray scintillation properties of Cs4PbI6 SCs at the temperature range of 50-290 K. The temperature-dependent radioluminescence (RL) spectrum and decay time were investigated. It was found that the RL spectra show very pronounced temperature-dependent changes in the overall shape. The RL intensity increases with a decrease in the temperature under X-ray excitation. The emission bands at 318, 360, and 554 nm are attributed to the near-band-edge emission in Cs4PbI6 SCs, the 3P1 → 1S0 transition of the Pb2+ ion, and the emission of δ-CsPbI3 aggregates dispersed in the Cs4PbI6 SC matrix, respectively. With decreasing temperature, the fast and slow decay times tend to slow down and are estimated to be 46.0 ns (33.22%) and 820 ns (66.78%) at 50 K, which are far superior to that of the common cryogenic scintillator. These cryogenic scintillation characteristics of Cs4PbI6 SCs demonstrate its potential for cryogenic detection.

The Hoffa-like fracture of the tibial plateau: a clinical study.

BACKGROUND: Given the contrapositive link between the posterior tibial plateau and the femoral condyle and the similar injury cause, the fracture type should be the same as the well-known Hoffa fracture of the femoral condyle. This study aims to report a case series with Hoffa-like tibial plateau fractures to improve understanding. METHODS: We analysed six consecutive patients presented with Hoffa-like tibial plateau fractures in our hospital between October 2014 and December 2020, a period in which 1924 tibial plateau fractures were treated. Patients' data on demographics, radiographs, surgical therapy, and assessment at a 12-month follow-up were retrieved. RESULTS: The incidence of Hoffa-like tibial plateau fractures was 0.31% (6/1924). This study included three men and three women, with a mean age of 45.8 years. The injury mechanism was either a fall from a great height or a vehicle accident. On average, 7.5 days after the injury, patients were surgically treated with open reduction and internal fixation (ORIF) with place/screws via a lateral or posteromedial approach. At 10 to 15 weeks, all instances had osseous union on radiography. At 12-month follow-up, the HSS score of the operated knee ranged from 93 to 98 points (mean: 94.8), and Rasmussen radiograph score was from 15 to 18 (mean: 15.8). There were no intra-operative or post-operative problems. CONCLUSION: This Hoffa-like fracture of the tibial plateau is a rare condition; however, it can occur. Orthopaedic surgeons should pay attention to this neglected but actually familiar fracture type.

Incidence of and risk factors for pre-operative deep venous thrombosis in geriatric intertrochanteric fracture patients.

PURPOSE: The purpose of this prospective study was to investigate the pre-operative incidence of and risk factors for deep venous thrombosis (DVT) in geriatric intertrochanteric fractures to help facilitate the peri-operative management of them. MATERIALS AND METHODS: Data of 1515 geriatric intertrochanteric fracture patients were extracted from a prospective intertrochanteric fractures database according to the inclusion criteria and exclusion criteria. The demographics, fracture characteristics, and pre-operative laboratory indicators of patients were evaluated statistically. RESULTS: The incidence of pre-operative DVT was 10.2% (155 in 1360 patients) in the present study. The rates of proximal DVT, distal DVT, and mixed DVT were 18.1% (28 patients), 56.8% (88 patients), and 25.2% (39 patients), respectively. The percentages of DVT developing in the affected limb, uninjured limb, and bilateral limbs were 74.2% (115 in 55 patients), 16.8% (26 in 155 patients), and 9% (14 in 155 patients), respectively. After the multivariable analysis, the time from injury to surgery (TIS) > 4 days [odds ratio (OR) = 1.870, p = 0.001], the number of comorbidities > 2 (OR = 2.124, p = 0.014), and albumin (ALB) < 35 g/L (OR = 1.516, p = 0.043), etc. were significantly associated with the development of preoperative DVT in geriatric intertrochanteric fracture patients. CONCLUSIONS: Although routine anticoagulant therapy was used to prevent the formation of DVT, the incidence of which was still high. Therefore, pre-operative ultrasound of both lower extremities was advised for pre-operatively, especially for patients with delayed surgery, hypoproteinemia, three or more comorbidities, and a D-dimer level > 1.59 mg/L.

Multiplanar fracture reducer versus manual traction in the treatment of tibial shaft fractures with intramedullary nails.

