[Research progress on mechanism of traumatic brain injury promoting fracture healing].

Objective: To summarize the research progress on the mechanism related to traumatic brain injury (TBI) to promote fracture healing, and to provide theoretical basis for clinical treatment of fracture non-union. Methods: The research literature on TBI to promote fracture healing at home and abroad was reviewed, the role of TBI in fracture healing was summarized from three aspects of nerves, body fluids, and immunity, to explore new ideas for the treatment of fracture non-union. Results: Numerous studies have shown that fracture healing is faster in patients with fracture combined with TBI than in patients with simple fracture. It is found that the expression of various cytokines and hormones in the body fluids of patients with fracture and TBI is significantly higher than that of patients with simple fracture, and the neurofactors released by the nervous system reaches the fracture site through the damaged blood-brain barrier, and the chemotaxis and aggregation of inflammatory cells and inflammatory factors at the fracture end of patients with combined TBI also differs significantly from those of patients with simple fracture. A complex network of humoral, neural, and immunomodulatory networks together promote regeneration of blood vessels at the fracture site, osteoblasts differentiation, and inhibition of osteoclasts activity. Conclusion: TBI promotes fracture healing through a complex network of neural, humoral, and immunomodulatory, and can treat fracture non-union by intervening in the perifracture microenvironment.

Intraoperative electrical stimulation promotes the short-term recovery of patients with cubital tunnel syndrome after surgery.

BACKGROUND: This study was designed to investigate whether intraoperative electrical nerve stimulation has effects on the short-term recovery of cubital tunnel syndrome patients after ulnar nerve release. METHODS: Patients diagnosed as cubital tunnel syndrome were selected. At the same time, they received conventional surgery treatment. The patients were divided by a randomized digits table into two groups. The control group underwent conventional surgery, and the electrical stimulation (ES) group underwent intraoperative electrical stimulation. All the patients were tested for sensory and motor functions, grip strength, key pinch strength, motor conductivity velocity (MCV), and maximum compound muscle action potential (CMAP) before operation and 1 month and 6 months after operation. RESULTS: In patients treated with intraoperative ES, the sensory and motor functions and the strength of muscle were significantly improved after 1-month and 6-month follow-up than the control group. After the follow-up, the patients in the ES group had significantly higher grip strength and key pinch strength than the control group. After the follow-up, the patients in the ES group had significantly higher MCV and CMAP than the control group. CONCLUSION: Intraoperative electrical stimulation of nerve muscle can significantly promote the short-term recovery of nerve and muscle functions after the surgery in cubital tunnel syndrome patients.

Effects of combined enzymatic hydrolysis and fed-batch operation on efficient improvement of ferulic acid and p-coumaric acid production from pretreated corn straws.

In the present work, the effects of combined enzymatic hydrolysis by cellulase and xylanase (CXEH), fed-batch enzymatic hydrolysis (FBEH) operation and kinetics on production of ferulic acid (FA) and p-coumaric acid (pCA) from pretreated corn straws were investigated. The results showed that CXEH could efficiently increase production of FA and pCA. When performed the FBEH operation by feeding 150 mL enzymatic hydrolysis solution (1.5 % enzyme concentration, 5:4 (v/v) ratio of cellulase to xylanase and 2.0 % substrate loading) to 250 mL batch enzymatic hydrolysis solution at 36 h, the maximum production (2178.58 and 2710.17 mg/L) and production rate (590.95 and 727.89 mg/L.h) of FA and pCA were respectively obtained. Moreover, the disruption of fiber tissues, enhancement of crystallinity and accelerated degradation of hemicelluloses and lignocelluloses caused by CXEH contributed to effectively improving production of FA and pCA in corn straws.

Investigations on the thermoelectric and thermodynamic properties of Y2CT2 (T = O, F, OH).

