Meiotic chromatin-associated HSF5 is indispensable for pachynema progression and male fertility.

Pachynema progression contributes to the completion of prophase I. Nevertheless, the regulation of this significant meiotic process remains poorly understood. In this study, we identified a novel testis-specific protein HSF5, which regulates pachynema progression during male meiosis in a manner dependent on chromatin-binding. Deficiency of HSF5 results in meiotic arrest and male infertility, characterized as unconventional pachynema arrested at the mid-to-late stage, with extensive spermatocyte apoptosis. Our scRNA-seq data confirmed consistent expressional alterations of certain driver genes (Sycp1, Msh4, Meiob, etc.) crucial for pachynema progression in Hsf5-/- individuals. HSF5 was revealed to primarily bind to promoter regions of such key divers by CUT&Tag analysis. Also, our results demonstrated that HSF5 biologically interacted with SMARCA5, SMARCA4 and SMARCE1, and it could function as a transcription factor for pachynema progression during meiosis. Therefore, our study underscores the importance of the chromatin-associated HSF5 for the differentiation of spermatocytes, improving the protein regulatory network of the pachynema progression.

Biplane Reduction: A Novel Technique for Restoring Fibula Length in Maisonneuve Fracture.

OBJECTIVE: Fibular length is important for ankle stability. Failure to adequately restore and stabilize fibula length may result in malunion, hindering postoperative functional exercises and recovery of ankle function. However, there is no unified and effective reduction method for fibular shortening in Maisonneuve fractures. In this study, we introduce the biplane reduction as an effective surgical technique for restoring the length of the fibula in Maisonneuve fractures. METHODS: This retrospective study enrolled 12 patients preoperatively diagnosed with Maisonneuve fractures between June 2019 and June 2022. All patients underwent our biplane reduction technique to restore the length of their fibula. Operation time, hospital stay, complications, FTA (the angle between the fibular tip and the superior articular surface of the talus), visual analog pain score, and the American Orthopaedic Foot and Ankle Society ankle-hindfoot score were recorded. An independent sample t-test was used for component comparisons, and a paired sample t-test or one-way analysis of variance was used for intra-group comparisons. RESULTS: No patient was lost to follow-up and no obvious postoperative complications were observed. After operation, FTA recovered from 37.52 ± 0.37 ° to 40.42 ± 0.43 °, which was significantly improved compared with that before operation (p < 0.01). At the last follow-up, both the VAS and AOFAS scores showed significant improvement compared to pre-surgery scores. CONCLUSIONS: The reduction technique proposed in this study to restore the length of the fibula in Maisonneuve fractures is simple and effective, does not require special equipment, and has the advantage of directly examining the reduction condition.

Circ_0079471 Regulates the Proliferation, Migration, Invasion and Apoptosis of Osteosarcoma Cells by Mediating miR-485-3p and TRIP6.

BACKGROUND: Circular RNAs (circRNAs) are a special class of non-coding RNA molecules that show a closed circular structure and have been implicated in both tumour formation and oncogenesis. OBJECTIVE: This study aimed to learn more about how circ_0079471 functions in osteosarcomas (OSs). METHOD: Quantitative real-time polymerase chain reaction was used to detect the expression levels of thyroid hormone receptor-interacting protein 6 (TRIP6), miR-485-3p and circ_0079471. Methyl-thiazolyl-tetrazolium and flow cytometry were used to track cell growth and cell-cycle progression, and the research explored wound healing (migration) and invasion using Transwell plates. Western blotting was used to determine the protein expression of TRIP6, proliferating cell nuclear antigen and cyclin D1, and a dual-luciferase assay revealed the target relationship. RESULT: A xenograft experiment evaluated the in vivo effects of circ_0079471 on OS, and the results revealed the high expression of circ_0079471 in OS tissue and cells. The proliferation, cell-cycle migration and invasion of cells were reduced after circ_0079471 knockdown in OS cells; however, the effects of this knockdown were reversed when TRIP6 was overexpressed in the OS cells. The function of circ_0079471 was also achieved by in vivo miR-485-3p sponging. The upregulation of miR-485-3p and the downregulation of TRIP6 partly resulted in circ_0079471 downregulation, which subsequently inhibited OS progression. CONCLUSION: According to these results, circ_0079471 influences the development of OS by regulating miR-485-3p and TRIP6.

