A Feasibility Study on Using Hanging Arm Test to Assess Elbow Stability During Surgical Treatment for Varus Posteromedial Rotatory Instability.

Objectives: The aim of this study to investigate the safety and effectiveness of performing the hanging arm test during surgical treatment for elbow varus posteromedial rotatory instability (VPMRI) to assess elbow stability and determine whether to repair the lateral ulnar collateral ligament (LUCL). Methods: In a retrospective study from August 2014 to March 2019, 27 patients with VPMRI who had a negative result in the hanging arm test after fixation of coronoid fracture were selected. Intraoperative bleeding, operative time, elbow range of motion (ROM), and complications were recorded. Elbow function was evaluated with the Mayo elbow performance score (MEPS) and the disabilities of the arm, shoulder, and hand (DASH) score. Results: The operation time was 85.9 ± 11.06 min (range 65-110). The intraoperative blood loss was 70.7 ± 9.31 ml (range 60-100). At the last follow-up, the elbow joint averaged 73.8° ± 2.931° in pronation, 78.9° ± 2.941° in supination, 7.2° ± 3.207° in extension, and 123.3° ± 6.651° in flexion. The MEPS score was 90.7 ± 4.36 (range 74-95), and the DASH score was 9.8 ± 2.58 (range 6.67-13.3). One patient presented with symptoms of ulnar nerve entrapment 2 months after operation and was treated with ulnar nerve release. The symptom of numbness went away completely 1 week after operation. No complications such as wound infection, arthritis, or chronic instability of the elbow were found in the other patients. Conclusion: Our findings suggest that not all VPMRI patients need the LUCL to be repaired, and the hanging arm test is a safe and reliable method to assess whether to repair the LUCL in the treatment of elbow VPMRI. Level of evidence: Level IV; Retrospective studies.

Intrinsic Cortical Property Analysis of the Medial Column of Proximal Humerus.

OBJECTIVE: Adequate mechanical support of the medial column is paramount to maintain fracture reduction in locking plating of proximal humerus fractures. However, intrinsic cortical properties of the medial column are rarely discussed. The purpose of the study is to describe regional variation of cortex in the medial column. METHODS: A total of 147 healthy participants were eligible for enrollment between December 2016 and December 2018. Subjects were divided into three groups: group A (20-39 years), group B (40-59 years), and group C (>60 years). For each individual, a color 3D thickness map for proximal humerus was created by cortical bone mapping (CBM) technique after bilateral shoulders were imaged by computed tomography. Measurement Indices including the cortical thickness (CTh), cortical mass surface density (CM) and the endocortical trabecular density (ECTD) were determined, after six regions of interest (ROI) were defined in metaphyseal region. Regional parameter variations were analyzed by one-way ANOVA. RESULTS: The CTh, CM and ECTD values were approximately equivalent between genders in the proximal part of the medial column across all ages (P > 0.05).The greatest difference between sexes was found in CTh and CM values of middle and distal part (P < 0.05). The CTh and CM within medial column were negatively associated with age (P < 0.05). The proximal cortical bone of the medial column was thicker and more dense, compared to the lateral column (P < 0.05). Significant regional variation was found in all measured parameters in group A, but not in groups B and C. CONCLUSION: Our finding proved that regional differences in the distribution of cortical bone in the medial column The attenuation of cortical bone heterogeneity in the medial column was found after the age of 40 years.

Open reduction through original fracture line and fixation with locking plate is a feasible approach for extra-articular distal radius fracture malunion.

OBJECTIVES: This study aims to investigate the effectiveness of open reduction through original fracture line and fixation with locking plate in treatment of extra-articular distal radius fracture (DRF) malunion. PATIENTS AND METHODS: Between January 2015 and December 2018, a total of 69 patients (27 males, 42 females; mean age: 62.0±8.9 years; range, 46 to 70 years) suffering from symptomatic extra-articular DRF malunion were included. All patients were followed for more than six months. Patient's demographics, hand dominance, data including Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, pain on a Visual Analog Scale (VAS) score, radius height, ulnar variance, wrist range of motion, volar tilt and radial inclination before and after surgery were analyzed. RESULTS: The median follow-up was 14.13 months, and the median time to fracture healing after the operation was 14.25 weeks. The mean QuickDASH score and VAS score were significantly reduced from 63.4±13.97 and 4.6±1.23 preoperatively to 7.8±4.67 and 1.3±0.76 at the final follow-up, respectively. Radius height, ulnar variance, volar tilt, radial inclination and wrist range of motion (flexion, extension, pronation, supination) were all significantly improved (p<0.001). Images showed good radius height, ulnar variance, volar tilt and radial inclination. The range of motion of wrist and forearm were improved substantially. Among 69 patients, two patients received allograft due to osteoporotic bone collapse. No serious complication was developed, except for minor pain in three patients during follow-up. CONCLUSION: Open reduction through original fracture line and fixation with locking plate is a feasible and effective treatment for selective DRF malunion.