Using the first-principle calculations combined with the Boltzmann transport theory, we studied the thermoelectric properties of Y2CT2 (T = O, F, OH) MXenes. Specifically, the Seebeck coefficient, thermal and electrical conductivities under constant relaxation time approximation were calculated. Results show that for p-type carriers, Y2CO2 has the largest power factor of up to 0.0017 W m-1 K-2 when the carrier concentration is 4.067 × 1013 cm-2 at 900 K, at the same temperature, for n-type carriers, the concentration is 9.376 × 1013 cm-2, the power factor in Y2C(OH)2 is 0.0026 W m-1 K-2. In particular, the figure of merit in Y2CF2 is 1.38 at 900 K because of its low thermal conductivity, indicating that it can be considered a potential medium-temperature thermoelectric material. In addition, the thermodynamics properties within 32 GPa and 900 K, such as bulk modulus, heat capacity and thermal expansion, are also estimated using the quasi-harmonic Debye model. Our results may offer some valuable hints for the potential application of Y2CT2 (T = O, F, OH) in the thermoelectric field.

Ulnar Groove Plasty Guided by a 3D Printing Technique for Moderate to Severe Cubital Tunnel Syndrome Caused by Elbow Osteoarthritis.

BACKGROUND The purpose of this study was to explore the feasibility of ulnar groove plasty guided by a three-dimensional (3D) printing technique for treatment of moderate to severe cubital tunnel syndrome (CuTS) caused by elbow osteoarthritis. MATERIAL AND METHODS Patients with moderate to severe CuTS secondary to osteoarthritis of the elbow were enrolled in our hospital from April 2015 to March 2018. Based on a previously proposed "elbow canal index", a 1: 1 model of the elbow joint was printed using CT image data collected preoperatively. After computer-aided measurement, the standard for enlargement of the ulnar nerve groove was calculated and a personalized "trial model" was created by 3D reconstruction. After intraoperative exposure of the ulnar nerve sulcus, the proliferative osteoid was burred with a grinding drill, and the cubital enlargement was verified by the trial model. The ulnar nerve was decompressed and reincorporated into the enlarged cubital canal, and the Osborne ligament was zig-zag elongated and reconstructed. RESULTS None of the patients reported experiencing medial elbow instability, medial elbow pain, ulnar nerve subluxation, flexor-pronator weakness, or incision infection. There was significant improvement of the motor nerve conduction velocity, sensory nerve conduction velocity, two-point discrimination of the little finger, grip strength, pinch strength of the thumb and index finger, VAS score, and DASH score in this study (P<0.001). CONCLUSIONS Ulnar groove plasty guided by a 3D printing technique may be another effective treatment of moderate to severe CuTS caused by elbow osteoarthritis.

Femoral-tibial contact stresses on fixed rotational femur models.

Objectives: This study aims to quantitatively evaluate the femoral-tibial contact pressure on the knee under certain malrotaional degrees. Methods: Femoral-tibial contact pressure was carried out on 14 fixed rotational knee models under 200/400/600 N vertical load using ultra-low-pressure sensitive film technology, rotation angles including neutral position (0°, anatomically reduced), 5°, 10°, and 15° internally and externally. Data were collected and analyzed with SPSS software. Results: There are significant statistical differences between the medial contact pressure among rotational deformities (including neutral position) (P < 0.01), the increase in the degree of fixed internal malrotation of the femur resulted in a linear increase in the medial femoral-tibial contact pressures (P < 0.05) under 200/400/600 N vertical load, while increase in the degree of fixed external malrotation resulted in a linear decrease (P < 0.05). Except the 200 N compression, we can't find significant differences in lateral contact pressures (P > 0.05). In the comparison of medial to lateral contact pressures, no statistically significant differences were found in neutral and 5° internal rotation under 200/400 N, neutral, 5° internal rotation, and 15° external rotation under 600 N. In contrast, medial contact pressures were higher than lateral at other angles (P < 0.05). Conclusion: Obvious contact pressure changes were observed in rotatory femur. Doctors should detect rotational deformity as much as possible during operation and perform anatomical reduction. For patients with residual rotational deformities, indication of osteotomy should not be too broad.

A primary Ewing's sarcoma of pleura: Case report and literature review.

