Metabolic Landscape of Osteosarcoma: Reprogramming of Lactic Acid Metabolism and Metabolic Communication.

BACKGROUND: Lactic acid, previously regarded only as an endpoint of glycolysis, has emerged as a major regulator of tumor invasion, growth, and the tumor microenvironment. In this study, we aimed to explore the reprogramming of lactic acid metabolism relevant to osteosarcoma (OS) microenvironment by decoding the underlying lactic acid metabolic landscape of OS cells and intercellular signaling alterations. METHODS: The landscape of OS metabolism was evaluated using single-cell gene expression data, lactic acid metabolism clustering, and screening of the hub genes in lactic acid metabolism of OS samples using transcriptome data. The role of the hub gene NADH:Ubiquinone Oxidoreductase Complex Assembly Factor 6 (NDUFAF6) was validated with in vitro studies and patient experiments. RESULTS: Single-cell RNA sequencing data validated a lactic acid metabolismhigh subcluster in OS. Further investigation of intercellular communications revealed a unique metabolic communication pattern between the lactic acid metabolismhigh subcluster and other subclusters. Next, two lactic acid metabolic reprogramming phenotypes were defined, and six lactic acid metabolism-related genes (LRGs), including the biomarker NDUFAF6, were screened in OS. In vitro studies and patient experiments confirmed that NDUFAF6 is a crucial lactic acid metabolism-associated gene in OS. CONCLUSIONS: The patterns of lactic acid metabolism in OS suggested metabolic reprogramming phenotypes relevant to the tumor microenvironment (TME) and identified NDUFAF6 as an LRG prognostic biomarker.

Lumbar Lordosis Distribution in Asymptomatic Adult Volunteers: A Systematic Review.

Background: Restoring lumbar lordosis is important for adult spinal deformity surgery. Several reports have suggested that lumbar lordosis distribution has a significant impact on the outcome of surgery, including lumbar distribution index (LDI), proximal lumbar lordosis (PLL), and distal lumbar lordosis (DLL). The features of lumbar lordosis distribution are inconclusive in asymptomatic adults. Questions/Purposes: We sought to evaluate the variation of lumbar lordosis distribution (LDI, PLL, and DLL) and to identify associated factors in asymptomatic adult volunteers. Methods: We performed a systematic review of the Embase and Medline databases to identify studies in asymptomatic adult volunteers to evaluate lumbar lordosis distribution including LDI, PLL, and DLL. Results: Twelve articles met eligibility criteria and were included in our review. The respective pooled estimates of mean and variance, respectively, were 65.10% (95% confidence interval [CI]: 62.61-67.58) and 13.70% in LDI, 16.51° (95% CI: 5.54-27.49) and 11.46° in PLL, and 35.47° (95% CI: 32.79-38.18) and 9.10° in DLL. Lumbar lordosis distribution was associated with race, age, sex, body mass index, pelvic incidence, and Roussouly classification. Conclusions: This systematic review found that despite a wide variation in LDI and PLL, DLL is maintained in a narrower range in asymptomatic adult volunteers, especially in white populations. Distal lumbar lordosis may be a more reliable radiographic parameter to restore the lumbar lordosis distribution in preoperative planning.

Accuracies of various types of spinal robot in robot-assisted pedicle screw insertion: a Bayesian network meta-analysis.

BACKGROUND: With the popularization of robot-assisted spinal surgeries, it is still uncertain whether robots with different designs could lead to different results in the accuracy of pedicle screw placement. This study aimed to compare the pedicle screw inserting accuracies among the spinal surgeries assisted by various types of robot and estimate the rank probability of each robot-assisted operative technique involved. METHODS: The electronic literature database of PubMed, Web of Science, EMBASE, CNKI, WANFANG and the Cochrane Library was searched in November 2021. The primary outcome was the Gertzbein-Robbins classification of pedicle screws inserted with various operative techniques. After the data extraction and direct meta-analysis process, a network model was established in the Bayesian framework and further analyses were carried out. RESULTS: Among all the 15 eligible RCTs, 4 types of robot device, namely Orthbot, Renaissance, SpineAssist and TiRobot, were included in this study. In the network meta-analysis, the Orthbot group (RR 0.27, 95% CI 0.13-0.58), the Renaissance group (RR 0.33, 95% CI 0.14-0.86), the SpineAssist group (RR 0.14, 95% CI 0.06-0.34) and the conventional surgery group (RR 0.21, 95% CI 0.13-0.31) were inferior to the TiRobot group in the proportion of grade A pedicle screws. Moreover, the results of rank probabilities revealed that in terms of accuracy, the highest-ranked robot was TiRobot, followed by Renaissance and Orthbot. CONCLUSIONS: In general, current RCT evidence indicates that TiRobot has an advantage in the accuracy of the pedicle screw placement, while there is no significant difference among the Orthbot-assisted technique, the Renaissance-assisted technique, the conventional freehand technique, and the SpineAssist-assisted technique in accuracy.