OBJECT: The purpose of this study was to propose a new traction device, a multiplanar fracture reducer (MFR), for the treatment of tibial shaft fractures with intramedullary nails (IMN). The efficiencies of the multiplanar fracture reducer and manual traction (MT) in the treatment of tibial shaft fractures with IMN were compared. METHODS: From January 2019 to January 2020, a total of 79 patients were enrolled in this study, among whom 38 were treated with MFR while 41 were treated with MT. Their demographics and fracture characteristics, surgical data, and prognostic data between the two groups were compared. RESULTS: The mean number of intra-operative fluoroscopies in the MFR group was less than that in the MT group (19.4 vs 21.2, p < 0.001); surgical procedures involving open reduction were more in the MT group than in MFR group (0 vs 5, p = 0.026); there were less assistants in the MFR group than in the MT group (1 vs 1.9, p < 0.001), while the average Lysholm Knee Function Score and knee flexion were 92.7 ± 2.0 and 128.8 ± 1.4 in the MFR group, and 91.9 ± 2.1 and 127.5 ± 1.8 in the MT group, respectively. Both LKFS and knee flexion in the MFR group were significantly better than those in the MT group (p = 0.032 and p < 0.001). The remaining data between the two groups were comparable. CONCLUSION: MFR is a safe and effective device for the minimal invasive treatment of tibial shaft fractures fixed with IMN.

Biomechanical study on the stability and strain conduction of intertrochanteric fracture fixed with proximal femoral nail antirotation versus triangular supporting intramedullary nail.

OBJECTIVES: Based on the features of the three-dimensional spatial structure of the proximal femoral trabeculae, we developed a bionic triangular supporting intramedullary nail (TSIN) for the treatment of the femoral intertrochanteric fracture. The current study aimed to compare the mechanical stability and restoration of mechanical conduction between proximal femoral nail antirotation (PFNA) and TSIN to fix the intertrochanteric fractures. METHODS: Firstly, five sets of PFNA and TSIN with the same size were selected and fixed on a biomechanical testing machine, and strain gauges were pasted on the main nail, lag screw, and supporting screw to load to the vertical load to 600 N, and the displacement and strain values were recorded. Secondly, formalin-preserved femurs were selected, and the left and right femurs of the same cadaver were randomly divided into two groups to prepare intertrochanteric femur fractures (AO classification 31-A1), which were fixed with PFNA (n = 15) and TSIN (n = 15), respectively. Sixteen sites around the fracture line were chosen to paste strain gauges and loaded vertically to 600 N, and then, the fracture fragment displacement and strain values were recorded. Finally, a 10,000-cycle test ranging from 10 to 600 N was conducted, and the cycle number and displacement value were recorded. RESULTS: The overall displacement of PFNA was 2.17 ± 0.18 mm, which was significantly greater than the displacement of the TSIN group (1.66 ± 0.05 mm, P < 0.05) under a vertical load of 600 N. The strain below the PFNA lag screw was 868.29 ± 147.85, which was significantly greater than that of the TSIN (456.02 ± 35.06, P < 0.05); the strain value at the medial side of the PFNA nail was 444.00 ± 34.23, which was significantly less than that of the TSIN (613.57 ± 108.00, P < 0.05). Under the vertical load of 600 N, the displacement of the fracture fragments of the PFNA group was 0.95 ± 0.25 mm, which was significantly greater than that of the TSIN group (0.41 ± 0.09 mm, P < 0.05). The femoral specimens in the PFNA group showed significantly greater strains at the anterior (1, 2, and 4), lateral (7, 9, and 10), posterior (11), and medial (15 and 16) sites than those in the TSIN group (all P < 0.05). In the cyclic compression experiment, the displacements of the PFNA group at 2000, 4000, 6000, 8000, and 10,000 cycles were 1.38 mm, 1.81 mm, 2.07 mm, 2.64 mm, and 3.58 mm, respectively, which were greater than the corresponding displacements of the TSIN group: 1.01 mm, 1.48 mm, 1.82 mm, 2.05 mm, and 2.66 mm (P8000 = 0.012, P10000 = 0.006). CONCLUSIONS: The current study showed that TSIN had apparent advantages in stability and stress conduction. TSIN enhanced the stability of intertrochanteric fractures, particularly in superior fracture fragments, improved stress conduction, reduced the stress in the anterior and medial femur, and restored the biomechanical properties of the femur.

CT-Based Classification Systems for Intra-Articular Calcaneal Fractures: The Inter- and Intraobserver Variations as well as Integrality.