Ewing's sarcoma was first reported by J.Ewing in 1921, which is generally originated from soft tissue of the trunk or limbs. Primary Extraskeletal Ewing sarcoma (EES) of pleura is an uncommon condition, which is challenging to diagnose, and rarely reported. Herein, we present a previously 14-year-old male patient with fever and dyspnea for 1 month presented to the department of respiratory medicine in Binzhou Medical University Hospital. Radiology revealed a soft mass with massive pleural effusion in the right side of pleural cavity. After admission, we performed the transthoracic catheter drainage for the patient, followed by thoracoscopy and biopsy. Histopathology revealed a small round cell malignant tumor, combined with immunohistochemistry assay and the Fluorescence in-situ hybridization (FISH) detection of EWSR1 gene arrangement, Ewing's sarcoma was finally diagnosed. Despite receiving chemo- and radiotherapy, the patient died 1 year later after diagnosis. This paper reports a rare case that originated in parietal pleura with massive pleural effusion of Ewing's sarcoma, which was not previously reported. This rare tumor and its unusual clinical manifestations prompt us to report the current case.

Dermoid cyst with a congenital sinus tract over the left sternoclavicular joint: a case report and literature review.

Dermoid cysts are rare benign tumors that arise from ectopic epiblastic inclusions and account for 0.4% to 1.5% of all tumors. They are usually 1 to 5 cm in size and composed of a pasty semisolid material. The orbital dermoid cyst is the most common type. Dermoid cysts can also occur in the spinal cord, ovaries, and pancreas. We encountered a 24-year-old man with a dermoid cyst over the left sternoclavicular joint. He reported intermittent secretion of a white tofu-like exudate from an underlying congenital sinus tract since birth. The secretion had turned hemorrhagic for the last month and had been accompanied by progressive swelling and pruritus for 1 week. Ultrasonography and magnetic resonance imaging revealed characteristics of a dermoid cyst, and histopathological examination confirmed the diagnosis. The patient underwent surgical excision of the cyst under local anesthesia. The incision healed well with no postoperative complications. Considering that a dermoid cyst has the potential to become infected or progress into squamous cell carcinoma, its removal at an early stage is suggested. Few reports in the literature have described a dermoid cyst that secretes hemorrhagic contents from a congenital sinus tract. We present this case to provide a reference for clinicians.

Biomechanical Study on the Stress Distribution of the Knee Joint After Tibial Fracture Malunion with Residual Varus-Valgus Deformity.

OBJECTIVE: To investigate the effect of residual varus and valgus deformity on the stress distribution of the knee joint after tibial fracture malunion. METHODS: Fourteen adult cadaver specimens were selected to establish the models of tibial fractures, which were fixed subsequently at neutral position (anatomical reduction) and malunion positions (at 5°, 10°, and 15° valgus positions, and 5°, 10°, and 15° varus positions). The stress distribution on the medial and lateral plateau of the tibia was quantitatively measured using ultra-low-pressure sensitive film technology. The changes in the stress distribution of the knee joint after tibial fracture malunion and the relationship between the stress values and the residual varus or valgus deformity were analyzed. RESULTS: Under 400 N vertical load, the stress values on the medial and lateral plateau of the tibia at the neutral position were 1.137 ± 0.139 MPa and 1.041 ± 0.117 MPa, respectively. When compared with the stress values measured at the neutral position, the stress on the medial plateau of the tibia was significantly higher at varus deformities and lower at valgus deformities, and the stress on the lateral plateau was significantly higher at valgus deformities and lower at varus deformities (all P < 0.05). The stress values on the medial plateau of the tibia were significantly higher than the corresponding data on the lateral plateau at neutral and 5°, 10°, and 15° varus deformities, respectively (all P < 0.05), and significantly lower than the corresponding data on the lateral plateau at 5°, 10°, and 15° valgus deformities, respectively (all P < 0.05). CONCLUSION: Residual varus and valgus deformity after tibial fracture malunion can lead to obvious changes of the stress distribution of the knee joint. Therefore, tibial fractures should be reduced anatomically and fixed rigidly to avoid residual varus-valgus deformity and malalignment of lower limbs.