A new type of elastic fixation, using an encircling and binding technique, for tibiofibular syndesmosis stabilization: comparison to traditional cortical screw fixation.

BACKGROUND: The distal tibiofibular syndesmosis (DTS) is a complex fibrous joint that contributes to the stability and weight-bearing function of the ankle. As such, repair of DTS injury is required, providing fixation strength while maintaining ankle range of motion. The aim of this study was to compare a new elastic fixation technique, using an encircling and binding technique, for DTS stabilization, compared to the traditional cortical bone screw fixation. METHODS: This was a retrospective analysis of 67 patients treated for a DTS injury at our hospital, between June 2019 and June 2021. Of them, 33 were treated with encircling and binding (EB group) and 34 using a cortical screw (CS group). The following outcomes were compared between groups: time to inferior tibiofibular fixation; length of hospital stay; time to partial weight bearing; time to complete weight bearing; complications; imaging data; and functional scores. RESULTS: Successful stabilization was achieved in all cases, with a mean follow-up period of 15.78 ± 2.97 months. Time to fixation and time to partial and complete weight bearing were shorter for the EB than that for the CS group. The length of hospital was not different between groups. With regard to complications, a superficial infection developed in one patient in each group, with wound healing achieved after active treatment. Screw fracture occurred in two patients in the CS group. At 3 months post-surgery, the American Foot Surgery Association Ankle-Hindfoot score (AOFAS) was higher and the pain score lower for the EB than that for the CS group, but with no between-group difference at the final follow-up. On imaging, the tibiofibular clear space and tibiofibular overlap were not different between groups. CONCLUSIONS: DTS fixation using encircling and binding yielded better clinical and functional outcomes than did cortical screw fixation at 3 months post-surgery, with no difference at the final follow-up. This novel fixation technique provides firm fixation, combined with earlier return to postoperative exercise and recovery of ankle function.

A New Method of Nice Knot Elastic Fixation for Distal Tibiofibular Syndesmosis Injury.

OBJECTIVE: The distal tibiofibular syndesmosis (DTS) is a fretting joint and it is still a hot issue how to satisfy strong internal fixation while allowing fretting. This study described and evaluated a new method for elastic fixation of DTS injury with Nice Knot. METHODS: The study was designed as a retrospective study. Between June 2020 and June 2021, 31 patients who were diagnosed with ankle fracture and DTS injury without additional orthopedic injuries were enrolled in this case series. The study included 22 males and nine females, with an average age of 34.71 ± 14.66 years. All patients were treated with Nice Knot binding for DTS. Surgical time, length of stay, time of DTS fixation, total weight-bearing time, complications, imaging parameters, and functional scores at follow-up were recorded. Paired sample t-tests or single factor analyses of variance were used at intra-group comparison. RESULTS: All patients completed surgery with normal syndesmotic parameters. The recovery of DTS injury was verified by Hook and lateral malleolus rotation tests. The average follow-up time was 15.97 ± 3.30 months. Only one case showed superficial infection after surgery, and the wound healed after symptomatic treatment. In terms of imaging, there were no significant differences in tibiofibular clear space (TFCS), tibiofibular overlap distance (TFOS), medial clear space (MCS), and superior clear space (SCS) immediately and at different follow-up points after surgery. All obtained excellent and good outcomes according to the AOFAS score at least follow-up after surgery. CONCLUSIONS: Nice Knot elastic fixation of DTS injury is firm and stable while maintaining the physiological micromotion of the ankle joint.

Interleukin 22 and its association with neurodegenerative disease activity.

It is worth noting that neuroinflammation is well recognized as a symptom of neurodegenerative diseases (NDs). The regulation of neuroinflammation becomes an attractive focus for innovative ND treatment technologies. There is evidence that IL-22 is associated with the development and progression of a wide assortment of NDs. For example, IL-22 can activate glial cells, causing them to generate pro-inflammatory cytokines and encourage lymphocyte infiltration in the brain. IL-22 mRNA is highly expressed in Alzheimer's disease (AD) patients, and a high expression of IL-22 has also been detected in the brains of patients with other NDs. We examine the role of IL-22 in the development and treatment of NDs in this review, and we believe that IL-22 has therapeutic potential in these diseases.