Comparison of the feasibility of 3D printing technology in the treatment of pelvic fractures: a systematic review and meta-analysis of randomized controlled trials and prospective comparative studies.

PURPOSE: The objective of this meta-analysis was to assess the influence of 3D printing technology on the open reduction and internal fixation (ORIF) of pelvic fractures from current randomized controlled trials and prospective comparative studies. METHODS: In this meta-analysis, we conducted electronic searches of Pubmed, Embase, Cochrane library, Web of Science and CNKI up to February 2020. We collected clinical controlled trials using 3D printing-assisted surgery and traditional techniques to assist in pelvic fractures, evaluating the quality of the included studies and extracting data. The data of operation time, blood loss, follow-up function (Majeed function score), quality of fracture reduction (Matta score) and complications (infection, screw loosening, pelvic instability, venous thromboembolism, sacral nerve injury) were extracted. Stata 12.0 software was used for our meta-analysis. RESULTS: Five RCTs and 2 prospective comparative studies met our inclusion criteria with 174 patients in the 3D printing group and 174 patients in the conventional group. There were significant differences in operation time [SMD = - 2.03], intraoperative blood loss [SMD = - 1.66] and postoperative complications [RR = 0.17] between the 3D group and conventional group. And the excellent and good rate of pelvic fracture reduction in the 3D group [RR = 1.32], the excellent and good rate of pelvic function [RR = 1.29] was superior to the conventional group. CONCLUSIONS: The 3D group showed shorter operation time, less intraoperative blood loss, less complications, better quality of fracture reduction and fast function recovery. Therefore, compared with conventional ORIF, ORIF assisted by 3D printing technology should be a more appropriate treatment of pelvic fractures.

The effects of oyster shell/alpha-calcium sulfate hemihydrate/platelet-rich plasma/bone mesenchymal stem cells bioengineering scaffold on rat critical-sized calvarial defects.

Engineering scaffolds combining natural biomineral and artificially synthesized material hold promising potential for bone tissue regeneration. We fabricated a bioengineering scaffold, oyster shell (OS) and alpha-calcium sulfate hemihydrate (α-CSH) as scaffold, platelet-rich plasma (PRP) as provider of growth factors and bone mesenchymal stem cells (BMSCs) as seed cells, and determined it could be applied as a new type of bone graft substitutes by rat calvarial defects repairing experiment in vitro and in vivo. SEM showed that the mean diameter of the pores was about 150 µm with a range of 50-200 µm, and scaffold's porosity was ~27.4% by Archimedes' Principle. In vitro, Scaffold + BMSCs + PRP group presented a higher ALP activity compared with other groups by ELISA (P < 0.05). But the expression of OC was not detectable on day 4 or 8. The MTT assay showed that the relative cell number of BMSCs+PRP group increased significantly (P < 0.05). In vivo, the smallest defect area of skull and highest volume of regenerated new bone were observed in Scaffold + PRP + BMSCs group by X-ray and Micro-CT analysis (P < 0.05). And the similar results also were observed in HE and Masson staining. The immunohistochemistry staining for osteogenic marker proteins ALP and OC showed that the most obvious positive staining was observed in Scaffold + PRP + BMSCs group (P < 0.05). The expression of inflammatory markers IL-6 and TNF-α was the lowest in control group (P < 0.05). In conclusion, a bioengineering scaffold based on OS, created by simply combining α-CSH and PRP and implanting with BMSCs, could be clinically useful and has marked advantages as a targeted, off-the-shelf, cell-loaded treatment option for the bone healing of critical-size calvarial defects.