Carcinoma ex pleomorphic adenoma of the trachea: A case report.

BACKGROUND: Carcinoma ex pleomorphic adenoma (CXPA) is defined as a malignant salivary gland tumor arising from a primary or recurrent pleomorphic adenoma. Only three cases of CXPA of the trachea have been reported in the literature. CASE SUMMARY: We report a case of tracheal CXPA in a 55-year-old woman, who presented with a more than 3-mo history of progressive dyspnea. Computed tomography of the neck and thorax revealed an inhomogeneous, broad-based lesion arising from the tracheal wall on the right side. Endoscopy revealed a subglottic neoplasm causing up to 90% luminal stenosis. The tumor was resected using a high-frequency electrosurgical snare combined with argon plasma coagulation. Histopathology and immunohistochemistry revealed that the tumor was a CXPA of the trachea. CONCLUSION: We report the fourth case of tracheal CXPA, and present the first instance of resection of CXPA using high-frequency electrosurgical snare and laser ablation. We also discuss the pathogenesis, diagnosis, histopathology, and systemic therapy of this rare disease.

Effectiveness of physical therapy on the suboccipital area of patients with tension-type headache: A meta-analysis of randomized controlled trials.

BACKGROUND: There has been a lot of research on physical therapy for tension-type headaches. However, the efficacy of physical therapy on the suboccipital region remains unclear. OBJECTIVE: To establish the effectiveness of physical therapy on the suboccipital area of patients with tension-type headache. METHODS: Databases including Cochrane Library, Medline/Pubmed, CNKI, Embase, and Google Scholar were searched. After independent study selection by 2 authors, data were extracted and collected independently. On 1 hand, authors compared the treatment of the suboccipital area with control group. On the other hand, the efficacy of several physical therapy techniques on the suboccipital region was compared. The quality of the included studies was assessed using the Cochrane Handbook. RevMan 5.3 software was used for data analysis. The primary outcome measures were the cervical range of motion, the visual analog scale, and headache disability inventory. RESULTS: Six randomized controlled trials with a total of 505 participants were included. Suboccipital soft-tissue inhibition technique (SIT) + occiput-atlas-axis global manipulation (OAA) was more effective than SIT in increasing craniocervical extension at 4 weeks post-treatment, the overall mean differences (MD) was 3.61, 95% confidence interval (CI) (0.89-6.34). There was no difference at 8 weeks post-treatment (MD 2.38, 95% CI -1.02 to 5.78, P = .17). SIT was more effective than SIT + OAA in increasing cervical flexion at 4-week post-treatment (MD -3.36, 95% CI -6.65 to -0.05). SIT + OAA was more effective than SIT on decreasing intensity of pain at 4-week post-treatment (MD -0.91, 95% CI -1.78 to -0.04), but no difference at 8-week (MD -0.43, 95% CI -1.18 to 0.33, P = .27). SIT + OAA was more effective than SIT in reducing the functional score of the headache disability inventory at 4-week post-treatment (MD -4.47, 95% CI -8.44 to -0.50). These results may indicate that the SIT + OAA combined therapy is more effective in short term (4-week), no major difference in longer term (8-week). CONCLUSION: Combined therapy may be more suitable for the treatment of tension-type headache.

Application of multidimensional interpolation on nonhomogeneous cancellous bone.

