Replantation and Lengthening of a Lower Leg in a 7-Year-Old Child: A Case Report.

Replantation of the lower leg has controversial indications, but it may be considered in carefully selected patients. Although the function of prosthetic lower legs has been improved in recent decades, leg salvage remains a laudable goal. We present the case of a 7-year-old child who sustained a traumatic amputation at the level of the middle tibia with loss of the middle portion of the lower leg. We performed successful replantation, and tibia lengthening was performed starting 10 days after replantation and lasted 6 months.

Distal Finger Reconstruction by Bilateral Lateral Hallux Osteo-onychocutaneous Free Flap.

OBJECTIVE: In this report, we present our experience on the use of bilateral lateral hallux osteo-onychocutaneous free flaps for reconstruction of distal finger and the aesthetic and functional results of this technique in a series of cases. PATIENTS AND METHODS: From February 2005 to May 2015, 7 patients underwent finger reconstruction distal to the distal interphalangeal joint using the bilateral lateral hallux osteo-onychocutaneous free flaps. The mean age was 29.3 years (range, 24-33 years). The lateral hallux osteo-onychocutaneous flaps were harvested from bilateral donor sites. The size of each flap was designed based on the size of half distal finger defect. The lateral hallux osteo-onychocutaneous free flaps from both donor sites were combined to reconstruct the distal finger. More than 50% of hallux nail was preserved in each of donor sites, which was covered with a local flap. RESULTS: All flaps used for reconstruction survived without complications after surgery. The average length of follow-up was 93.4 months (range, 16-163 months). All reconstructed distal fingers showed good aesthetic appearance, except one that underwent a secondary debulking procedure. The average total active motion of the finger was 215.7 degrees (range, 200-230 degrees). Neither pain nor numbness sensation in the reconstructed fingers was complained by the patients. The donor site morbidity was minimal. All patients had pain-free and good function outcome in both feet. CONCLUSIONS: The use of the bilateral lateral hallux osteo-onychocutaneous free flaps may provide an option for distal finger reconstruction with satisfactory function and anesthetic outcomes with minimal hallux donor site morbidity.

The psychological impact of external fixation using the Ilizarov or Orthofix LRS method to treat tibial osteomyelitis with a bone defect.

OBJECTIVE: To examine the psychological impact of external fixation for a tibial bone defect due to osteomyelitis, and to compare the Orthofix limb reconstruction system (LRS) with the Ilizarov external fixator. MATERIALS AND METHODS: The SCL-90-R questionnaire was administered at four different time points (before surgery, while patients wore the external fixation device, when the device was removed, and two to three months after). The scores at the four time points were compared, as were the two different methods of external fixation (Orthofix LRS vs. Ilizarov). RESULTS: The patients experienced a significant adverse impact on their mental health, with the worst outcomes at Time 2 (while wearing the external fixator), but with some negative effects still present even several months after removal of the fixation device. Although the Orthofix LRS and Ilizarov groups showed similar mental health scores at Time 1 (preoperatively) and Time 3 (upon removal of the fixation device), the Orthofix LRS was associated with better scores, specifically in the Hostility (Time 2), Phobic Anxiety (Time 2), Psychoticism (Times 2 and 4), and Other (Time 2) sub-scores, as well as the total score (Times 2 and 4). CONCLUSIONS: Although both Ilizarov and Orthofix LRS fixation resolved the bone defects, external fixation had a negative impact on the patients' mental health, which persisted even after removal of the devices. Although both methods led to negative effects on the patients' mental, the impact of the Orthofix LRS was less severe.

Outcomes of post-traumatic tibial osteomyelitis treated with an Orthofix LRS versus an Ilizarov external fixator.

OBJECTIVE: To compare the therapeutic effects of the Orthofix limb reconstruction system (LRS) versus the Ilizarov external fixator on osteomyelitis of a tibial bone defect. MATERIALS AND METHODS: Among 153 patients hospitalized for bone lengthening therapy from January 1, 1996 to January 1, 2015, 129 patients were selected for a retrospective analysis. Forty-three of the candidate patients were treated using the Orthofix LRS and the other 86 were treated using an Ilizarov external fixator. The average follow-up was 96 months. We evaluated the patients at follow-up visits, and compared the length of time the patients wore the fixation devices. We also examined the scores of Activities of Daily Living (ADL) tests and a Self-rated Anxiety Scale (SAS), the range of motion, and the incidence of pin track infections. RESULTS: The results indicated that both approaches were effective for treating the bone defect. Compared with the patients who wore an Ilizarov fixator for the treatment of post-traumatic osteomyelitis, those who wore an Orthofix LRS tended to be more satisfied with their quality of life and the outcome after the operation. CONCLUSION: Although both approaches were effective for treating the bone defect, the overall patient outcomes were superior for the Orthofix LRS, suggesting that it should be considered as the first option in the treatment of traumatic osteomyelitis of the tibial diaphysis.

NRSN2 promotes osteosarcoma cell proliferation and growth through PI3K/Akt/MTOR and Wnt/ß-catenin signaling.

Osteosarcoma is the most common bone cancer in children and adults. However, its pathogenesis, especially molecular mechanisms remain elusive. In current study, we screened GEO Database and found a poorly studied protein Neurensin-2 (NRSN2), which is highly expressed in osteosarcoma tissues. Neurensin-2 (NRSN2) is a small neuronal membrane protein and localized in small vesicles in neural cells, previous study found that it has been implicated in hepatocellular carcinoma (HCC) and non-small cell lung cancer (NSCLC). We here report that the expression of NRSN2 is more commonlyelevated in 18 fresh osteosarcoma tissues. Furthermore, both loss- and gain-functions assays revealed that NRSN2 could promote osteosarcoma cell proliferation and growth both in vitro and in vivo. In addition, we further found that those effects on osteosarcoma by NRSN2 are associated with the dysregulated PI3K/AKT/mTOR signaling and Wnt/ß-catenin signaling. In conclusion, our study found a novel oncogenic protein, NRSN2, which promotes osteosarcoma cell proliferation and as a membrane protein, NRSN2 also could be a potential treatment target for osteosarcoma.