Crocin enhances the viability of random pattern skin flaps: involvement of enhancing angiogenesis and inhibiting oxidative stress.

The random pattern skin flap has been an important procedure in plastic and reconstructive surgery to cover various challenging defects. However, distal flap necrosis is problematic. Crocin is a natural carotenoid compound, which have been reported to possess a wide spectrum of properties and induce pleiotropic anti-inflammatory, anti-oxidative and cytoprotective effects. We explored whether crocin enhanced random skin flap survival. Thirty-six male SD rats were distributed to two groups randomly: the crocin and control groups. Flap survival areas were measured 7 days after surgery. Neutrophil numbers and microvascular density were evaluated via haematoxylin and eosin staining, and blood perfusion via laser Doppler imaging. Vascular endothelial growth factor (VEGF) levels were measured by immunohistochemical staining and Western blotting. We also measured the levels of markers of ischaemia-reperfusion injury [malondialdehyde (MDA) and superoxide dismutase (SOD)]. With regard to flap survival area assay, a significant between-group difference of survival area for the experimental flap was evident. As for flap blood flow test in Area II, the crocin group was statistically better than that of the control group. And in the histological result, the mean vessel density and VEGF level were statistically higher when treated with crocin. Crocin also decreased the MDA but increased the SOD level. Crocin thus improved random skin flap viability, enhancing angiogenesis and inhibiting ischaemia-reperfusion injury.

The efficacy and safety of tranexamic acid in the treatment of intertrochanteric fracture: an updated meta-analysis of 11 randomized controlled trials.

This meta-analysis was performed to investigate the efficacy and safety of tranexamic acid (TXA) in the elderly patients undergoing intertrochanteric fracture surgery from the current literatures. The electronic literature database of PubMed, Embase and Cochrane library were searched in October 2019. The intraoperative blood loss, hidden blood loss, postoperative drainage and total blood loss, postoperative hemoglobin, length of stay, transfusion rate, mortality rate, thromboembolic events and wound complications were extracted. Stata 14.0 software was used for our meta-analysis. A total of 11 RCTs (3 new RCTs in 2019) with 1202 patients met our inclusion criteria. This meta-analysis showed that administration of TXA can reduce intraoperative blood loss (P = 0.009), hidden blood loss (P = 0.000), total blood loss (P = 0.000), length of stay (P = 0.003), transfusion rate (P = 0.000) and the occurrence of wound complications (P = 0.006). Furthermore, administration of TXA was associated with an increase in the postoperative Hb level at day 1, 2 and 3 (P = 0.000, P = 0.000 and P = 0.000, respectively) after surgery. However, no significant difference was found between the TXA group and control group regarding the occurrence of thromboembolic events (P = 0.978, including deep vein thrombosis, P = 0.850; pulmonary embolism, P = 0.788; cerebrovascular accident, P = 0.549; myocardial infarction, P = 0.395) and mortality rate (P = 0. 338). Our meta-analysis suggested that administration of TXA is effective in reducing intraoperative blood loss, hidden blood loss, total blood loss, length of stay, transfusion rate, wound complications and enhancing postoperative Hb without increasing the risk of thromboembolic events and mortality rate in intertrochanteric fracture surgery. More large multi-center and high-quality RCTs are required for further research.

Metabolic Syndrome, as Defined Based on Parameters Including Visceral Fat Area, Predicts Complications After Surgery for Rectal Cancer.