Conductive Collagen-Based Hydrogel Combined With Electrical Stimulation to Promote Neural Stem Cell Proliferation and Differentiation.

Injectable biomimetic hydrogels are a promising strategy for enhancing tissue repair after spinal cord injury (SCI) by restoring electrical signals and increasing stem cell differentiation. However, fabricating hydrogels that simultaneously exhibit high electrical conductivities, excellent mechanical properties, and biocompatibility remains a great challenge. In the present study, a collagen-based self-assembling cross-linking polymer network (SCPN) hydrogel containing poly-pyrrole (PPy), which imparted electroconductive properties, is developed for potential application in SCI repair. The prepared collagen/polypyrrole (Col/PPy)-based hydrogel exhibited a continuous and porous structure with pore sizes ranging from 50 to 200 µm. Mechanical test results indicated that the Young's moduli of the prepared hydrogels were remarkably enhanced with PPy content in the range 0-40 mM. The conductivity of Col/PPy40 hydrogel was 0.176 ± 0.07 S/cm, which was beneficial for mediating electrical signals between tissues and accelerating the rate of nerve repair. The investigations of swelling and degradation of the hydrogels indicated that PPy chains interpenetrated and entangled with the collagen, thereby tightening the network structure of the hydrogel and improving its stability. The cell count kit-8 (CCK-8) assay and live/dead staining assay demonstrated that Col/PPy40 coupled with electrical simulation promoted the proliferation and survival of neural stem cells (NSCs). Compared with the other groups, the immunocytochemical analysis, qPCR, and Western blot studies suggested that Col/PPy40 coupled with ES maximally induced the differentiation of NSCs into neurons and inhibited the differentiation of NSCs into astrocytes. The results also indicated that the neurons in ES-treated Col/PPy40 hydrogel have longer neurites (170.8 ± 37.2 µm) and greater numbers of branch points (4.7 ± 1.2). Therefore, the prepared hydrogel system coupled with ES has potential prospects in the field of SCI treatment.

Role and mechanism of the lncRNA SNHG1/miR­450b­5p/IGF1 axis in the regulation of myocardial ischemia reperfusion injury.

The increasing rates of morbidity and mortality caused by ischemic heart disease pose a serious threat to human health. Long non­coding (lnc)RNA small nucleolar RNA host gene 1 (SNHG1) has a protective effect on the myocardium. In the present study, the role of lncRNA SNHG1 in myocardial ischemia reperfusion injury (MIRI) and the underlying mechanisms were investigated. After hypoxia/reoxygenation (H/R) induction, the expression levels of lncRNA SNHG1 were detected using reverse transcription­quantitative PCR. After lncRNA SNHG1 overexpression via cell transfection, cell viability was detected using an MTT assay, apoptotic rates were detected using TUNEL staining, apoptosis­related protein expression levels were detected using western blotting and respective kits were used to measure the oxidative stress levels. The Encyclopedia of RNA Interactomes database predicted the presence of binding sites between lncRNA SNHG1 and microRNA (miR)­450b­5p, and between miR­450b­5p and insulin­like growth factor 1 (IGF1). These interactions were then verified using luciferase reporter assays. Subsequently, the regulatory mechanism underlying the lncRNA SNHG1/miR­450b­5p/IGF1 axis in MIRI was investigated by overexpressing miR­450b­5p and knocking down IGF1 expression in H/R­induced cells. Finally, the expression of PI3K/Akt signaling pathway­related proteins was detected using western blotting. lncRNA SNHG1 expression was significantly downregulated in H/R­induced AC16 cells. lncRNA SNHG1 overexpression significantly inhibited apoptosis and decreased oxidative stress levels in H/R­induced AC16 cells, which was mediated via regulation of the miR­450b­5p/IGF1 axis and activation of the PI3K/Akt signaling pathway. Therefore, the present study suggested that activation of the PI3K/Akt signaling pathway via the lncRNA SNHG1/miR­450b­5p/IGF1 axis inhibited the apoptosis and oxidative stress levels of H/R­induced AC16 cells.

A comparative study of the clinical efficacy of supination-adduction type II ankle fracture surgery based on the medial pilon fracture concept versus the ankle fracture concept.

