Pathoanatomy and Injury Mechanism of Typical Maisonneuve Fracture.

OBJECTIVE: Maisonneuve fracture is a special type of injury which are rare in clinic. The manifestation of such fractures is variable. The aim of this study is to describe the pathoanatomical features of typical Maisonneuve fracture on the basis of radiographs, computed tomography (CT) scans, magnetic resonance imaging (MRI), and intraoperative exploration findings, and to investigate the injury mechanism of this variety. METHODS: The data of 41 patients with Maisonneuve fracture from April 2014 to September 2019 were retrospectively analyzed. There were 32 males and nine females, the average age was 37.9 years (range, 18 to 61 years), the fractures occurred on the left side in 20 patients and on the right side in 21 patients. The cause of injuries were traffic accident in five patients, sprain injury in 20 patients, and falling injury from height in 16 patients. All patients underwent posteroanterior and lateral X-ray examinations of the ankle and calf. CT scan of the ankle was performed in 38 patients, including three-dimensional reconstruction in 33 patients. MRI examination of the ankle and calf was performed in 28 and five patients, respectively. Forty patients were treated with open reduction and internal fixation. The features of proximal fibular fracture, injuries of the medial and posterior structures of the ankle, injuries of the anterior inferior tibiofibular ligament and the interosseous membrane were recorded and analyzed. RESULTS: Forty-one patients had proximal one-third fractures of the fibula including six patients with fracture involving the fibular neck, 30 with proximal one-third fractures of the fibular shaft, and five with proximal-medial one-third junction fracture of the fibular shaft. Thirty-five patients (35/41, 85.37%) with injury of posterior structures, 34 patients had posterior malleolar fracture (34/41, 82.93%), and one patient had posterior inferior tibiofibular ligament rupture (1/41, 2.44%). There were 20 patients with type I fracture, four patients with type II fracture, and 10 patients with type III fracture according to the Haraguchi classification of posterior malleolus fracture. The fracture of the medial malleolus was in 30 patients (30/41, 73.17%), rupture of the deltoid ligament was in 10 patients (10/41, 24.39%), and medial structures intact were in one patient (1/41, 2.44%). All 41 patients had injury of the anterior inferior tibiofibular ligament. CONCLUSIONS: Maisonneuve fracture is characterized by fractures of the proximal fibula and the complete rupture of the anterior inferior tibiofibular ligament. Pronation-external rotation is the main injury mechanism. The manifestations of typical Maisonneuve fracture including that the fibular fracture located in proximal one-third diaphysis and the fracture line was from anterosuperior to posteroinferior.

Long non-coding RNA ZFAS1 sponges miR-486 to promote osteosarcoma cells progression and metastasis in vitro and vivo.

Long noncoding RNAs (lncRNAs) have been wildly demonstrated to participate in the osteosarcoma tumorigenesis. ZFAS1 is a novel identified lncRNA, however, its role in osteosarcoma is still unclear. In present study, we utilize lncRNA microarray assay to screen the lncRNA expression profile in osteosarcoma tissue, and investigate the regulatory function of ZFAS1 in osteosarcoma. LncRNA microarray assay revealed that lncRNA ZFAS1 was significantly up-regulated in 3 pairs of osteosarcoma and adjacent non-tumor tissue, which was confirmed by RT-PCR. Furthermore, in 53 pairs of osteosarcoma patient samples, the up-regulated expression of ZFAS1 was closely related to poor prognosis. In vitro, loss-of-function experiments showed that ZFAS1 knockdown significantly suppressed the proliferation, induced cycle arrest at G0/G1 phase and enhance apoptosis. In vivo, ZFAS1 knockdown inhibited the tumor growth. Bioinformatics online programs predicted that ZFAS1 sponge miR-486 at 3'-UTR with complementary binding sites, which was validated using luciferase reporter assay and RNA immunoprecipitation (RIP) assay. Rescue experiments confirmed that miR-486 could reverse the functions of ZFAS1 on osteosarcoma genesis. In conclusion, our results demonstrate that ZFAS1 act as competing endogenous RNA (ceRNA) for miR-486, and act as oncogene in osteosarcoma tumorigenesis, and discover the functional regulatory pathway of ZFAS1 sponging miR-486.

Three-dimensional Computer-assisted Modeling of Talus Morphology in Chinese Patients.