BACKGROUND/OBJECTIVES: Metabolic syndrome (MetS) has become a major public health problem. However, few studies have examined the impact of MetS on the postoperative complications of colorectal cancer and the conclusions remain controversial. The present study aimed to investigate whether MetS, as defined based on visceral fat area (VFA) instead of BMI or waist circumference, would predict complications after surgery for rectal cancer. SUBJECTS/METHODS: We conducted a retrospective study of patients who underwent surgery for rectal cancer at our department between January 2013 and August 2018. Univariate and multivariate analyses evaluating the risk factors for postoperative complications were performed. A receiver operating characteristic curve analysis was used to determine the gender-specific cut-off values for VFA. RESULTS: A total of 381 patients were included in the study. The optimal cut-off values for VFA were 117.9 cm2 for men and 76.9 cm2 for women, and 153 patients were diagnosed as having MetS. The rate of postoperative complication was significantly higher in the MetS group than that in the non-MetS group (34.6% versus 15.8%, P < 0.001). The multivariate logistic regression analysis demonstrated that MetS (OR 3.712, P < 0.001), NRS 2002 scores ≥ 3 (OR 2.563, P = 0.001), and tumor located at the lower 1/3 (OR 3.290, P = 0.001) were independent risk factors for complications after surgery for rectal cancer. CONCLUSION: Metabolic syndrome, as defined based on parameters including visceral fat area, was an independent risk factor for complications after surgery for rectal cancer.

3D printing-based Ganz approach for treatment of femoral head fractures: a prospective analysis.

BACKGROUND: Femoral head fractures are uncommon injuries. Open reduction and internal fixation (ORIF) of femoral head fracture is the preferred treatment for most patients. There are several surgical approaches and treatments for this difficult fracture. However, the optimal surgical approach for the treatment of femoral head fracture remains controversial. Meanwhile, the operation is difficult and the complications are numerous. We prospectively reviewed patients with femoral head fractures managed surgically through the 3D printing-based Ganz approach to define a better approach with the least morbidity. PATIENTS AND METHODS: Between 2012 and 2017, a total of 17 patients were included in this study. An exact 1:1 3D printing model of the injured hip side was fabricated for each patient and simulated surgery was finished preoperative. The surgical approach was performed as described by Ganz. Functional assessment was performed using the modified Merle d'Aubigne scores. The reduction of the fracture was evaluated according to Matta's criteria. The incidence of complications, such as heterotopic ossification (HO) and avascular necrosis (AVN), and the need for additional surgery were also documented. RESULTS: Twelve of 17 patients (four females and eight males) were available for 2 years follow-up. The mean follow-up was 35 months (25-48 months). Average age for the 12 patients was 39.9 ± 12.2 years. According to the Pipkin classification, four patients were type I fracture, three patients were type II fracture, and five patients were type IV fracture. The mean operative time was 124.2 ± 22.1 min, and the estimated blood loss was 437.5 ± 113.1 ml. According to Merle d' Aubigne scores, excellent results were achieved in six of the 12 patients; four good and two poor results occurred in the rest of the patients. On the radiograph evaluation, fracture reduction was defined as anatomical in eight patients, and imperfect in four. Most patients had good outcomes and satisfactory hip function at last follow-up. Almost all great trochanteric osteectomy healed uneventfully. One patient developed symptomatic AVN of the femoral head and underwent THA at 3 years. After THA, she regained a good hip function with the ability to return to work and almost no reduction in sports activities. Heterotopic ossification was found in four cases (type I-1, type II-2, and type III-1). CONCLUSIONS: The 3D printing-based Ganz approach provides a safe and reliable approach and satisfactory results of treatment in femoral head fractures. Using 3D printed model for the fracture of the femoral head, the fracture can be viewed in every direction to provide an accurate description of fracture characteristics, which contributes to make a reasonable surgical plan for patients. In addition, the 3D printing-based Ganz approach can obtain excellent surgical exposure and protection of the femoral head blood supply, reduce the operation time and intraoperative blood loss, make the precise osteotomy, anatomically fix the intra-articular fragments, and effectively reduce postoperative complications. TRIAL REGISTRATION: We register our research at http://www.researchregistry.com . The Unique Identifying Number (UIN) from the Research Registry of the study is researchregistry4847 .

Factors associated with the decision for operative versus conservative treatment of displaced distal radius fractures in the elderly.

