Lag screw osteosynthesis of simple olecranon fractures: A biomechanical comparative study.

Olecranon fractures are most frequently stabilized by tension band wiring (TBW), which unfortunately leads to relevant implant removal rates due to K-wire migration and soft tissue irritation. As lag screw osteosynthesis (LSO) might be a gentle and effective alternative in simple fracture patterns, the goal of the present study was to biomechanically compare LSO with TBW in simple olecranon fractures at a cadaver model. A simple olecranon fracture (Mayo type IIA) was created in eight pairs of human cadaver elbows, which were pairwise fixed by either TBW or two transcortical 4.0 mm lag screws. Biomechanical testing was conducted as a pulling force, applied to the triceps tendon in a 90° position. First, cyclic loading between 10 and 300 N was performed for 50,000 cycles. Afterward, maximum load was raised by 0.02 N/cycle until construct failure, what was defined as displacement >2 mm. Besides fracture displacement, failure cycle and failure load, the modes of failure were analyzed. Within the first five cycles, there was no significant difference in displacement (median TBW: 0.2 mm; LSO: 0.5 mm; p = 0.091). Both after 2000 (median TBW: 0.2 mm; LSO: 0.6 mm; p = 0.042) and after 20,000 cycles (median TBW: 0.4 mm; LSO: 0.9 mm; p = 0.027), the difference was significant. Failure cycle (median TBW: 72,639 cycles; LSO: 43,429 cycles; p = 0.017) and failure load (median TBW: 702 N; LSO: 303 N; p = 0.025) differed significantly as well. TBW mostly (6/8) failed at the lock of the cerclage wire, whereas most LSO constructs (5/8) failed as a pullout of the proximal fragment. In conclusion, to our biomechanical findings at human cadaver specimens, simple olecranon fractures treated by LSO show higher dislocation rates and lower failure loads compared to conventional TBW and mostly fail by pullout of the proximal fragment.

Autologous Minced Cartilage Implantation for Arthroscopic One-Stage Treatment of Osteochondritis Dissecans of the Elbow.

This Technical Note describes the full arthroscopic one-stage treatment of high-grade osteochondritis dissecans of the humeral capitellum of the elbow joint by means of minced cartilage implantation.

Low-profile double plating of unstable osteoporotic olecranon fractures: a biomechanical comparative study.

BACKGROUND: In the treatment of unstable olecranon fractures, anatomically preshaped locking plates exhibit superior biomechanical results compared with tension band wiring. However, posterior plating (PP) still is accompanied by high rates of plate removal because of soft-tissue irritation and discomfort. Meanwhile, low-profile plates precontoured for collateral double plating (DP) are available and enable muscular soft-tissue coverage combined with angular-stable fixation. The goal of this study was to biomechanically compare PP with collateral DP for osteosynthesis of unstable osteoporotic fractures. METHODS: A comminuted displaced Mayo type IIB fracture was created in 8 osteoporotic pairs of fresh-frozen human cadaveric elbows. Pair-wise angular stable fixation was performed by either collateral DP or PP. Biomechanical testing was conducted as a pulling force to the triceps tendon in 90° of elbow flexion. Cyclical load changes between 10 and 300 N were applied at 4 Hz for 50,000 cycles. Afterward, the maximum load was raised by 0.02 N/cycle until construct failure, which was defined as displacement > 2 mm. Besides failure cycles and failure loads, modes of failure were analyzed. RESULTS: Following DP, a median endurance of 65,370 cycles (range, 2-83,121 cycles) was recorded, which showed no significant difference compared with PP, with 69,311 cycles (range, 150-81,938 cycles) (P = .263). Failure load showed comparable results as well, with 601 N (range, 300-949 N) after DP and 663 N (range, 300-933 N) after PP (P = .237). All PP constructs and 3 of 8 DP constructs failed by proximal fragment cutout, whereas 5 of 8 DP constructs failed by bony triceps avulsion. CONCLUSION: Angular-stable DP showed comparable biomechanical stability to PP in unstable osteoporotic olecranon fractures under high-cycle loading conditions. Failure due to bony triceps avulsion following DP requires further clinical and biomechanical investigation, for example, on suture augmentation or different screw configurations.

Expression patterns of key Sonic Hedgehog signaling pathway components in the developing and adult mouse midbrain and in the MN9D cell line.

The temporal dynamic expression of Sonic Hedgehog (SHH) and signaling during early midbrain dopaminergic (mDA) neuron development is one of the key players in establishing mDA progenitor diversity. However, whether SHH signaling is also required during later developmental stages and in mature mDA neurons is less understood. We study the expression of SHH receptors Ptch1 and Gas1 (growth arrest-specific 1) and of the transcription factors Gli1, Gli2 and Gli3 in mouse midbrain during embryonic development [embryonic day (E) 12.5 onwards)], in newborn and adult mice using in situ hybridization and immunohistochemistry. Moreover, we examine the expression and regulation of dopaminergic neuronal progenitor markers, midbrain dopaminergic neuronal markers and markers of the SHH signaling pathway in undifferentiated and butyric acid-treated (differentiated) MN9D cells in the presence or absence of exogenous SHH in vitro by RT-PCR, immunoblotting and immunocytochemistry. Gli1 was expressed in the lateral mesencephalic domains, whereas Gli2 and Gli3 were expressed dorsolaterally and complemented by ventrolateral expression of Ptch1. Co-localization with tyrosine hydroxylase could not be observed. GAS1 was exclusively expressed in the dorsal mesencephalon at E11.5 and co-localized with Ki67. In contrast, MN9D cells expressed all the genes investigated and treatment of the cells with butyric acid significantly upregulated their expression. The results suggest that SHH is only indirectly involved in the differentiation and survival of mDA neurons and that the MN9D cell line is a valuable model for investigating early development but not the differentiation and survival of mDA neurons.

TGF-ß signaling directly regulates transcription and functional expression of the electrogenic sodium bicarbonate cotransporter 1, NBCe1 (SLC4A4), via Smad4 in mouse astrocytes.

The electrogenic sodium bicarbonate cotransporter NBCe1 (SLC4A4) expressed in astrocytes regulates intracellular and extracellular pH. Here, we introduce transforming growth factor beta (TGF-ß) as a novel regulator of NBCe1 transcription and functional expression. Using hippocampal slices and primary hippocampal and cortical astrocyte cultures, we investigated regulation of NBCe1 and elucidated the underlying signaling pathways by RT-PCR, immunoblotting, immunofluorescence, intracellular H(+ ) recording using the H(+ ) -sensitive dye 2',7'-bis-(carboxyethyl)-5-(and-6)-carboxyfluorescein, mink lung epithelial cell (MLEC) assay, and chromatin immunoprecipitation. Activation of TGF-ß signaling significantly upregulated transcript, protein, and surface expression of NBCe1. These effects were TGF-ß receptor-mediated and suppressed following inhibition of JNK and Smad signaling. Moreover, 4-aminopyridine (4AP)-dependent NBCe1 regulation requires TGF-ß. TGF-ß increased the rate and amplitude of intracellular H+ changes upon challenging NBCe1 in wild-type astrocytes but not in cortical astrocytes from Slc4a4-deficient mice. A Smad4 binding sequence was identified in the NBCe1 promoter and Smad4 binding increased after activation of TGF-ß signaling. The data show for the first time that NBCe1 is a direct target of TGF-ß/Smad4 signaling. Through activation of the canonical pathway TGF-ß acts directly on NBCe1 by binding of Smad4 to the NBCe1 promoter and regulating its transcription, followed by increased protein expression and transport activity.