Bone, especially cancellous bone, has been demonstrated to be nonhomogeneous. When applied to bone study, it raises the following question: How should the material properties of the bone from the available experimental data be interpolated?In this study, the finite element model of the femur has been built and the nonhomogeneous material properties of the femur have been assigned from the computed tomography (CT) data. These results have been applied to assess some common interpolation algorithms on the bone study, such as Linear Multivariate, Radial Basis, and Nearest Neighbor. It was found that among 3 tested algorithms, the RBAS algorithm has more points with errors from 0% to 15% than in the other 2 algorithms. When the supporting points jump from 160 to 288, the interpolation results significantly improve. When the finite element model reduces the element number from 38,230 to 13,424, all 3 algorithms have slightly better results.The interpolation of bone material properties should use 2 different approaches. The bone interpolation should be applied only to the bone with uniform structure. For the area with dramatic change of structure, the material properties can be defined directly. Among 3 tested algorithms, the Radial Basis algorithm performs best in the statistic study and should be the first choice in the bone study. In addition, the Radial Basis algorithm can be introduced into other methods to smooth the distribution of material properties. Also, with more supporting points (experimental data), the interpolation error becomes less. The interpolation approach offers a significant advantage in the finite element analysis: only 1 material ID needs to define the material interpolated from experimental data, unlike the several hundred material IDs defined for the elements derived from CT data that take material inhomogeneity into account.

Posterior paraspinal muscle versus post-middle approach for the treatment of thoracolumbar burst fractures: A randomized controlled trial.

BACKGROUND: This randomized controlled trial (RCT) aimed to compare the clinical outcomes of thoracolumbar burst fractures (TLBFs) treated with open reduction and internal fixation via the posterior paraspinal muscle approach (PPMA) and the post-middle approach (PA). METHODS: Patients with a traumatic single-level TLBFs (T10-L2), treated at our hospital between December 2009 and December 2014, were randomly allocated to Group A (PPMA) and Group B (PA). Sex, age, time from injury to surgery, the American Spinal Injury Association Impairment Scale score (ASIAIS), comorbidities, vertebral level, pre- and postoperative kyphotic angle (KA), visual analog scale (VAS) pain score, and the Oswestry Disability Index (ODI) scores were included in the analysis. Operative time, intraoperative blood loss, x-ray exposure time, postoperative drainage volume, superficial infection, and occurrence of deep infection were documented. The patients were followed up at 2 weeks; 1, 3, and 6 months; 1 and 2 years; and every 6 months thereafter. Radiological assessments were performed to assess fracture union and detect potential loosening and breakage of the pedicle screws and rods at each follow-up. Postoperative VAS and ODI scores were used to evaluate the clinical outcomes. RESULTS: A total of 62 patients were enrolled (30 in Group A and 32 in Group B, respectively). The operative time (P < .001) and x-ray exposure time (P < .001) in Group A were significantly longer than those in Group B. However, compared to Group B, there were less intraoperative blood loss (P < .001), lower postoperative drainage volume (P < .001), lower VAS scores (2-week (P = .029), 1-month (P = .023), 3-month (P = .047), and 6-month follow-up (P = .010)), and lower ODI scores (2-week, P = .010; 1-month, P < .001; 3-month, P = .028; and 6-month follow-up, P = .033) in Group A. CONCLUSIONS: Although PPMA required a longer operative time and x-ray exposure time, PPMA provided several advantages over PA, including less intra-operative blood loss and lower postoperative drainage volume, and greater satisfaction with postoperative pain relief and functional improvement, than PA, especially at the 6-month follow-up after surgery. Further high-quality multicenter studies are warranted to validate our findings.

Preventable risk factors of mortality after hip fracture surgery: Systematic review and meta-analysis.