OBJECTIVE: To provide more accurate reference data for the assessment and treatment of talar injuries by constructing 3-D computer-assisted models of the talus and comparing them with reference data obtained from measurements on cadaver specimens. METHODS: Three-dimensional talus models were constructed from CT data recorded for healthy Chinese volunteers using SuperImage Orthopedics software. Structural variables such as length, width, height and volume of talus were compared using the Fisher least significant difference test to determine the significance of bilateral or sex-specific differences in the study cohort. RESULTS: Measurement data were normally distributed. No significant difference between the left and right talus in either men or women was identified for any measurement (P > 0.05). The bilateral mean volume of the talus in men (37.87 ± 6.69 mm) was significantly larger than that in women (26.95 ± 5.73 mm; P < 0.05). Although the dimensions of most of the structural features and articular surfaces of the talus were significantly larger in men than in women (P < 0.05), no significant differences in the angles of the talar neck and head were observed between men and women in our cohort (P > 0.05). CONCLUSION: Our method of 3-D model construction provided precise measurements of the structural features of the talus. The talar dimensions in our Chinese study cohort differ from those previously reported for people of different ethnic groups. Our models should provide accurate reference data for constructing models based on CT images for the assessment and treatment of talar injuries in Chinese patients.

[Extorsion traction and pushing manipulation with fingers for the treatment of anterior shoulder dislocation in elderly].

OBJECTIVE: To investigate a manipulating therapy for treatment of anterior shoulder dislocation in elderly. METHODS: From October 2011 to June 2012,27 elderly patients with anterior shoulder dislocation were treated by extorsion traction and pushing manipulation with fingers, including 7 males and 20 females aged from 65 to 86 years old with an average of 77. The course of disease ranged from 1 h to 1 d. The shoulder manifested square deformity, Dugus signs showed positive, and X-ray displayed anterior shoulder dislocation. Dugus fixation was applied for and removed external fixation at 3 weeks after operation and carried out shoulder functional exercise. Functional evaluation standard on shoulder joint injuries was used for evaluate clinical outcomes. RESULTS: All patients were gained reduction for the first time, and followed up at 3 months after operation, no dislocation occurred. According to functional evaluation standard on shoulder joint injuries, 22 cases got an excellent result,2 cases good,and 1 case moderate. CONCLUSION: Extorsion traction and pushing manipulating therapy for treatment of anterior shoulder dislocation in elderly, which has advantages of simple, convenient, less painful, and can avoid iatrogenic injury, is feasible to widespread.

Overexpression of suppressors of cytokine signaling 1 promotes the neuronal differentiation of C17.2 neural stem cells.

OBJECTIVE: To investigate the role and mechanism of suppressor of cytokine signaling 1 (SOCS1) in the regulation and differentiation of C17.2 neural stem cells (NSCs). METHODS: In this study, lentiviral (LV)-SOCS1-enhanced green fluorescent protein (EGFP) was constructed and transfected into C17.2 NSCs. There were three groups of C17.2 NSCs: LV-SOCS1-EGFP, LV-EGFP, and phosphate-buffered saline (PBS). The expression levels of microtubule-associated protein 2 (MAP2), glial fibrillary acidic protein (GFAP), myelin basic protein (MBP), nestin, and ß-tubulin III in C17.2 NSCs were analyzed by reverse transcription-polymerase chain reaction (RT-PCR), immunocytochemistry, and western blot. In addition, the phosphorylation level of Jaks/Stats family members in C17.2 NSCs were analyzed by western blot. Moreover, the morphological changes of C17.2 NSCs after transfection were observed by light microscopy. RESULTS: The gene expression of MAP2 increased significantly and the gene expression of nestin decreased significantly in C17.2 NSCs transfected with LV-SOCS1-EGFP. Some C17.2 NSCs underwent prominent neuronal morphological changes and expressed ß-tubulin III after LV-SOCS1-EGFP transfection. The number of positive cells for ß-tubulin III immunocytochemical staining and ß-tubulin III protein expression in C17.2 NSCs after LV-SOCS1-EGFP transfection were both more than those after LV-EGFP transfection or PBS treatment. The phosphorylation levels of Jak2 and Stat3 but not Jak3 in C17.2 NSCs were inhibited by SOCS1 overexpression. CONCLUSION: Overexpression of SOCS1 in C17.2 NSCs promotes the generation of neurons, which is likely mediated by the negative feedback inhibition of Jak2 and Stat3. This study is the first to provide evidence that SOCS1 is involved in the regulation of neurogenesis.

[Treatment of anterior cruciate ligament injury with peroneus longus tendon].

