Open reduction and internal fixation of humeral midshaft fractures: anterior versus posterior plate fixation.

BACKGROUND: Fractures of the humeral shaft represent 2-4% of all fractures. Fractures of the humerus have traditionally been approached posteriorly for open reduction and internal fixation. Reports of treating midshaft fractures with an open anterolateral approach and anterior plating are limited. The purpose of this study was to evaluate a series of humeral shaft fractures treated with plate osteosynthesis regarding the effect of the approach and plate location on the healing rate and occurrence of complications. METHODS: We conducted a retrospective chart review of patients aged over 18 years with humeral midshaft fractures treated with anterior or posterior plate fixation. Selection of the approach to the humerus was based on the particular pattern of injury and soft tissue involvement. The minimum follow-up duration was set at six months. The outcomes included the rate of union, primary nerve palsy recovery, secondary nerve damage, infection and revision surgery. RESULTS: Between 2006 and 2014, 58 patients (mean age, 59.9; range, 19-97 years) with humeral midshaft fractures were treated with anterior (n = 33) or posterior (n = 25) plate fixation. After a mean follow-up duration of 34 months, 57 of 58 fractures achieved union after index procedure. Twelve fractures were associated with primary radial nerve palsy. Ten of the twelve patients with primary radial palsy recovered completely within six months after the index surgery. In total, one patient developed secondary palsy after anterior plating, and three patients developed secondary palsy after posterior plating. No significant difference in the healing rate (p = 0.4), primary nerve palsy recovery rate (p = 0.6) or prevalence of secondary nerve palsy (p = 0.4) was found between the two clinical groups. No cases of infection after plate fixation were documented. CONCLUSIONS: Open reduction and internal fixation using an anterior approach with plate fixation provides a safe alternative to posterior plating in the treatment of humeral shaft fractures. An anterior approach allows supine positioning of the patient and yields union and complication rates comparable to those of a posterior approach with plate fixation for the treatment of humeral shaft fractures.

Clinical outcome and quality of life of patients with periprosthetic distal femur fractures and retained total knee arthroplasty treated with polyaxial locking plates: a single-center experience.

PURPOSE: The number of total knee arthroplasties (TKA) increased rapidly. In conjunction with higher implantation rates, periprosthetic femur fractures following TKA are also gradually increasing. Purpose of this study was to evaluate polyaxial locking plate treatment of periprosthetic femoral fractures with retained total knee replacement using polyaxial locking plates in regard to quality of life, functional outcome and complications. METHODS: The Study design is a single-center retrospective cohort analysis. Included were patients with periprosthetic supracondylar femoral fractures with a well-fixed knee prosthesis initially treated with NCB plate (Non-contact bridging plate, Zimmer Inc., Warsaw, IN). Primary outcome was measured including quality of life and functional status using the SMFA-D score (German short musculoskeletal function assessment questionnaire), the mortality rate and union rate. Formerly published SMFA-data presenting representative randomly chosen cross-sectional data from general population of the USA and Dutch population was used as historic control group. RESULTS: In total, 45 patients with a mean age of 74 years were included (10 males; 35 females). Body mass index averaged 27.4 kg/m2. Follow-up averaged 52 months. Comparison of the SMFA-D scores showed higher scores according to bother index (41.5 vs. 15.7/13.8) and function index (42.5 vs. 14.5/12.7). Mortality rate was 26.7%. The CCI was directly related to the mortality rate (p = 0.033). Union was achieved in 35 of 45 fractures (78%) six months after the index procedure. The ultimate union rate including following procedures at last follow-up was 95.6%. CONCLUSION: Besides already highlighted limitations in range of motion, we quantified patient-related limitations in daily living. A large number of patients after surgery are not self-reliant mobile or on orthopedic aids. A high CCI was directly related to the mortality rate and can be used as a predictive factor for postoperative mortality.

Zoledronic Acid Inhibits the Motility of Cancer Stem-like Cells from the Human Breast Cancer Cell Line MDA-MB 231.

BACKGROUND/AIM: Various effects on tumor cells have been described for zoledronic acid (ZOL). However, only limited data exist regarding its influence on the motility of tumor cells. Since migration of tumor stem cells is a decisive step in metastasis, we examined whether ZOL reduces their motility. MATERIALS AND METHODS: We investigated the effects of ZOL on stem-like progenitor cells obtained via the formation of spheroids from the human breast cancer cell line MDA-MB 231. Stem cell properties were verified by measurement of high CD44 expression and absence of CD24 expression. Motility was explored by time-resolved videography, protein expression by western blotting. RESULTS: ZOL strongly reduced the migration of stem-like progenitor cells. Cellular velocity was reduced by 61% following exposure to 1 µM ZOL and by 82% after exposure to 10 µM ZOL. Accumulated distance traveled by the cells was reduced by 60% and 79% after exposure to 1 µM and 10 µM ZOL, respectively. The remaining cellular motility led to very little change in distance, with cellular activity appearing more as "stepping on the spot". The reduced motility might be due to reduced phosphorylation of focal adhesion kinase (FAK), an important enzyme in cellular migration. CONCLUSION: ZOL reduces the motility and cellular velocity of breast cancer cells in vitro. The reduced mobility might slow down or even stop metastasis, which is a known result of adjuvant ZOL therapy in breast cancer patients. In vivo studies are warranted to evaluate the impact of the reduced motility on the metastatic cascade.