Reverse homodigital artery versus reverse dorsal homodigital island flaps for fingertip defect repair: A meta-analysis.

PURPOSE: This review aimed to systematically and comprehensively compare the effectiveness and applicability of reverse homodigital artery island flaps (RHAIF) and reverse dorsal homodigital island flaps (RDHIF) to treat fingertip defects. METHODS: A comprehensive search was conducted in multiple databases for studies that compared RHAIF versus RDHIF for treating fingertip defects with no language restrictions from inception until July 31, 2022. A meta-analysis was performed using RevMan 5.4 software. RESULTS: A total of 14 articles were retrieved, comprising 484 patients (509 fingers) in the RHAIF group and 453 patients (484 fingers) in the RDHIF group. The pooled estimates suggested that patients treated with RHAIF experienced more donor-side complications and less postoperative venous crisis than patients in the RDHIF group. On the other hand, no significant differences were found in operative time, flap necrosis, static 2-point discrimination, moving two-point discrimination, total active motion, satisfaction rates and sensory recovery grade (S3+ to S4) between the RHAIF and RDHIF groups. CONCLUSIONS: No difference in effectiveness was found between the two surgical procedures for treating fingertip defects. Accordingly, the selection of the optimal approach should be based on the functional requirements of the patient and the surgeon's expertize.

[Wrist arthroscopy assisted open reduction and volar ligament reconstruction through osseous internal fixation for the treatment of distal radius Fernandez type â £ fractures].

OBJECTIVE: To explore clinical effect of treatment for distal radius Fernandez type Ⅳ fractures by wrist arthroscopy assisted open reduction and volar ligament reconstruction through osseous, internal fixation. METHODS: From January 2018 to December 2019, 11 patients distal radius Fernandez type Ⅳ fractures treated with wrist arthroscopy assisted open reduction and volar ligament reconstruction through osseous, internal fixation, including 8 males and 3 females, aged from 23 to 42 years old. The fracture were all calssified to type Ⅳ according to Fernandez classification. Postoperative fracture healing, activity of wrist joint and recovery of wrist joint were observed, postoperative visual analogue scale(VAS) at 12 months was used to evaluate pain of wrist joint, and Cooney wrist score scale was used to evaluate clinical effects. RESULTS: All the 11 patients were followed up from 12 to 13 months, and fractures were healed well for 4 to 6 months. Postoperative VAS at 12 months ranged from 0 to 3, palm tilt angle ranged from 0° to 15 °, ulnar drift angle ranged from 15° to 21°, wrist flexion and extension motion ranged from 110° to 162°, forearm rotation motion ranged from 165° to 178°. Cooney wrist joint comprehensive score ranged from 70 to 95 points, and 8 patients got excellent result, 2 good, and 1 fair. No osteoarthritis and complications occurred. CONCLUSION: Wrist arthroscopy assisted open reduction and volar ligament reconstruction through osseous, internal fixation for the treatment of Fernandez Ⅳ distal radius fractures could recevie effective fixation, and could receive satisfied clinical effect with system function exercise postoperative.

Efficacy and Mechanism of Mallotus furetianus Müll. Arg. Extract on Nonalcoholic Fatty Liver Disease.

Nonalcoholic fatty liver disease (NAFLD) is currently the major cause of chronic liver disease globally. To observe the sedative effect of Mallotus furetianus extract (MFE) on NAFLD and the potential molecular mechanism, a high-fat diet (HFD) was used to induce NAFLD in rats for 8 weeks. Rats were orally given MFE (1.7 g/kg, 2.5 g/kg, and 3.3 g/kg) every day. Serum and liver biochemical indexes were detected. 16S rDNA sequencing was performed to test the changes in the gut microbiota. Mass spectrometry was used to analyze the changes in blood and liver metabolites and to perform a joint analysis of differential flora and differential metabolites. The results showed that MFE alleviated liver injury and decreased hepatic lipids content. ELISA analysis certificated that MFE reduced inflammation levels in rats fed with HFD. Compared to HFD rats with a normal diet, MFE significantly changed the overall structure of the intestinal flora and the composition of the intestinal microbes destroyed by HFD. In addition, MFE changes the metabolic levels of lipids and proteins in HFD rats. In conclusion, MFE effectively treated NAFLD and significantly improved the overall structure and intestinal microbial composition of the intestinal microbiota. The abundance of Bacteroides fragilis and Escherichia coli increased significantly in the partridge tea treatment group.