BACKGROUND: A supination-adduction (SAD) ankle fracture is a special type of ankle fracture that results in collapse of the distal tibial articular surface; as such, orthopaedic surgeons require greater awareness of this type of fracture. The severity of this injury lies between that of an ordinary ankle fracture and a pilon fracture, and the treatment of such fractures based on the ankle fracture concept leads to extremely high rates of postoperative complications and a poor prognosis. In this retrospective study, we aimed to explore the treatment of SAD fractures based on the pilon fracture concept. METHODS: We retrospectively analysed the clinical data of 67 patients with Lauge-Hansen supination-adduction type II (SAD-II) ankle fractures, most of whom had a 44-A AO classification. Patients underwent surgical treatment at the Second Affiliated Hospital of Anhui Medical University from January 2009 to June 2019. The patients were divided into two groups based on the surgical concept employed: 43 patients were included in the ankle fracture surgical concept group, and 24 patients were included in the medial pilon fracture surgical concept group. The therapeutic effect was evaluated based on the Burwell-Charnley radiological reduction standard, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and postoperative visual analogue scale (VAS) pain score 1 year after surgery using regression with adjustment for confounding factors. RESULTS: All 67 patients were followed up. Twenty-four patients were treated according to the medial pilon fracture concept, and forty-three patients were treated according to the ankle fracture concept. The AOFAS score 1 year after surgery in the medial pilon group (89.83 ± 2.77) was higher than that in the ankle fracture group (83.63 ± 7.97) (p < 0.05). The VAS score 1 year after surgery in the medial pilon fracture group (1.17 ± 0.96) was significantly better than that in the ankle fracture group (2.28 ± 0.96) (p < 0.05). CONCLUSION: Patients with Lauge-Hansen SAD-II ankle fractures treated based on the medial pilon fracture surgical concept had better postoperative outcomes than those treated based on the ankle fracture surgical concept. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Chromatin-Associated Protein Sugp2 Involved in mRNA Alternative Splicing During Mouse Spermatogenesis.

Mammalian spermatogenesis is a highly ordered process that is determined by chromatin-associated moderators which still remain poorly understood. Through a multi-control group proteomics strategy, we confirmed that Sugp2 was a chromatin-associated candidate protein, and its signal arose along spermatogenesis. The expression results showed that Sugp2, which is mainly expressed in the testis, had two transcripts, encoding one protein. During spermatogenesis, Sugp2 was enriched in the nucleus of male germ cells. With the depletion of Sugp2 by CRISPER-Cas9 technology, we found that Sugp2 controlled a network of genes on metal ion and ATP binding, suggesting that alternative splicing regulation by Sugp2 is involved in cellular ion and energy metabolism during spermatogenesis, while it had a little effect on meiotic progression and male fertility. Collectively, these data demonstrated that, as a chromatin-associated protein, Sugp2 mediated the alternative splicing regulatory network during spermatogenesis.

Upregulated bone morphogenetic protein 5 enhances proliferation and epithelial-mesenchymal transition process in benign prostatic hyperplasia via BMP/Smad signaling pathway.

BACKGROUND: Benign prostatic hyperplasia (BPH) is one of the most common illnesses in aging men. Recent studies found that bone morphogenetic protein 5 (BMP5) is upregulated in BPH tissues, however, the role of BMP5 in the development of BPH has not been examined. The current study aims to elucidate the potential roles of BMP5 and related signaling pathways in BPH. METHODS: Human prostate cell lines (BPH-1, WPMY-1) and human/rat hyperplastic prostate tissues were utilized. Western blot, quantitative real-time polymerase chain reaction, immunofluorescent staining, and immunohistochemical staining were performed. BMP5-silenced and -overexpressed cell models were generated and then cell cycle progression, apoptosis, and proliferation were determined. The epithelial-mesenchymal transition (EMT) was also quantitated. And rescue experiments by BMP/Smad signaling pathway agonist or antagonist were accomplished. Moreover, BPH-related tissue microarray analysis was performed and associations between clinical parameters and expression of BMP5 were analyzed. RESULTS: Our study demonstrated that BMP5 was upregulated in human and rat hyperplastic tissues and localized both in the epithelial and stromal compartments of the prostate tissues. E-cadherin was downregulated in hyperplastic tissues, while N-cadherin and vimentin were upregulated. Overexpression of BMP5 enhanced cell proliferation and the EMT process via phosphorylation of Smad1/5/8, while knockdown of BMP5 induced cell cycle arrest at G0/G1 phase and blocked the EMT process. Moreover, a BMP/Smad signaling pathway agonist and antagonist reversed the effects of BMP5 silencing and overexpression, respectively. In addition, BMP5 expression positively correlated with prostate volume and total prostate-specific antigen. CONCLUSION: Our novel data suggest that BMP5 modulated cell proliferation and the EMT process through the BMP/Smad signaling pathway which could contribute to the development of BPH. However, further studies are required to determine the exact mechanism. Our study also indicated that BMP/Smad signaling may be rediscovered as a promising new therapeutic target for the treatment of BPH.