BACKGROUND: The treatment of senile distal radius fractures had not been clearly defined. The objective of this study was to identify the factors associated with the decision for operative treatment of displaced distal radius fractures in patients aged over 55 years. METHODS: Data of 318 patients with displaced distal radius fractures were collected on patient-, fracture- and surgeon-related characteristics that were plausibly related to the decision for operation. Mean comparisons or chi-squared test were used for univariate analysis of the above-mentioned factors, and then multiple logistic regression was used to identify factors associated with the decision for operation. RESULTS: Univariate analysis showed that age, osteoporosis, Charlson score, associated orthopaedic injuries requiring surgery, Orthopaedic Trauma Association (AO) and Fernandez classification, radial height, volar tilt, volar/dorsal comminution, ulnar variance, intra-articular displacement/step-off, associated distal radioulnar joint instability or radiocarpal joint dislocation and subspecialty of treating surgeons had statistically significant association with operative intervention. In the multivariate analysis, the predictors of operative intervention were younger patient age (P = 0.028), associated orthopaedic injuries requiring surgery (P = 0.020), higher AO classification (P = 0.037), higher Fernandez classification (P = 0.041), radial shortening >5 mm (P = 0.020), volar tilt > -10° (P = 0.020), volar/dorsal comminution (P = 0.020), ulnar variance >5 mm (P = 0.023), intra-articular displacement/step-off >2 mm (P = 0.004), associated distal radioulnar joint instability or radiocarpal joint dislocation (P = 0.047) and treatment by an upper extremity specialist (P = 0.038). CONCLUSION: The decision for surgery was predominantly influenced by the characteristics and severity of the fracture. Patients' age and treatment by an upper extremity specialist were also significant factors associated with a higher likelihood of operative intervention.

An injectable thermosensitive hydrogel for sustained release of apelin-13 to enhance flap survival in rat random skin flap.

With the advantage of handy process, random pattern skin flaps are generally applied in limb reconstruction and wound repair. Apelin-13 is a discovered endogenous peptide, that has been shown to have potent multiple biological functions. Recently, thermosensitive gel-forming systems have gained increasing attention as wound dressings due to their advantages. In the present study, an apelin-13-loaded chitosan (CH)/ß-sodium glycerophosphate (ß-GP) hydrogel was developed for promoting random skin flap survival. Random skin flaps were created in 60 rats after which the animals were categorized to a control hydrogel group and an apelin-13 hydrogel group. The water content of the flap as well as the survival area were then measured 7 days post-surgery. Hematoxylin and eosin staining was used to evaluate the flap angiogenesis. Cell differentiation 34 (CD34) and vascular endothelial growth factor (VEGF) levels were detected by immunohistochemistry and Western blotting. Tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were assessed by enzyme linked immunosorbent assays (ELISAs). Oxidative stress was estimated via the activity of tissue malondialdehyde (MDA) and superoxide dismutase (SOD). Our results showed that CH/ß-GP/apelin-13 hydrogel could not only reduce the tissue edema, but also improve the survival area of flap. CH/ß-GP/apelin-13 hydrogel also upregulated levels of VEGF protein and increased mean vessel densities. Furthermore, CH/ß-GP/apelin-13 hydrogel was shown to significantly inhibit the expression of TNF-α and IL-6, along with increasing the activity of SOD and suppressing the MDA content. Taken together, these results indicate that this CH/ß-GP/apelin-13 hydrogel may be a potential therapeutic way for random pattern skin flap.

Orthogonal plating method versus parallel plating method in the treatment of distal humerus fracture: A systematic review and meta-analysis.

PURPOSE: This systematic review and meta-analysis was performed to investigate the outcomes of orthogonal plating method and parallel plating method in the treatment of distal humerus fracture from the current literatures. METHODS: The electronic literature database of Pubmed, Embase, and Cochrane library were searched in November 2018. The data operation time, union time, Mayo Elbow Performance Score (MEPS), range of motion (ROM) of elbow, arc of elbow flexion, arc of elbow extension, rate of excellent and good results and complications (including heterotopic ossification, transient ulnar nerve neuropathy and ankylosis) were extracted. Stata 14.0 software was used for our meta-analysis. RESULTS: A total of 8 studies including 6 RCTs and 2 cohort studies met our inclusion criteria. This meta-analysis showed that there was no significant difference between the two groups regarding operation time, MEPS, ROM of elbow, arc of elbow flexion, arc of elbow extension and rate of excellent and good results at final follow-up (P = 0.50, P = 0.39, P = 0.87, P = 0.18, P = 0.58 and P = 0.59 respectively). However, the present meta-analysis demostrated that parallel plating method had significantly shorter union time than orthogonal plating method (P = 0.018). As for the complications (heterotopic ossification, transient ulnar nerve neuropathy and ankylosis), there was no significant difference between the two groups (P = 0.89, P = 0.08 and P = 0.29 respectively). CONCLUSION: Our meta-analysis suggested that both orthogonal plating and parallel plating method could achieve satisfactory outcomes with the similarly low complications in the treatment of distal humerus fracture. More RCTs are required for further research.