[Open pulling reduction and bone graft by overstretched wrist traction and internal fixation for the treatment of distal radius type Fernandez â ¢ fractures].

OBJECTIVE: To explore the clinical effect of the treatment of Fernandez type Ⅲ fracture of the distal radius with hyperextension traction prying, volar reduction, bone grafting and internal fixation. METHODS: From February 2017 to March 2018, 11 cases of Fernandez type Ⅲ fracture of the distal radius were treated with intraoperative hyperextension traction and volar prying reduction and bone grafting and internal fixation, including 6 males and 5 females, aged 55 to 67 years. Preoperative X-ray and CT evaluated the distal radius fracture dorsal angulation with articular surface compression, collapse. According to Fernandez, all of them were type Ⅲ. After operation, the reduction of articular surface and fracture healing were evaluated. VAS score and Cooney wrist score were used to evaluate the curative effect. RESULTS: All the patients were followed up for 12 to 14 months. All the fractures healed. Cooney wrist score scale was used to evaluate the curative effect, 9 cases were excellent, 1 case was good and 1 case was fair. CONCLUSION: In the operation of Fernandez type Ⅲ fracture of the distal radius, hyperextension traction was used to enlarge the angle, and through the volar fracture end prying reduction and internal fixation with bone graft, the collapsed articular surface could be effectively reduced and fixed. The early functional exercise after the operation had satisfactory clinical effect.

[Wrist arthroscopic treatment of Die-punch fracture of distal radius].

OBJECTIVE: To evaluate the effect of open reduction assisted by wrist arthroscopy in the treatment of Diepunch fracture of the distal radius. METHODS: The clinical data of 50 patients with die punch fracture of distal radius from December 2015 to May 2017 were analyzed retrospectively, including 31 males and 19 females, aged 20 to 45 (34.12±2.56) years. All patients were treated with open reduction and internal fixation of volar plate through volar approach under the assistance of wrist arthroscope. The range of wrist movement and Cooney wrist function score before and after treatment were compared. RESULTS: All patients were followed up with an average of 18 months. DR scan showed that all fractures healed and no shortening of radial axis. Three cases of incision infection occurred and disappeared after treatment. At 18 months after operation, the range of wrist movement was significantly larger than that before operation (P<0.05) . At 18 months after operation, Cooney wrist function score was higher than that before operation (P<0.05) , excellent in 33 cases, good in 13 cases, fair in 3 cases and poor in 1 case. CONCLUSION: The treatment of die punch fracture of the distal radius with open reduction assisted by arthroscopy can restore the flatness of the joint surface, promote the recovery of the function of the wrist joint quickly, and has high safety, which is worth popularizing.

[Wrist arthroscopy assisted open reduction and bone graft through bone window internal fixation for the treatment of distal radius Die-punch fractures].

OBJECTIVE: To explore clinical effect of wrist arthroscopy assisted open reduction and bone graft through bone window internal fixation in treating distal radius Die-punch fractures. METHODS: From March 2016 to March 2017, 12 patients with distal radius Die-punch fractures were treated by wrist arthroscopy assisted open reduction and bone graft through bone window internal fixation, including 8 males and 4 females aged from 20 to 42 years old. Preopeative X-ray and CT were used to diagnosed as compress and collapse Die-punch fractures. Joint activity was observed, postoperative VAS score and Cooney wrist score were used to evaluate pain and wrist function at 12 months. RESULTS: No surgical complications occurred. All patients were followed up from 10 to 13 months with an average of 12.1 months. VAS score was for 0 to 3 points at 12 months after operation. Palmer tilt angle was for 5° to 15°, ulnar drift angle was for 14° to 23°, wrist flexion motion ranged from 123° to 168°, and forearm rotation motion ranged from 115° to 170°. Postoperative Cooney wrist score at 12 months ranged from 70 to 95 points, 10 patients got excellent results, 1 good, and 1 moderate. CONCLUSIONS: Wrist arthroscopy assisted open reduction and bone graft through bone window internal fixation in treating distal radius Die-punch fractures has advantages of good recovery of wrist function, reduce pain symptom, and could receive satisfied clinical effects.