SYMPK Is Required for Meiosis and Involved in Alternative Splicing in Male Germ Cells.

SYMPK is a scaffold protein that supports polyadenylation machinery assembly on nascent transcripts and is also involved in alternative splicing in some mammalian somatic cells. However, the role of SYMPK in germ cells remains unknown. Here, we report that SYMPK is highly expressed in male germ cells, and germ cell-specific knockout (cKO) of Sympk in mouse leads to male infertility. Sympk cKODdx4-cre mice showed reduced spermatogonia at P4 and almost no germ cells at P18. Sympk cKOStra8-Cre spermatocytes exhibit defects in homologous chromosome synapsis, DNA double-strand break (DSB) repair, and meiotic recombination. RNA-Seq analyses reveal that SYMPK is associated with alternative splicing, besides regulating the expressions of many genes in spermatogenic cells. Importantly, Sympk deletion results in abnormal alternative splicing and a decreased expression of Sun1. Taken together, our results demonstrate that SYMPK is pivotal for meiotic progression by regulating pre-mRNA alternative splicing in male germ cells.

lncRNA ZFAS1 promotes ox-LDL induced EndMT through miR-150-5p/Notch3 signaling axis.

EndMT is an active contributor to atherosclerosis pathology, and lncRNAs is widely involved in the occurrence and development of atherosclerosis. The purpose of this study was to investigate the regulatory mechanisms of ZFAS1 in EndMT of atherosclerosis. Here, the ApoE-/- mice were feed with high-fat diet to establish the atherosclerosis model, and HUVECs was stimulated with ox-LDL to induce EndMT. RT-PCR and western blot were used to detect the mRNA and protein expression, respectively. The expression of EndMT markers were detected by immune-fluorescence. The relationships among ZFAS1, miR-150-5p and Notch3 were evaluated by luciferase reporter assay. The role of ZFAS1 in EndMT and its dependence on miR-150-5p/Notch3 axis was further detected by knocking down or over-expressing ZFAS1. We found that ZFAS1 and Notch3 were upregulated while miR-150-5p was downregulated in atherosclerosis mice and ox-LDL-treated HUVECs. The expression of CD31 and vWF were significant decreased, while the α-SMA and vimentin were significant increased in ox-LDL-treated HUVECs, and overexpression of ZFAS1 enhanced the effect of ox-LDL on HUVECs. Further, ZFAS1 functions as a ceRNA to increase Notch3 expression through sponging miR-150-5p, and miR-150-5p mimic or si-Notch3 could reverse LV-ZFAS1-mediated EndMT. In summary, lncRNA ZFAS1 promotes ox-LDL induced HUVECs EndMT through regulating miR-150-5p/Notch3 axis.

Administration of alpha-lipoic acid could maintain bone mass and bone strength in senile female rats with alcohol consumption.

Previous studies have demonstrated the damaging effect of alcohol (ALH) consumption on bone tissue and bone metabolism. Alpha-lipoic acid (ALA) promotes osteoblast proliferation and inhibits osteoclast proliferation, and positively affects bone regeneration; however, reports about effects of ALA on bone loss for aged female rats with ALH consumption are limited. This study was designed to investigate the impact of treatment with ALA on bone loss for aged female rats with ALH consumption. In this study 30 female Sprague-Dawley rats (22 months old), weighing approximately 520 g, were incorporated. The animals were randomly divided into three groups: group CON, group ALH and group ALH + ALA and received saline, ALH, ALH plus ALA treatment until death at 16 weeks, respectively. The results of maintaining bone mass and bone strength in senile female rats with ALH consumption were evaluated by histology, microcomputerized tomography, gene expression analysis and biomechanical tests. Results from this study indicated that ALH + ALA had stronger effects on the prevention and treatment of osteoporosis in senile female rats with ALH consumption. The ALH + ALA produced stronger effects on the bone volume ratio (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N) and trabecular separation (Tb.Sp), BMD and strength of distal femurs, and regulation of osteogenesis and bone resorption-related gene expression. These results seem to indicate that ALA intervention prevents bone loss in senile female rats with ALH consumption.