OBJECTIVE: Although many studies have reported risk factors of mortality following hip fracture surgery, the preventable risk factors of mortality following hip fracture surgery have not been well-identified. The aim of this study was to identify the preventable risk factors of mortality following hip fracture surgery. METHODS: We searched PubMed, Web of Science, Google scholar, and the Chinese National Knowledge Infrastructure (CNKI) databases from January 1997 to March 2017 for studies reporting risk factors of mortality following hip fracture surgery. The primary outcomes assessed in this meta-analysis were time to surgery, residential status, smoking, cardiovascular disease, pulmonary disease, diabetes, and malignancy. All analyses were conducted using Stata/SE version 11.0 software. RESULTS: Sixteen studies involving 25 349 patients meeting the inclusion criteria were included. Statistically significant associations between the mortality after hip fracture surgery and the risk factors, including the time to surgery (>2days/<2days) (odds ratio[OR] = 1.91; 95%CI, 1.14-3.18; P = 0.013), residential status (nursing home/home) (OR = 1.97; 95%CI, 1.02-3.78; P = 0.043), cardiovascular disease (OR = 1.14; 95%CI, 1.03-1.26; P = 0.012), pulmonary disease (OR = 1.52; 95%CI, 1.37-1.69; P < 0.001), diabetes (OR = 1.41; 95%CI, 1.19-1.67; P < 0.001), and malignancy (OR = 2.99, 95%CI, 1.14-7.83; P = 0.013) were established. However, the available data failed to demonstrate an association between the mortality, and time to surgery (>1day/<1day) (OR = 1.25; 95%CI, 0.93-1.66; P = 0.136) and smoking (OR = 0.89; 95%CI, 0.69-1.14; P = 0.340). CONCLUSION: This meta-analysis explicitly indicated that malignancy, nursing home residence, time to surgery (>2days/<2days), pulmonary disease, diabetes, and cardiovascular disease significantly increased the risk of mortality after hip fracture surgery. These preventable risk factors may be used to create algorithms that are more effective and pertinent to reduce the mortality following hip fracture surgery.

Finite Element Study of Implant Subsidence and Medial Tilt in Agility Ankle Replacement.

BACKGROUND Clinical studies indicate that in total ankle arthroplasty, postoperative implant subsidence and medial tilt become two significant concerns of the ankle replacement system, and which are associated with the contact between the bones and the talar component. Up to now, little attention has focused on the contact between the bones and the talar component. MATERIAL AND METHODS In order to address implant subsidence and medial tilt, one three-dimensional finite element model of contact between the bone and the talar components was built with the material properties of the cancellous bone interpolated from the experimental data, which represents variation of material properties through the cancellous bones. The finite element model was used to study the following: variation of the Young's modulus of the bones, stiffness of the talar component, loading direction, and loading magnitude with the implant subsidence. RESULTS The computational results reveal that a variety of Young's modulus of the cancellous bones causes the medial tilting of the talar component and that big plastic strains are associated with tilting. The implant subsidence increases from 0.169 mm to 0.269 mm when the loading changes from 272 kg to 408 kg. However, to the contrary, the implant subsidence decreases from 0.2676 mm to 0.1783 mm when Young's modulus of the bones increases 50%. However, the implant subsidence shows little change with a different Young's modulus of the talar component from 88 GPa to 132 GPa. CONCLUSIONS Our study indicates that a variety of different Young's modulus of the cancellous bones cause the medial tilting of the talar component. To solve subsidence and tilting, both the contact area and the variation of material properties should be taken into account.

Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: A meta-analysis of current evidence base.

BACKGROUND: The relative efficacy of operative and nonoperative treatments for the displaced intra-articular calcaneal fractures (DIACF) remains uncertain. OBJECT: We conducted a meta-analysis to compare the effectiveness of operative and nonoperative treatments in treating patients with DIACF. METHODS: Databases including Cochrane Library, Medline, Embase, CBM, CNKI, and Google Scholar were searched. After independent study selection by 2 authors, data were extracted and collected independently. Comparisons were performed between operative treatment group and nonoperative treatment group. The quality of included studies was assessed using the Newcastle-Ottawa Scale. RevMan 5.3 was used for data analysis. The primary outcome measures were anatomical measures (changes in Böhler angle and calcaneal height and width), functional measures (shoe problems, resuming preinjury work, and residual pain), and complications (including superficial and deep wound infection, skin flap necrosis, neurovascular injury, secondary arthrodesis, reflex sympathetic dystrophy, osteotomy, thromboembolism, and compartment syndromes). RESULTS: Eighteen trials (8 randomized controlled trials and 10 controlled clinical trials) including 1467 patients were considered. For anatomical measurements, the overall mean differences (MDs) for the mean Böhler angle, calcaneal height and width were 15.39 (95% confidence interval [CI] 9.12-21.67), 6.55 (95% CI 2.67-10.43), and 7.05 (95% CI -7.83 to -6.27), respectively. In functional measures, the overall effect MD of American Orthopedic Foot and Ankle Society was 6.23 (95% CI 5.22-17.67) and 0.38 (95% CI 0.22-0.67). The overall relative risks (RRs) of wearing shoes, resuming preinjury work, and having residual pain were 0.32 (95% CI 0.32-1.00), 0.56 (95% CI 0.40-0.77), and 0.90 (95% CI 0.68-1.20), respectively. The overall RR of the incidence of complications was 2.00 (95% CI 1.51-2.64). CONCLUSION: Operative treatment of DIACF may lead to a higher incidence of complications but has better anatomical recovery when compared with nonoperative treatment.

