Predictors of failure of nonoperative treatment for type-2 supracondylar humerus fractures.

BACKGROUND: Closed reduction and casting for type-2 supracondylar fractures is a viable treatment option, but studies have shown that some patients will fail to maintain the initial reduction in a cast. This study sought to identify predictors of failed treatment of closed reduction and casting for these fractures. METHODS: We performed a retrospective case-control study of type-2 supracondylar fractures treated by closed reduction and casting. Using radiographic failure of reduction as our primary outcome measure, we examined injury, postreduction, and follow-up films evaluating the anterior humeral line, cast flexion angle, and degree of cast padding in an attempt to identify predictors of failure. RESULTS: We reviewed 645 fractures. Of 126 type-2 fractures, 61 fractures were included in the study. There were 49 (80%) nonoperative treatment successes and 12 failures (20%) with an average follow-up of 41 days (range, 20 to 161 d). We found that (1) the degree of fracture extension using an index based on the anterior humeral line on the injury film was significantly related to failure of cast treatment (P=<0.01), and (2) the width of the soft tissue shadow of the upper arm on the postreduction film was of borderline significance (P=0.02). Cast flexion angle and cast padding were not predictive of radiographic loss of reduction (P=0.94 and 0.70). CONCLUSIONS: Despite adequate reduction and casting of type-2 supracondylar fractures, some fractures will lose reduction and require delayed pinning. The degree of extension of the distal fragment at the time of injury may help to predict the likelihood of failure of nonoperative treatment.

Ezrin mediates growth and survival in Ewing's sarcoma through the AKT/mTOR, but not the MAPK, signaling pathway.

Recent reports on the role of the membrane-cytoskeleton linker protein ezrin in sarcomas showed an effect on the formation of metastases, dependent on the level of ezrin expression. In this study, we explore the role of ezrin in Ewing's sarcoma, a frequently fatal mesenchymal neoplasm of children and young adults. Through both immunohistochemistry and Western immunoblot studies we find ubiquitous, high-level expression of ezrin in Ewing's sarcoma. In contrast to the observations in osteosarcoma and rhabdomyosarcoma, we demonstrate that inhibition of ezrin-mediated signal transduction, through the expression of a non-phosphorylatable T567A mutant, slows primary growth of Ewing's sarcoma cells in vitro. This reduction in growth is a result of increased apoptosis in the mutant expressing cells. We further show that expression of this mutant reduces the ability of Ewing's sarcoma cells to form experimental metastases in vivo. Molecular examination reveals that the action of ezrin in Ewing's sarcoma is dependent on the AKT/mTOR signal transduction cascade, but not MAP Kinase. These results, therefore, demonstrate that, in Ewing's sarcoma, the biology of ezrin is distinct from that described in other sarcomas. This study further validates ezrin as a potential therapeutic target.

Single-row, double-row, and transosseous equivalent techniques for isolated supraspinatus tendon tears with minimal atrophy: A retrospective comparative outcome and radiographic analysis at minimum 2-year followup.

PURPOSE: The purpose of this study was to measure and compare the subjective, objective, and radiographic healing outcomes of single-row (SR), double-row (DR), and transosseous equivalent (TOE) suture techniques for arthroscopic rotator cuff repair. MATERIALS AND METHODS: A retrospective comparative analysis of arthroscopic rotator cuff repairs by one surgeon from 2004 to 2010 at minimum 2-year followup was performed. Cohorts were matched for age, sex, and tear size. Subjective outcome variables included ASES, Constant, SST, UCLA, and SF-12 scores. Objective outcome variables included strength, active range of motion (ROM). Radiographic healing was assessed by magnetic resonance imaging (MRI). Statistical analysis was performed using analysis of variance (ANOVA), Mann - Whitney and Kruskal - Wallis tests with significance, and the Fisher exact probability test <0.05. RESULTS: Sixty-three patients completed the study requirements (20 SR, 21 DR, 22 TOE). There was a clinically and statistically significant improvement in outcomes with all repair techniques (ASES mean improvement P = <0.0001). The mean final ASES scores were: SR 83; (SD 21.4); DR 87 (SD 18.2); TOE 87 (SD 13.2); (P = 0.73). There was a statistically significant improvement in strength for each repair technique (P < 0.001). There was no significant difference between techniques across all secondary outcome assessments: ASES improvement, Constant, SST, UCLA, SF-12, ROM, Strength, and MRI re-tear rates. There was a decrease in re-tear rates from single row (22%) to double-row (18%) to transosseous equivalent (11%); however, this difference was not statistically significant (P = 0.6). CONCLUSIONS: Compared to preoperatively, arthroscopic rotator cuff repair, using SR, DR, or TOE techniques, yielded a clinically and statistically significant improvement in subjective and objective outcomes at a minimum 2-year follow-up. LEVEL OF EVIDENCE: Therapeutic level 3.