[Case-control studies on modified anterolateral approach with modified postmedial approach for the treatment of trimalleolar fractures].

OBJECTIVE: To compare clinical effect of modified anterolateral approach combined with modified posteromedial approach and conventional posterolateral approach combined with medial-aided in treating trimalleolar fractures. METHODS: From January 2015 to August 2017, 108 patients with trimalleolar fractures were enrolled and randomly divided into modified approaches (experimental group) and conventional approaches(control group). There were 53 patients in experimental group including 31 males and 22 females aged from 18 to 67 years old with an average of(40.2±16.4) years old; 19 patients on the left side and 34 patients on the right side; 39 patients were supination external rotation and 14 patients were pronation-external rotation; preoperative waiting time ranged from 6 to 14 d with an average of(9.6±3.1) d; performed operation through modified anterolateral approach combined with modified posteromedial approach. There were 55 patients in control group, including 34 males and 21 females aged from 19 to 69 years old with an average of (42.1±15.3) years old; 18 patients on the left side and 37 patients on the right side; 42 patients were supination external rotation and 13 patients were pronation-external rotation; preoperative waiting time ranged from 7 to 16 d with an average of (10.3±3.4) d; performed operation through conventional posterolateral approach combined with medial-aided. Operation time, intraoperative blood loss, postoperative drainage volume, cases of incision complications and excellent-good reduction, fracture healing time, cases of nerve injury and muscular flexor contracture, cases of incision complications between two groups were compared; AOFAS score were used to evaluate clinical efficacy at 1 year after operation. RESULTS: All patients were followed up from 12 to 24 months with an average of (16.4 ±7.5) months. Operation time, intraoperative blood loss, postoperative drainage volume and incision complication in experimental group were (95.3±22.6) min, (114.7±68.7) ml, (127.5±87.8) ml and 1 case, respectively; while in control group were (112.5±53.8) min, (155.2±79.6) ml, (178.4±73.8) ml and 3 cases respectively; the data in experimental group were better than that of control group. In experimental group, 36 cases got excellent results, 14 good and 3 poor on the quality of reduction, while 30 patients got excellent results, 15 good and 10 poor in control group; the experimental group was better than control group. Fracture healing time in experimental group were(5.5±1.6) months, 2 patients occurred incision complications, while(6.7±2.1) months, 12 patients in control group; the experiment group were better than control group. Postoperative AOFAS score at 12 months in experimental group was 92.9±18.4, and better than control group 80.3±38.3; 32 patients got excellent results, 17 good, 3 moderate and 1 poor in experimental group; 25 patients got excellent results, 18 good, 8 moderate and 4 poor in control group; there was statistical difference between two groups. CONCLUSIONS: Both of modified anterolateral approach combined with modified posteromedial approach and conventional posterolateral approach combined with medial-aided in treating trimalleolar fractures could receive good clinical effect. While compared with conventional posterolateral approach combined with medial-aided, modified anterolateral approach combined with modified posteromedial approach is more fit for blood supply of local soft tissue, and has advantages of less trauma, safety operation and clearly exposure.

Chinese Consensus on Insertional Achilles Tendinopathy.