The aim of this study was to measure the inter- and intraobserver variations as well as integrality of the Zwipp, Crosby-Fitzgibbons, Sanders, and Eastwood-Atkins classification systems based on more accurate CT scans. Five hundred and forty-nine patients with intra-articular calcaneal fractures from January 2018 to December 2019 taken from a database in our level-I trauma center (3 affiliated hospitals) were included. For each case, normative CT (1 mm slices) scans were available. Four different observers reviewed all CT scans 2 times according to these 4 most prevalent fracture classification systems (FCSs) within a 2-month interval. For these 4 FCSs, the kappa [κ] coefficient was used to evaluate interobserver reliability and intraobserver reproducibility, and the percentage that can be classified was used to indicate integrality. The κ values were measured for Zwipp (κ = 0.38 interobserver, κ = 0.61 intraobserver), Crosby-Fitzgibbons (κ = 0.48 interobserver, κ = 0.79 intraobserver), Sanders (κ = 0.40 interobserver, κ = 0.57 intraobserver), and Eastwood-Atkins (κ = 0.44 interobserver, κ = 0.72 intraobserver). Furthermore, the integralities were calculated for Zwipp (100%), Crosby-Fitzgibbons (100%), Sanders (92%) as well as Eastwood-Atkins (89.6%). Compared with previous literatures, CT scanning with higher accuracy can significantly improve intraobserver reproducibility of Zwipp and Eastwood-Atkins FCSs, but it has no positive effect on variability of Sanders FCS and interobserver reliability of Crosby-Fitzgibbons FCS. In terms of integrality, Zwipp and Crosby-Fitzgibbons FCSs appear to be superior to the other 2 FCSs.

Relationship between surgeon volume and the risk of deep surgical site infection (DSSI) following open reduction and internal fixation of displaced intra-articular calcaneal fracture.

It is well established that the postoperative results were affected by the surgeon volume in a variety of elective and emergent orthopaedic surgeries; however, by far, no evidences have been available as for surgically treated displaced intra-articular calcaneal fractures (DIACFs). We aimed at investigating the relationship between surgeon volume and deep surgical site infection (DSSI) following open reduction and internal fixation (ORIF) of DIACFs. This was a further analysis of prospectively collected data from a validated database. Patients with DIACFs stabilised by ORIF between 2016 and 2019 were identified. Surgeon volume was defined as the number of surgically treated calcaneal fractures within one calendar year and was dichotomised based on the optimal cut-off value. The outcome measure was DSSI within 1 year postoperatively. Multivariate logistics regression analyses were performed to examine the relationship, adjusting for confounders. Among 883 patients, 19 (2.2%) were found to have a DSSI. The DSSI incidence was 6.5% in surgeons with a low volume (<6/year), 5.5 times as that in those with a high volume (≥6/year) (incidence rate, 1.2%; P < 0.001). The multivariate analyses showed a low volume <6/year was associated with a 5.8-fold increased risk of DSSI (95% confidence interval, 2.2-16.5, P < 0.001). This value slightly increased after multiple sensitivity analyses, with statistical significances still unchanged (OR range, 6.6-6.9; P ≤ 0.001). The inverse relationship indicates a need for at least six cases/year for a surgeon to substantially reduce the DSSIs following the ORIF of DIACFs.

Establishment of a typing model for diffuse large B-cell lymphoma based on B-cell receptor repertoire sequencing.

BACKGROUND: The purpose of this study was to construct a new typing model for diffuse large B-cell lymphoma (DLBCL) patients based on the B-cell receptor (BCR) and explore its potential molecular mechanism. METHODS: BCR repertoire sequencing and whole-exome sequencing were performed on formalin-fixed paraffin-embedded samples from 12 DLBCL patients. Subsequently, a typing model was built with cluster analysis, and prognostic indicators between the two groups were compared to verify the typing model. Then, mutation and bioinformatics analyses were conducted to investigate the potential biomarkers of prognostic differences between the two groups. RESULTS: Based on BCR sequencing data, we divided patients into two clusters (cluster 1 and cluster 2); this classification differed from the traditional typing method (GCB and non-GCB), in which cluster 1 included some non-GCB patients. The progression-free survival (PFS), overall survival (OS), metastasis and Shannon diversity index of IGH V-J and survival after chemotherapy were significantly different (P < 0.05) between the two clusters, but no statistical significance was found between the GCB and non-GCB groups. The mutation status of 248 genes was significantly different between cluster 1 and cluster 2. Among them, FTSJ3, MAGED2, and ODF3L2 were the specific mutated genes in all patients in cluster 2, and these genes could be considered critical to the different prognoses of the two clusters of DLBCL patients. CONCLUSION: We constructed a new typing model of DLBCL based on BCR repertoire sequencing that can better predict the survival time after chemotherapy. FTSJ3, MAGED2, and ODF3L2 may represent key genes for the difference in prognosis between the two clusters.