Displaced Intra-articular Calcaneal Fractures: Classification and Treatment.

The calcaneus is the most commonly fractured tarsal bone. Displaced intraarticular calcaneal fractures are usually caused by a fall from height with one or both heels directly hitting the ground. Displaced intra-articular calcaneal fractures are complex and highly disabling injuries. There is ongoing debate regarding the optimal treatment for each type of displaced intra-articular calcaneal fracture. This review aims to summarize the classification of, various treatment options for, prevention of perioperative complications in, and management algorithms for displaced intra-articular calcaneal fractures. [Orthopedics. 2017; 40(6):e921-e929.].

Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A meta-analysis.

BACKGROUND: The debate on the efficacy of unilateral percutaneous kyphoplasty (UPKP) and bilateral percutaneous kyphoplasty (BPKP) for the treatment of osteoporotic vertebral compression fractures (OVCFs) is ongoing.This meta-analysis aimed to evaluate the clinical results of UPKP and BPKP in the treatment of OVCFs. METHODS: Web of Science, PubMed, Embase, and the Chinese Biomedical Database publication databases were searched using a date range of January 2008 to November 2016, for studies comparing UPKP and BPKP for the treatment of OVCFs. The clinical effectiveness was assessed by comparing perioperative outcomes (surgery time, the volume of injected cement, X-ray exposure time, and kyphotic angle reduction), clinical outcomes (visual analogue scale [VAS] for pain relief and Oswestry Disability Index [ODI] for quality of life), and surgery-related complications (cement leakage and adjacent vertebral fractures). Data were analyzed using Stata/SE11.0 software. RESULTS: Fourteen trials with 1194 patients were retrieved. The pooled results showed significant differences in surgery time (weighted mean difference [WMD] -21.44, 95% confidence interval [CI] [-23.57 to -19.30]; P < .001); volume of injected cement [WMD -1.90, 95% CI [-2.26 to -1.54); P < .001); and X-ray exposure time (WMD -13.66, 95%CI [-19.59 to -7.72]; P < .001) between UPKP and BPKP treatments. However, the pooled results showed no significant differences in kyphotic angle reduction, VAS in the short-term, VAS in the long-term, ODI, cement leakage, or adjacent vertebral fractures between the 2 surgical procedures. Following a subgroup analysis, the results based on randomized controlled trials (RCTs) indicated that there were significant differences in surgery time (WMD -24.65, 95%CI [-26.53 to -22.77]; P < .001) and the volume of injected cement (WMD -1.66, 95%CI [-1.97 to -1.36]; P < .001) between UPKP and BPKP treatment procedures, respectively. The results based on RCTs indicated that there were no significant differences, either in kyphotic angle reduction or in X-ray exposure time, between the 2 surgical procedures. CONCLUSIONS: Compared to BPKP procedures, UPKP procedures may achieve similar clinical results in the treatment of OVCFs when assessed in terms of the pain relief, improvements in life quality, and surgery-related complications. However, UPKP procedures had a shorter operation time and volume of injected cement compared with BPKP procedures. Additional high quality and multicenter RCTs are needed to provide further robust evidence.

Are there too many screw holes in plates for fracture fixation?