BACKGROUND: Insertional Achilles tendinopathy (IAT) is a common finding in the clinic. However, consensus on its mechanism, pathological process, diagnosis, treatment, and rehabilitation is lacking. Thus, the Chinese Society of Sports Medicine organized and invited experts representing the fields of ankle disease and tendinopathy to jointly develop an expert consensus on IAT. STUDY DESIGN: A consensus statement of the Chinese Society of Sports Medicine. METHODS: A total of 34 experts in the field of sports medicine and orthopaedics were invited to participate in the compilation of a consensus statement regarding IAT. Consensus was achieved according to the Delphi method. First, 10 working groups composed of 34 experts were established to compile draft statements about clinical problems related to IAT by reviewing and analyzing the available literature. An expert consensus meeting to discuss drafts was then arranged. Each statement was individually presented and discussed, followed by a secret vote. Consensus was reached when more than 50% of the experts voted in its favor. The strength of the proposed recommendation was classified based on the proportion of favorable votes: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimity, 100%. RESULTS: Of the 10 expert consensus statements on the clinical diagnosis and treatment of IAT, there was strong consensus for 8 statements and unanimity for 2 statements. CONCLUSION: This expert consensus focused on the concepts, causes, pathological process, clinical diagnosis, and treatment of IAT. Accepted recommendations in these areas which will assist clinicians in carrying out standardized management of related diseases.

Open reduction and internal fixation of Gustilo type-I and type-II open pilon fractures using a lateral approach.

BACKGROUND: Traditional anteromedial incision for pilon fractures would further increase the damage to the subcutaneous tissues anterior and medial to tibia. In this study, we retrospectively evaluated the method and the outcomes of lateral approach for surgical treatment of Gustilo type-I and type-II open pilon fractures with medial soft tissue injuries. METHODS: From May 2014 to September 2017, 35 patients with Gustilo type-I and type-II open pilon fractures were treated with standard protocol using a lateral approach. The initial wound debridement and application of a spanning external fixator or traction of calcaneal tubercle were performed within 24 h and a definitive fixation was performed when the wound was healed. The mean time from primary surgery to definite surgery was 11.8 (range: 8-16) days. Postoperative radiographs, complications, bone union, and American Orthopedic Foot and Ankle Society (AOFAS) ankle/hind foot score were recorded. RESULTS: The mean follow-up period was 17 months (range: 13-23). The average time to bone union was 22 weeks (range: 18-25). In 35 patients, 2 patients had a superficial wound infection and another 1 patient showed limitation of ankle joint motion. No cases of deep infection, skin necrosis, and symptomatic implant reported. The mean AOFAS score was 89.8 (range: 84-95). On final outcome, 25 patients come under excellent and 10 patients had good result. CONCLUSION: From the results of this study, we can conclude that the lateral approach to treat Gustilo type-I and type-II open pilon fractures was a safe option with a low complication rate. On the other hand, it provides sufficient exposure to restore anatomic articulation, which is worthy of clinical recommendation.

A modified tarsal sinus approach for intra-articular calcaneal fractures.

BACKGROUND: Plate fixation using traditional lateral L-shape approach for intra-articular calcaneal fractures is complicated by 30% of wound complications, and the lateral small incision techniques with a tarsal sinus approach cannot sufficiently address all the fragments. A modified tarsal sinus approach with combined advantages of traditional lateral L-shape and tarsal sinus approaches for the treatment of intra-articular calcaneal fractures was developed. METHOD: This prospective study included 29 patients (13 Sanders type II and 16 type III) with calcaneal fractures were managed with this technique. Calcaneal height, width, length, Bohler's angle, and Gissane angle were measured preoperatively, postoperatively, and at 1-year follow-up. Functional outcomes were assessed based on American Orthopedic Foot and Ankle Society (AOFAS) ankle/hindfoot score. RESULTS: Twenty-nine patients with average follow-up time of 18 (range 13-29) months were included. The radiographs demonstrated significant corrections of the Bohler's angle and Gissane angle, calcaneal width, length, and height from preoperation to postoperation and 1-year follow-up. Among all follow-up patients, one case had skin necrosis but healed after dressing. Another case had symptoms of numbness in the sural innervation area, which disappeared after 5 months of physical therapy and drug therapy. One case showed degenerative changes of subtalar joint at 1-year follow-up. No other wound complications like incision infection (superficial or deep) and wound dehiscence occurred. At 1-year follow-up, the mean AOFAS score was 90.2 ± 17.7 (range 70-98) and the good and excellent rate was 89.7%. CONCLUSION: The modified tarsal sinus approach in the treatment of Sander's type II and III calcaneal fractures allowed adequate reduction and rigid fixation with low incidence of wound complications. Compared to sinus tarsi approach, this technique required shorter learning curve and was more easily mastered by young orthopedic surgeons. Thus, it was worthy of application clinically.