MutiLoc Nail Versus Philos Plate in Treating Proximal Humeral Fractures: A Retrospective Study Among the Alderly.

BACKGROUND: Proximal humeral fractures (PHFs) account for 4-5% of all fractures in the elderly. There is still a controversy among the treatments in the displaced PHFs. Our aim was to explore the clinical outcome of PHFs with the treatment of MultiLoc nail or Philos plate in the elderly patients. METHODS: A total of 82 sustained elderly patients with PHFs were finally recruited between Dec 2016 and Dec 2017. 34 patients were treated with MultiLoc nail and 48 patients were treated with Philos plate. The demographics, fracture types, blood loss, operation time, union time, postoperative complications, visual analog scores (VASs), Constant scores, American Shoulder and Elbow Scores (ASESs), and neck-shaft-angle (NSA) between the two groups were compared. RESULTS: No differences were observed in the demographics, fracture types, VAS, Constant scores, and ASES scores between the two groups at final follow-up. Compared with the plate group, the blood loss, operation time, and union time were significantly lower in the nail group (all P < .05). The rate of general complications was 54.17% in the plate group, which was higher than that in the nail group (26.47%, P = .01). Three patients experienced reoperation in the plate group (3/48; 6.25%), but none in the nail group. Although there were no significant differences in intraoperative NSA between the two groups, the NSA at final follow-up in the nail group was much higher than the plate group (137.55 ± 5.53°vs 134.47 ± 5.92°, P = .02). CONCLUSIONS: Multiloc intramedullary nail showed the similar effectiveness of final VAS, final Constant scores, and ASES scores in PHFs treatment with Philos plate. However, MultiLoc nail is superior to Philos plate in blood loss, operation time, complications, reoperation rate, and the change of NSA.

Tanshinone­IIA attenuates the deleterious effects of oxidative stress in osteoporosis through the NF­κB signaling pathway.

Osteoclasts are responsible for bone resorption caused by bone microstructural damage and bone-related disorders. Evidence shows that tanshinone IIA (Tan­IIA), a traditional Chinese medicine, is used clinically as a drug for the treatment of cardiovascular and cerebrovascular diseases. However, the efficacy and mechanism underlying the effect of Tan­IIA on the viability of osteoclasts remain to be fully elucidated. The present study investigated the therapeutic effects of Tan­IIA on osteoblast differentiation and oxidative stress in vitro and in vivo. Cell viability was analyzed and oxidative stress was examined in the osteoblasts. Wnt1sw/sw mice were used to investigate the therapeutic effects of Tan­IIA on spontaneous tibia fractures and severe osteopenia. The bone strength, collagen and mineral were examined in the tibia. Osteoblast activity was also analyzed in the experimental mice. The Tan­IIA­induced differentiation of osteoclasts and the mechanism of action were investigated in osteocytes. The data showed that Tan­IIA treatment improved cell viability. The data also demonstrated that Tan­IIA decreased the levels of H2O2, accumulation of reactive oxygen species and apoptosis of osteoblasts. Tan­IIA inhibited the deleterious outcomes triggered by oxidative stress. In addition, Tan­IIA inhibited the activation of nuclear factor (NF)­κB and its target genes, tumor necrosis factor (TNF)­α, inducible nitric oxide synthase and cyclooxygenase 2, and increased the levels of TNF receptor­associated factor 1 and inhibitor of apoptosis protein­1/2 in the osteocytes. Furthermore, it was shown that Tan­IIA reduced the propensity to fractures and severe osteopenia in mice with osteoporosis. Tan­IIA also exhibited improved bone strength, mineral and collagen in the bone matrix of the experimental mice. It was found that the Tan­IIA­mediated benefits on osteoblast activity and function were through the NF­κB signaling pathway. Taken together, the data obtained in the present study suggested that Tan­IIA had protective effects against oxidative stress in osteoblastic differentiation in mice with osteoporosis by regulating the NF­κB signaling pathway.

Sanders II type calcaneal fractures: a retrospective trial of percutaneous versus operative treatment.

OBJECTIVE: The purpose of this study was to compare the clinical results of percutaneous reduction and Steinman pin fixation for Sanders II calcaneal fractures with those of operative management through an extensile lateral approach. METHODS: Fifty-three patients treated with standard open reduction and internal fixation (ORIF group) and 54 patients who had undergone percutaneous reduction and Steinman pin fixation (CRIF group) were retrospectively reviewed. There were no differences between the groups regarding sex, age or fracture classification. Pain and functional outcome were evaluated with a visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores. Wound complications and radiological results were compared. RESULTS: At a mean follow-up of 40.4 months (24 to 56 months), there were no differences between the two groups in mean AOFAS score, VAS score or radiologically determined variables. Two cases of deep infection and six of poor wound healing occurred in the ORIF group and none in the CRIF group. Subtalar and ankle motion was found to be better in the CRIF group. CONCLUSIONS: Percutaneous reduction and Steinman pin fixation minimizes complications and achieves functional outcomes comparable to those of the open techniques in patients with Sanders II calcaneal fractures.