Evaluating the safety and feasibility of a new surgical treatment for forearm fractures in older children: study protocol for a randomised controlled trial.

BACKGROUND: Both-bone forearm fractures are a common fracture, accounting for 3.4% of all paediatric fractures. For now, elastic stable intramedullary nailing (ESIN) and open reduction and internal fixation (ORIF) are the common surgical procedures for paediatric both-bone forearm fractures. Both ORIF and ESIN have their shortcomings. Therefore, we need to find another surgical treatment which can decrease the rate of complications and improve the clinical efficacy. Our study plans to test hybrid fixation, using an ESIN fixation for the radius and an ORIF for the ulna. Our study will conduct a randomised controlled trial (RCT) comparing double plate fixation with hybrid fixation for treatment of both-bone forearm fractures in older children between 10 and 16 years of age. The objectives of this trial are to compare the effectiveness between double plate fixation and hybrid fixation for treatment of both-bone forearm fractures in older children. METHODS: An RCT will be conducted, and the participants included will be randomly divided into either the hybrid fixation group or the double plate fixation group, at a ratio of 1:1. The primary clinical outcome measures are the Disabilities of the Arm, Shoulder and Hand score and radiological evaluation. Secondary clinical outcome measures are intraoperative blood loss, surgical duration, visual analogue scale score after surgery, hospital duration after surgery and complications. Follow-up will be conducted at 2 weeks and 1, 3, 6 and 12 months postoperatively. DISCUSSION: The trial will provide a new surgical treatment for forearm fractures in older children. Our hypothesis is that there is no clinically relevant difference in the primary outcome measures between the two treatment groups. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1800018060. Registered on 26 August 2018.

Inhibiting the PI3K/AKT/NF-κB signal pathway with nobiletin for attenuating the development of osteoarthritis: in vitro and in vivo studies.

Osteoarthritis (OA), an age-related degenerative disease, is characterized by progressive degradation of the articular cartilage. There is increasing evidence that nobiletin (NOB) exerts special biological functions in a variety of diseases. However, whether it protects against OA remains unknown. In this study, we investigated the anti-inflammatory and chondroprotective effects of NOB on IL-1ß-induced human OA chondrocytes and in the surgical DMM mice OA models. In vitro, NOB treatment completely suppressed the overproduction of pro-inflammatory mediators, including PGE2, NO, COX-2, iNOS, TNF-α and IL-6 in IL-1ß-induced human OA chondrocytes. Moreover, NOB exerted a potent inhibitory effect on the expression of MMP-13 and ADAMTS-5 as well as the degradation of aggrecan and collagen-II, which leads to the degradation of the extracellular matrix. Furthermore, NOB dramatically suppressed the IL-1ß-stimulated phosphorylation of PI3K/Akt and activation of NF-κB in human OA chondrocytes. In addition, treatment with NOB not only prevented the destruction of cartilage and the thickening of subchondral bone but also relieved synovitis in mice OA models. In conclusion, our study suggests that NOB holds novel therapeutic potential for the treatment of OA.

Deltoid-split approach versus deltopectoral approach for proximal humerus fractures: A systematic review and meta-analysis.

PURPOSE: To investigate the evidence of deltoid-split approach (DS) versus deltopectoral approach (DP) in treatment of proximal humerus fractures from current RCT and prospective literatures. METHODS: The electronic literature database of Pubmed, Embase, and Cochrane library was searched at December 2017. The data complications (including implant failure, humeral head necrosis, infection, radiological adverse events, nonunion rate, subacromial impingement, and damage of the axillary nerve), functional outcomes (including Constant, NEER, DASH, ADL, VAS score), operation time, hospital stay and intraoperative blood loss were extracted and analyzed by STATA 11.0 software. RESULTS: Three RCTs and three prospective comparative studies were included in this meta-analysis. The meta-analysis showed that the DS group had a significantly low humeral head necrosis rate and short operation time. No significant difference was found in total complication rate, functional outcome, and other Perioperative parameters between DS and DP groups. CONCLUSION: The prospective evidence suggested that DS approach for proximal humerus fractures had less humeral head necrosis and short operation time than DP approach. Both DS and DP approach had similar results in functional outcomes, total complication, VAS, and hospital stay.