OBJECTIVE: To evaluate the effects of anterior cruciate ligament reconstruction with peroneus longus tendon and observe the clinical outcomes of ankle joint after the resection of peroneus longus tendon. METHODS: From January 2006 to December 2009, 35 patients with anterior cruciate ligament injuries were recruited to undergo surgical procedures. There were 30 males and 5 females with an average age of 31.8 years (range: 21 - 56). All anterior cruciate ligament reconstructions underwent arthroscopy. All ligaments were reconstructed with peroneus longus tendon and fixed with absorb screw. The post-operative assessments included the followings:clinical evaluations, Lysholm knee score, KT-3000 arthrometer evaluation and the American Orthopedic Foot and Ankle Society ankle-hindfoot scale AOFAS). RESULTS: All cases were followed up for an average follow-up period of 15 months (range: 12 - 24). The healing time was 6 - 15 weeks.according to the Lysholm knee score, their outcomes were excellent (n = 25), good (n = 6), fair (n = 3) and poor (n = 1). The average score was 97.2 (range: 60 - 100). The rate of excellent and good was 88.6%; according to the KT-3000 arthrometer evaluations, the outcomes were normal (n = 28), nearly normal (n = 4), abnormal (n = 2) and poor (n = 1). Preoperatively, the average anterior displacement was 11.59 ± 1.25 mm and the average anterior displacement at final follow-up 1.76 ± 1.83 mm. The average AOFAS score was 96.3 (range: 84 - 100). Lysholm knee score and KT-3000 arthrometer evaluation had statistical differences (P < 0.05) while AOFAS score showed no difference (P > 0.05). CONCLUSION: Peroneus longus tendon can be a good substitute of anterior cruciate ligament reconstruction. And its resection has no major influence for ankle joint.

[Operative treatment of displaced intra-calcaneal fractures].

OBJECTIVE: To explore the clinical efficacies of displaced intra-calcaneal fractures with operative treatment. METHODS: From January 2005 to December 2010, 103 calcaneal patients (92 males, 11 females) were recruited. The mean age was 45.8 years old (range: 23 - 65). All received operative treatment. They included left calcaneal fractures (n = 51), right calcaneal fractures (n = 40) and bilateral calcaneal fractures (n = 12). All patients were of closed fractures. According to the Sanders classification, there were type II (n = 15), type III (n = 75) and type IV (n = 13). A modified lateral approach with profiled plate fixation was adopted for all. Partial weight-bearing occurred at 6 weeks and full weight-bearing at 12 weeks. Function assessment was made with the American Orthopedic Foot and Ankle Society ankle-hindfoot scale (AOFAS). RESULTS: The mean follow-up period was 18 months (range: 6 - 30) and the mean healing duration 12 weeks (range: 8 - 15). Two cases had incision dehiscence. After the removal of plate, the skin healed. Eight cases were associated with subtalus arthritis and painful walking. Three cases of caved calcaneal surface appeared after weight-bearing. According to the AOFAS foot score, the outcomes were excellent (n = 83), good (n = 13), fair (n = 5) and poor (n = 2). And the excellent and good rate was 93.2%. CONCLUSION: With a modified lateral approach, displaced intra-calcaneal fracture may be treated with a satisfactory clinical efficacy.But an orthopedic surgeon should master skillful surgical techniques.

[Therapeutic efficacies of bone grafing for calcaneal intra-calcaneal fractures].

OBJECTIVE: To evaluate the efficacies of treating intra-calcaneal fractures with bone grafting. METHODS: From January 2005 to October 2011, a total of 182 calcaneal patients underwent operations for closed fractures. There were 159 males and 23 females with an average age of 41.2 years old. The fractures were of the following types: left calcaneal (n = 68), right calcaneal (n = 86) and bilateral (n = 28). According to the Sander's classification, there were type II (n = 27), type III (n = 109) and type IV (n = 46). And they were divided into bone graft (n = 94) and non-bone graft (n = 88) groups. All of them underwent a profiled plate fixation via a lateral approach. No external fixation was necessary and early ankle functional exercises started postoperatively. They handled partial weight-bearing at Week 6 and full weight-bearing at Week 12. Their outcomes were assessed by the American Orthopedic Foot and Ankle Society ankle-hindfoot scale (AOFAS) while classification comparison affected the prognosis (P < 0.05). RESULTS: The follow-ups of 10 patients were lost at Month 3. And 172 cases were followed up for an average period of 14.2 months (range: 9 - 16). The average healing duration was 12 weeks (range: 6 - 15). None of follow-up cases had any complication, such as vascular and nerve injury and osteomyelitis. Twenty-nine cases in the non-bone graft group had articular cave-in after weight bearing. And 21 cases were associated with subtalar arthritis. And in the bone graft group, there was no articular cave-in and only 1 case was associated with subtalar arthritis. The outcomes of bone graft and non-graft groups were as follows: excellent (n = 68), good (n = 20), fair (n = 5) and poor (n = 1) vs. excellent (n = 44), good (n = 26), fair (n = 7) and poor (n = 9). The rate of excellent and good was 87.9%. And the post-operative AOFAS scores had statistical differences between 2 groups (P < 0.05). CONCLUSION: Bone grafting is important for improving the therapeutic efficacies for intra-calcaneal fractures.