High-level production of d-pantothenic acid from glucose by fed-batch cultivation of Escherichia coli.

d-Pantothenic acid (D-PA) is an essential vitamin widely used in food, feed, chemical, and pharmaceutical industries. An Escherichia coli platform was developed for the high-level production of D-PA from glucose through fed-batch cultivation. Initially, the effects of different glucose feeding strategies D-PA synthesis were studied. It was found that D-PA production in glucose control (5 g/L) fed-batch culture reached 24.3 g/L, which was 4.09 times that in the batch culture. Next, the effect of auxotrophic amino acid (isoleucine)-limited feeding on D-PA production was investigated. The results revealed that isoleucine feeding decreased the accumulation of by-product acetic acid and promoted D-PA production significantly. Furthermore, an isoleucine feeding embedded multistage glucose supply strategy was established, and a maximum titer of 39.1 g/L was achieved. To the best of our knowledge, this levels are the highest reported so far in engineered E. coli for the D-PA production. The developed fed-batch feeding strategy may be useful for the industrial D-PA production by E. coli.

Incidence and predictors of surgical site infection after distal femur fractures treated by open reduction and internal fixation: a prospective single-center study.

BACKGROUND: There remain limited data on the epidemiological characteristics and related predictors of surgical site infection (SSI) after open reduction and internal fixation (ORIF) for distal femur fractures (DFFs). We designed this single-centre prospective study to explore and forecast these clinical problems. METHODS: From October 2014 to December 2018, 364 patients with DFFs were treated with ORIF and followed for complete data within one year. Receiver operating characteristic (ROC) analyses, univariate Chi-square analyses, and multiple logistic regression analyses were used to screen the adjusted predictors of SSI. RESULTS: The incidence of SSI was 6.0 % (22/364): 2.4 % (9/364) for superficial SSIs and 3.6 % (13/364) for deep SSIs. Staphylococcus aureus (methicillin-resistant S. aureus in 2 cases) was the most common pathogenic bacteria (36.8 %,7/19). In multivariate analysis, parameters independently associated with SSI were: Open fracture (OR: 7.3, p = 0.003), drain use (OR: 4.1, p = 0.037), and incision cleanliness (OR: 3.5, p = 0.002). An albumin/globulin (A/G) level ≥ 1.35 (OR: 0.2, p = 0.042) was an adjusted protective factor for SSI. CONCLUSIONS: The SSI after ORIF affected approximately one in 15 patients with DFFs. The open fracture, drain use, high grade of intraoperative incision cleanliness, and preoperative A/G levels lower than 1.35 were significantly related to increasing the risk of post-operative SSI after DFFs. We recommended that more attentions should be paid to these risk factors during hospitalization. TRIAL REGISTRATION: NO 2014-015-1, October /15/2014, prospectively registered. We registered our trial prospectively in October 15, 2014 before the first participant was enrolled. This study protocol was conducted according to the Declaration of Helsinki and approved by the Institutional Review Board. The ethics committee approved the Surgical Site Infection in Orthopaedic Surgery (NO 2014-015-1). Data used in this study were obtained from the patients who underwent orthopaedic surgeries between October 2014 to December 2018.

Post-operative deep vein thrombosis in patients over sixty years of age diagnosed with closed distal femur fractures undergoing open reduction internal fixation.