Intramedullary versus extramedullary fixation for the treatment of subtrochanteric fracture: A systematic review and meta-analysis.

PURPOSE: This meta-analysis was performed to investigate the outcomes of intramedullary fixation versus extramedullary fixation in the treatment of subtrochanteric fracture from the current literature. METHODS: The electronic literature database of PubMed, Embase, Cochrane library, CNKI and Wanfang were searched in December 2018. The data operation time, intraoperative blood loss, length of incision, length of stay, union time, rate of infection, rate of fixation failure, rate of refracture, rate of reoperation, rate of nonunion and rate of excellent and good results were extracted. Stata 14.0 software was used for our meta-analysis. RESULTS: A total of 11 studies including 8 RCTs and 3 cohort studies met our inclusion criteria. This meta-analysis showed that intramedullary fixation could achieve significantly shorter operation time (P = 0.000), less intraoperative blood loss (P = 0.000), shorter length of incision (P = 0.000) and length of stay (P = 0.001) with evidently lower rate of fixation failure (P = 0.001), rate of reoperation (P = 0.003) and higher rate of excellent and good functional results (P = 0.003) than extramedullary fixation for subtrochanteric fractures. However, no significant difference was found regarding union time (P = 0.17), rate of infection (P = 0.99), rate of refracture (P = 0.98) and rate of nonunion (P = 0.42) between the two groups. CONCLUSION: Our meta-analysis suggested that intramedullary fixation for subtrochanteric fracture might be superior to extramedullary fixation in term of shorter operation time, less intraoperative blood loss, shorter length of incision, length of stay and better functional outcomes. Meanwhile, intramedullary fixation had lower rate of fixation failure and reoperation. Therefore, we recommend intramedullary fixation as the treatment of subtrochanteric fracture. More large multi-center and high-quality RCTs are required for further research.

Management of distal radius fracture: A comparison of actual and theoretical treatments.

PURPOSE: The objective of this study was to explore whether there were any differences between the theoretical operative treatment of distal radius fractures according to AAOS guideline on basis of measurement of radiographs and the treatment they actually received in our institution. METHODS: From April 2015 to February 2018, a total of 693 patients with 697 fresh close adult distal radius fractures were evaluated retrospectively. Fractures were respectively grouped into categories by AAOS criterion and actually treatment. After gleaning demographic information and measuring radiographic items, all results were put into a database. Single factors analysis, Chi-square test and further logistic regression analysis were performed to determine correlations between actual and theoretical treatments. RESULTS: In all 240 fractures fulfilled at least one AAOS criterion for surgery, only 61 fractures actually received operation. And in the conservative group recommended by AAOS, 52 of 457 fractures actually were proceeded with surgery. There were slight correlation between AAOS guideline and actually operation (Phi = 0.181). From multivariable logistic regression analysis, Only one of three AAOS criterion was proved probable indicator of clinic treatment. Three factors, namely age, intra-articular step-off as well as with other fractures, were proved probable actually surgery indications (P < 0.05). CONCLUSIONS: AAOS surgery criteria of distal radius fractures were partially instructive, but not so precise predictors for actually operation. In the clinic, the choice of operative treatment correlated with multiple factors.

Comparison of suture button fixation and syndesmotic screw fixation in the treatment of distal tibiofibular syndesmosis injury: A systematic review and meta-analysis.