[Open reduction and bone graft with internal fixation through bone window for the treatment of type B4 distal radius fractures].

OBJECTIVE: To explore clinical effect of open reduction and bone graft with internal fixation through bone window for the treatment of type B4 distal radius fractures. METHODS: From January 2015 to June 2016, 13 patients with type B4 distal radius fractures treated with bone graft with internal fixation through bone window, including 9 males and 4 females aged from 18 to 36 years old with an average of 26.3 years old. Fractures were classified to type B4 according to AO/OTA classification. Fracture healing and postoperative complication were observed, VAS score was used to evaluate pain, and Cooney wrist scoring was applied to evaluate recovery of function. RESULTS: All patients were followed up from 10 to 14 months with an average of 12.4 months. Fracture healed from 4 to 6months with an average of 5.2 months. According to Cooney wrist scoring, 10 got excellent results, 2 good and 1 moderate. VAS score was 1.0±1.1, grip strength of contralateral ratio was (88.2±2.7)%, palmer tilt angle was (12.2±3.8)°, ulnar drift angle was (19.3±5.4)°, wrist flexion mobility was (118.1±2.3)°, forearm rotation motion was (158.0±13.0)°. No osteoarthritis occurred and symptoms occurred during follow-up. CONCLUSIONS: Open reduction and bone graft with internal fixation through bone window for the treatment of type B4 distal radius fractures, which has advantages of satisfied clinical effects, less complications, is one of the effective method for type B4 distal radius fractures.

[Wrist arthroscopy assisted reduction and Herbert screw fixation for the treatment of type B distal radius fractures].

OBJECTIVE: To explore the clinical efficacy of internal fixation with arthroscope assistance in type B fractures of distal radius. METHODS: From June 2013 to July 2015, 28 cases of type B distal radius fracture patients were enrolled into the study, including 15 males and 13 females with an average age of 45.3 years old ranging from 17 to 69 years old. These patients were treated with manipulative and poking reduction wrist arthroscopy, internal fixation with Herbert screws and repair of articular soft tissue, and the course of disease was 4 to 7 days after injury. Injured patients had the typical signs of distal radius fracture with confirming of X ray and CT imaging. Finally, no other fractures, no neurovascular injury, no other severe diseases and no surgical cortraindications were identified. According to the classification of AO/OTA, there were 8 cases of type B1, 7 cases of type B2, 13 cases of type B3. Patients were followed up for fracture healing, wrist joint function recovery, and curative effect. RESULTS: The 28 cases of type B distal radius fractures were followed up with an average of(12.1±1.4) months, all fractures were healed, palmer tilt angle was(15.2±3.4)°, ulnar drift angles was(20.4±6.4)°. Wrist functions were evaluated according to Cooney system and rated as excellent in 21 cases, good in 5 cases and fair in 2 cases. Intraoperative arthroscopy showed the tear of scapholunate ligaments in 3 cases, tear of in lunotriguetal ligaments in 1 case, and TFCC tear in 16 cases. CONCLUSIONS: Wrist arthroscopy assisted treatment of distal radius fracture type B can make the recovery of joint surface roughness to a great extent. The application of Herbert screw brings in the small trauma, and the postoperative recovery time is short, reducing the incidence of traumatic arthritis and preventing the chronic pain or inastbility of the wrist in the future.