BACKGROUND AND PURPOSE: New-onset deep vein thrombosis (DVT) reportedly affects prognosis and surgical outcomes of elderly patients. However, its effect on distal femur fractures (DFFs) remains unclear. We aimed to address the epidemiological characteristics and the associated predictors for post-operative DVT in patients with closed DFFs over age 60 years old. PATIENTS AND METHODS: We designed a prospective cohort trial at our hospital between October 2018 and June 2020 and recruited consecutive 140 patients over age 60 years diagnosed with closed DFFs. We examined location and prognosis of postoperative DVT and then conducted a three month follow-up. We used Duplex ultrasonography (DUS) to diagnose DVT in all patients and then classified the subjects into DVT and non-DVT groups. We further classified DVTs into proximal, distal, and mixed thromboses and then performed Whitney U test or t test, receiver operating characteristic (ROC) curve analysis, Chi-square test, and multiple logistic regression analysis to confirm the adjusted factors of post-operative DVT. RESULTS: We found a 35% (n = 49) overall incidence of post-operative DVTs, which occurred 5.7 days following open reduction internal fixation (ORIF). Among patients with post-operative DVTs, 53.1% (n = 26) and 10.2% (n = 5) were distal and proximal thromboses, respectively. Additionally, peroneal veins were the most common DVT sites (71.4%, n = 35). Multivariate analysis revealed that venous thrombosis at admission (odds ratio [OR], 4.619; 95% confidence interval [CI]: 2.072-10.299; P = 0.000), operation duration over 195 minutes (OR, 3.289; 95% CI, 1.155-9.370; P = 0.026), intra-operative blood loss over 325 mL (OR, 2.538; 95% CI, 1.047-6.155; P = 0.039) were the three independent risk factors of post-operative DVT. Unified antithrombotic agents after diagnosis showed that 16.3% (n = 8) of DVTs were completely recanalized, 12.6 days after first diagnosis. CONCLUSION: Our findings indicate a strong association between venous thrombosis at admission, the longer operation duration, and considerable intra-operative blood loss with high risk of post-operative DVTs in patients over age 60 years with closed DFFs. Preventive approaches for postoperative DVTs should seek to shorten operation duration and reduce intra-operative blood loss.

Traction methods in the retrograde intramedullary nailing of femur shaft fractures: the double reverse traction repositor or manual traction.

OBJECTIVE: The purpose of this prospective study was to compare the double reverse traction repositor (DRTR) and manual traction in retrograde intramedullary nailing (RE-IMN) for femoral shaft fractures. PATIENTS AND METHODS: Seventy-seven patients with femur shaft fractures were randomized to undergo surgery with either DRTR or manual traction (MT) to facilitate RE-IMN between January 2018 and January 2019. Demographics, fracture characteristics, surgical data, post-operative complications, and functional outcomes were assessed. Data from 72 patients completing the final follow-up (12 months) were analysed in this study. RESULTS: The average number of intra-operative perspectives in the DRTR group was 27.7, which was significantly reduced compared with that in the MT group (31.3, p < 0.001). Fewer assistants were required in the DRTR group compared with the MT group (1.1 vs 1.9, p < 0.001). Fewer patients with open reduction were discovered in the DRTR group compared with the MT group (2.8 vs 19.4, p=0.024). Demographics, fracture characteristics, other surgical data, and prognostic parameters were comparative between the two groups. CONCLUSIONS: The DRTR can be effectively and safely used to treat femur shaft fractures with RE-IMN. The DRTR achieves similar results as MT and is also superior to MT in terms of intra-operative perspectives, the number of assistants, and the open reduction rate.

Changes in patellar height and posterior tibial slope angle following uniplanar medial opening wedge high tibial osteotomy using a novel wedge-shaped spacer implanation concurrent with proximal partial fibulectomy.

PURPOSE: The purpose of this study was to evaluate changes of patellar height and posterior tibial slope angle following uniplanar medial opening wedge high tibial osteotomy using a novel wedge-shaped spacer implanation concurrent with proximal partial fibulectomy. METHODS: All patients who underwent uniplanar medial opening wedge high tibial osteotomy using a novel wedge-shaped spacer implanation concurrent with proximal partial fibulectomy between January 2017 and February 2019 were included and assessed retrospectively. Radiological assessment was made in terms of the changes in patellar height and posterior tibial slope angle between pre-operative and post-operative radiographs. RESULTS: Thirty-five patients (9 males and 26 females) with a mean age of 57.3 years (range 50.8-64.2 years) were enrolled in this study protocol and demonstrated decreased posterior tibial slope angle post-operatively (9.7° ± 2.5° pre-operatively and 7.3° ± 1.8° post-operatively, P < 0.001). Patellar height was unchanged significantly post-operatively (Caton-Deschamps: 0.83 ± 0.12 pre-operatively and 0.82 ± 0.09 post-operatively, P > 0.05). CONCLUSIONS: Uniplanar medial opening wedge high tibial osteotomy using a novel wedge-shaped spacer implanation concurrent with proximal partial fibulectomy can decrease posterior tibial slope and maintain the patellar height.