BACKGROUND: Implant breakage after the fixation of traumatic fractures is rare; however, when it occurs, it is debilitating for the patients and a challenge for surgeons. The purpose of this study was to analyze and identify the independent risk factors for implant breakage of traumatic fractures treated with plate osteosynthesis. METHODS: We reviewed the medical records of patients with a fracture to any part of their four extremities, clavicle, hand or foot, who underwent surgical plate osteosynthesis from January 2005 to January 2015, and who sustained a subsequent implant breakage. Kaplan-Meier univariate and multivariate Cox regressions were performed to identify independent associations of potential risk factors for implant breakage in this cohort. RESULTS: We identified 168 patients who underwent plate osteosynthesis surgery and had subsequent internal fixator breakage. The mean patient age was 40.63 ± 16.71 years (range, 3 to 78 years), with 72.0% (121) males and 28.0% (47) females. The average time between surgery and implant breakage was 12.85 ± 12.42 months (range, 1 to 60 months). In the final regression model, we show that inserting screws close to the fracture line is an independent predictive risk factor for implant breakage (HR, 2.165, 95%CI, 1.227 to 3.822; P = 0.008). CONCLUSIONS: We found that inserting screws close to the fracture line is related to an increased risk of internal fixator breakage in patients treated with plate osteosynthesis after fracture. Plates with additional holes likely lead to an increased risk of implant breakage, presumably because surgeons cannot resist inserting extra screws into the holes adjacent to the fracture line, which reduces the stiffness of the plate. We have addressed this problem by designing a plate without holes adjacent to the fracture line.

Effectiveness of decompression alone versus decompression plus fusion for lumbar spinal stenosis: a systematic review and meta-analysis.

INTRODUCTION: The debate on efficacy of fusion added to decompression for lumbar spinal stenosis (LSS) is ongoing. No meta-analysis has compared the effectiveness of decompression versus decompression plus fusion in treating patients with LSS. METHODS: A literature search was performed in the Web of Science, PubMed, Embase, and Springer databases from 1970 to 2016. Relevant references were selected and the included studies were manually reviewed. We included trials evaluating decompression surgery compared to decompression plus fusion surgery in treating patients with LSS. The primary outcomes analyzed were back pain, leg pain, Oswestry Disability Index scores (ODI), the quality-of-life EuroQol-5 Dimensions (EQ-5D), duration of operation, intraoperative blood loss, length of hospital stay, major complications, walking ability, number of reoperation, and finally clinically excellent and good rates. Data analysis was conducted using the Review Manager 5.2 software. RESULTS: Fifteen studies involving 17,785 patients with LSS were included. The overall effect mean difference (MD) (95% CI) in the differences between pre- and post-operative back pain, leg pain, operative time, intraoperative blood loss, and length of stay were 0.04 (-0.36, 0.44), 0.69 (-0.38, 1.76), -2.04 (-3.12, -0.96), -3.96 (-6.64, -1.27) and -4.21 (-10.03, 1.62) (z = 0.18, 1.26, 3.71, 2.89 and 1.41, respectively; P = 0.86, 0.55, 0.0002, 0.004 and 0.16, respectively) in random effects models. The overall effect MD (95% CI) in ODI, EQ-5D, and walking ability were 0.43 (-1.15, 2.00), 0.01 (-0.01, 0.03) and 0.04 (-0.49, 0.57) (z = 0.52, 1.16 and 0.15, respectively; P = 0.59, 0.24 and 0.88, respectively) in fixed effects models. The overall effect odds ratio (OR) (95% CI) of major complications, number of reoperations, and clinically excellent and good rates between the two groups were 0.70 (0.60, 0.81), 1.04 (0.90, 1.19) and 0.31 (0.06, 1.59) (z = 4.63, 0.53 and 1.40, respectively; P < 0.00001, 0.60 and 0.16, respectively). Our study reveals no difference in the effectiveness between the two surgical techniques. CONCLUSIONS: The additional fusion in the management of LSS yielded no clinical improvements over decompression alone within a 2-year follow-up period. But fusion resulted in a longer duration of operation, more blood loss, and a higher risk of complications. Therefore, the appropriate surgical protocol for LSS should be discussed further.