PURPOSE: This systematic review and meta-analysis was performed to investigate the outcomes of syndesmotic screw fixation versus suture button fixation in the treatment of distal tibiofibular syndesmosis injury from the current literature. METHODS: The electronic literature database of PubMed, Embase, and Cochrane library were searched in August 2018. The data on medial clear space, tibiofibular clear space, tibiofibular overlap, American Orthopaedic Foot and Ankle Society (AOFAS) scores and complications (including wound infection, local irritation or discomfort, screw loosening and screw breakage) were extracted. Stata 14.0 software was used for our meta-analysis. RESULTS: A total of 11 studies including 5 randomized controlled trials (RCTs) and 6 cohort studies met our inclusion criteria. This meta-analysis showed that there was no significant difference between the two groups regarding medial clear space (P = 0.54), tibiofibular clear space (P = 0.23) and tibiofibular overlap (P = 0.88) postoperatively. However, the present meta-analysis demonstrated that the suture button fixation group had significantly higher AOFAS scores than the syndesmotic screw fixation group at 3rd, 6th, 12th and 24th months postoperatively (P = 0.001, P = 0.006, P = 0.000 and P = 0.049 respectively). Besides, the time to full weight bearing in the suture button fixation group was significantly earlier than that in the syndesmotic screw fixation group (P = 0.000). As for the complications, the suture button fixation group had a lower rate of post-operative complication (screw loosening and screw breakage) compared with the syndesmotic screw fixation group (P = 0.048 and P = 0.000 respectively). CONCLUSION: Our meta-analysis suggested that suture button fixation could achieve significant higher AOFAS scores with a lower rate of postoperative complications and earlier time to full weight bearing in distal tibiofibular syndesmosis injury. More RCTs are required for further research.

With versus without bone grafts for operative treatment of displaced intra-articular calcaneal fractures: A meta-analysis.

PURPOSE: This meta-analysis aimed to investigate the effectiveness of operative treatment of intra-articular calcaneal fractures with bone grafts versus without bone grafts. METHODS: The electronic literature database of Pubmed, Embase, and Cochrane library were searched in April 2018. The data on Böhler angle, Gissane angle, calcaneal width, calcaneal height, AOFAS hindfoot scores and complications (including wound edge necrosis, wound infection, deep infection, hematoma and sural nerve injury) were extracted. The Stata 14.0 software was used for the meta-analysis. RESULTS: Nine studies including 6 RCTs and 3 retrospective cohort studies met our inclusion criteria. This meta-analysis showed that there was no significant difference between the two groups regarding the Böhler angle (P = 0.44), Gissane angle (P = 0.06), calcaneal width (P = 0.09) and calcaneal height (P = 0.44) postoperatively and at the last follow-up. However, the bone graft group had significantly higher AOFAS scores than the non-bone graft group (P < 0.05). No significant difference was found between the two groups in complications (P = 0.63). CONCLUSION: This meta-analysis suggested that operative treatment of intra-articular calcaneal fractures with bone grafts achieved better AOFAS scores than the non-bone graft group. The two groups had similar results in Böhler angle, Gissane angle, calcaneal width and calcaneal height. No increased risk of postoperative complications was identified. More RCTs are required for further research.

Three-dimensional printing assisted ORIF versus conventional ORIF for tibial plateau fractures: A systematic review and meta-analysis.

PURPOSE: The objective of this meta-analysis was to assess the influence of three dimensional printing technology on the open reduction and internal fixation (ORIF) of tibial plateau fractures from current randomized controlled trials and prospective comparative studies. METHODS: The electronic literature database of Pubmed, Embase, and Cochrane library were searched in January 2018. The data operation time, intraoperative blood loss, follow-up knee function (Rasmussen score, HSS) and complications (including infection, screw loosening, knee stiffness, knee instability, posttraumatic osteoarthritis, VTE) were extracted. Stata 12.0 software was used for our meta-analysis. RESULTS: 11 RCTs and 6 prospective comparative studies met our inclusion criteria with 358 tibial plateau fractures patients in the 3D group and 378 patients in the routine ORIF group. The meta-analysis showed that there were significant differences in operation time, intraoperative blood loss and bony union time between the 3D group and conventional group. As for the complications and follow-up function recovery evaluated by the excellent and good rate based on HSS and Rasmussen score, no significant differences were found. CONCLUSION: The 3D group showed shorter operation time, less intraoperative blood loss and faster union time for patients with tibial plateau fractures. Therefore, compared with conventional ORIF, ORIF assisted by three-dimensional printing technology should be a more appropriate treatment of tibial plateau fractures. Further large-sample randomized controlled trials are needed in the future to confirm the superiority of three-dimensional printing assisted ORIF.