ABSTRACT
Objective:To evaluate the efficacy of orthogonal low profile double-plate osteosynthesis (DPO) in the treatment of Neer type IIB distal clavicular fractures.Methods:A retrospective case-control study was carried out to analyze the clinical data of 31 patients with Neer type IIB distal clavicular fractures admitted to Second Affiliated Hospital of Zhejiang University School of Medicine from June 2016 to October 2017. There were 23 males and 8 females, aged 45-76 years(mean, 61.8 years). The left side was involved in 24 patients and right sidein 7. Out Of them, 7 patients were treated with hook plate osteosynthesis (HPO) (HPO group), 13 patients with precontoured distal clavicular locking plate osteosynthesis (LPO) (LPO group), and 11 patients with DPO (DPO group). The Constant-Murley shoulder functional outcomes, clavicle-coracoids distance (CCD), complications and hardware related symptomswere compared between groups.Results:All the patients were followed up for 10-27months(mean, 15.1 months). At the latest follow-up, Constant-Murley score was (93.8±5.1)points in LPO group and (94.8±5.8)points in DPO group, better than (84.3±13.2)points in HPO group ( P<0.05), while there was no significant difference between DPO and LPO groups ( P>0.05). CCD was increased(1 patient in HPO group, 5 in LPO group, 3 in DPO group), but there was no significantdifference between groups( P>0.05). No infection or implant breakage occurred in each group. One patient had nonunion in HPO group, 1 had malunion at trapezoid ligament bony end in LPO group and all had bone union in DPO group, showing no significant difference between groups ( P>0.05). Two patients had acromial bone corrosion and 1 had distal clavicle osteolysisin in HPO group, but not in LPO and DPO groups ( P<0.05). Three patients had hardware related symptoms in HPO group, 6 in LPO group, and none in DPO group ( P<0.05). Conclusion:Orthogonal low profile DPO can be a good choice for the treatment of distal clavicle Neer type IIB fractures, for it has advantages of good functional outcomes, lower complications and less hardware related symptoms.
ABSTRACT
Objective To investigate the incidence of intercalary fragment in adult ankle fractures and analyze the morphological characteristics of intercalary fragment as well as its relationship with the type of posterior malleolus fractures.Methods Data of 247 cases with posterior malleolus fractures from 369 cases of adult ankle fractures who were treated from January 2014 to January 2016 were retrospectively analyzed.The pre-operative Ⅹ-ray and CT data of the group were analyzed,and the incidence of intercalary fragment was measured.The intercalary fragment was classified by position,size and shape of its morphological features.The posterior malleolus fracture was classified according to Bartonícek classification system.The relationship between type of posterior malleolar fracture and the intercalary fragment was studied.The incidence of malreduction was also studied using the criterion of more than 2 mm separation or step.Results One hundred and six cases had intercalary fragment,accounting for 42.91％ (106/247) of the posterior malleolus fracture,and 28.73％ (106/369) of all ankle fractures.There were 81 cases with intercalary fragment larger than 2 mm,accounting for 32.79％ (81/247) of the posterior malleolus fracture.There were 33 cases with intercalary fragment larger than 5 mm,accounting for 13.36％ (33/247) of the posterior malleolus fracture.The incidence of intercalary fragment occurred in the posterolateral side was 64.15％ (68/247).According to Bartonícek classification,the incidence of type Ⅰ,Ⅱ,Ⅲ,and Ⅳ posterior ankle fracture was 8.91％ (22/247),49.39％ (122/247),21.86％ (54/247),and 19.84％ (49/247),respectively.The incidence of intercalary fragment was 4.54％ (1/22) in type Ⅰ posterior ankle fractures,40.16％ (49/122) in type Ⅱ,70.37％ (38/54) in type Ⅲ,and 36.73％ (18/49) in type Ⅳ.The incidence in type Ⅲ posterior malleolus fracture was significantly higher than that of other types of posterior malleolus fracture.CT scan after operation was conducted in 43 cases in which 19 cases had their intercalary fragment malreducted,accounting for 44.19％(19/43).Conclusion Intercalary fragment has high incidence in the posterior malleolus fracture,and the highest incidence occurs in Bartoníeek Ⅲ type posterior malleolus fracture.The study helps to further understanding and treatment of the posterior malleolus fracture.
ABSTRACT
BACKGROUND:Basic fibroblast growth factor (bFGF) plays an important role in the ligament tissue healing process, and bone marrow mesenchymal stem cel s transfected with growth factors can be used as seed cel s in ligament tissue engineering. OBJECTIVE:To observe biological effect of bone marrow mesenchymal stem cel s transfected with recombinant adenovirus vectors carrying bFGF in three-dimensional co-culture with ligament fibroblasts. METHODS:Passage 3 bone marrow mesenchymal stem cel s were divided into three groups:control group, Ad-EGFP group and Ad-bFGF group. Under a phase contrast microscope, the changes in cel morphology were observed and the rate of transfection was analyzed by flow cytometry. Proliferation of bone marrow mesenchymal stem cel s and ligament fibroblasts was analyzed by MTS, the expression of bFGF protein in bone marrow mesenchymal stem cel s was determined by ELISA. Scleraxis, col agen type I, col agen type III, decorin and cartilage oligomeric matrix protein levels were detected in BMSCs and ligament fibroblasts using real-time fluorescent quantitative PCR. RESULTS AND CONCLUSION:Recombinant adenovirus-mediated bFGF gene could transfect bone marrow mesenchymal stem cel s efficiently. After co-culture for 3, 6 days, compared with the control group and Ad-EGFP group, in the Ad-bFGF group, the proliferation ability of bone marrow mesenchymal stem cel s and ligament fibroblasts was enhanced (P<0.01), the expression of bFGF protein in supernatant was obviously higher (P<0.01), the col agen type I, col agen type III, decorin and cartilage oligomeric matrix protein mRNA expression decreased in the ligament fibroblasts (P<0.01), but the mRNA expression of Scleraxis, col agen type I, col agen type III in bone marrow mesenchymal stem cel s increased (P<0.01). The results suggest that the co-culture of Ad-bFGF-transfected bone marrow mesenchymal stem cel s with ligament fibroblasts promotes the proliferation of ligament fibroblasts while decreases the col agen synthesis at the same time, and stimulates the proliferation and differentiation of bone marrow mesenchymal stem cel s into ligament fibrolasts.