Research progress on valgus impacted proximal humeral fractures / 中国修复重建外科杂志

OBJECTIVE@#To review the advancement made in the understanding of valgus impacted proximal humeral fracture (PHF).@*METHODS@#The domestic and foreign literature about the valgus impacted PHF was extensively reviewed and the definition, classification, pathological features, and treatment of valgus impacted PHFs were summarized.@*RESULTS@#PHF with a neck shaft angle ≥160° is recognized as a valgus impacted PHF characterized by the preservation of the medial epiphyseal region of the humeral head, which contributes to maintenance of the medial periosteum's integrity after fracture and reduces the occurrence of avascular necrosis. Therefore, the valgus impacted PHF has a better prognosis when compared to other complex PHFs. The Neer classification designates it as a three- or four-part fracture, while the AO/Association for the Study of Internal Fixation (AO/ASIF) categorizes it as type C (C1.1). In the management of the valgus impacted PHF, the selection between conservative and surgical approaches is contingent upon the patient's age and the extent of fracture displacement. While conservative treatment offers the advantage of being non-invasive, it is accompanied by limitations such as the inability to achieve anatomical reduction and the potential for multiple complications. Surgical treatment includes open reduction combined with steel wire or locking plate and/or non-absorbable suture, transosseous suture technology, and shoulder replacement. Surgeons must adopt personalized treatment strategies for each patient with a valgus impacted PHF. Minimally invasive surgery helps to preserve blood supply to the humeral head, mitigate the likelihood of avascular necrosis, and reduce postoperative complications of bone and soft tissue. For elderly patients with severe comminuted and displaced fractures, osteoporosis, and unsuitable internal fixation, shoulder joint replacement is the best treatment option.@*CONCLUSION@#Currently, there has been some advancement in the classification, vascular supply, and management of valgus impacted PHF. Nevertheless, further research is imperative to assess the clinical safety, biomechanical stability, and indication of minimally invasive technology.

Three-dimensional morphology of lateral malleolar fractures of Danis-Weber type B and its clinical implications / 中华创伤骨科杂志

Objective:To characterize the 3-D morphology of lateral malleolar fractures of Danis-Weber type B, especially the distribution of fracture apexes, for formulation of 3-D maps of fracture lines which may facilitate the treatment of the fractures.Methods:A retrospective study was conducted to analyze the CT tomography data of 114 patients who had been operatively treated for lateral malleolar fractures of Danis-Weber type B at Department of Orthopaedic Surgery, Yangpu Hospital from January 2017 to May 2022. There were 46 males and 68 females with a mean age of 61.5 (51.8, 68.0) years. The morphology of distal bone blocks was measured and positions of fracture apexes were observed on 3-D CT reconstruction. According to the positions of apex, the fractures were divided into 4 types: type Ⅰ with the apex located on the lateral ridge, type Ⅱ with the apex located on the posterolateral side, type Ⅲ with the apex located on the posterior ridge, and type Ⅳ with the apex located on the medial side. CT images of all fractures were superimposed on a standard template to create 3-D fracture line maps.Results:In this cohort, there were 7 cases of type Ⅰ (6.1%, 7/114), 65 cases of type Ⅱ(57.0%, 65/114), 39 cases of type Ⅲ (34.2%, 39/114) and 3 cases of type Ⅳ (2.6%, 3/114). In 49 cases (43.0%, 49/114), the fracture apex was not located on the posterolateral fibula (so that a conventional posterolateral steel plate cannot compress the apex). In fracture morphology of the 114 patients, the anterior fracture height, posterior fracture height, vertical fracture length, inclination angle, spiral angle, and apex spiral angle were, respectively, (-6.22±4.62) mm, (27.23±12.32) mm, (33.45±11.89) mm, 56.9°±9.6°, 269.8°±37.1°, and 156.2°±24.0°. The anterior fracture height, posterior fracture height, vertical fracture length, inclination angle, spiral angle, and apex spiral angle in type Ⅲ were all significantly larger than those in type Ⅱ ( P<0.05). The 3-D fracture line maps indicated that the lines of type Ⅲ fracture were steeper than those of type Ⅱ fracture. Conclusions:Since the apexes are not located on the posterolateral fibula in nearly half of the Danis-Weber type B lateral malleolar fractures, a conventional posterolateral steel plate cannot provide an effective anti-glide role. The higher a fracture line, the closer the fracture apex is to the posteriomedial fibula (posterior ridge and medial side). Fractures of type Ⅲ and type Ⅲ often indicate greater injury violence and more accompanying injuries.

Progress in research into the wedge effect during cephalomedullary nailing for intertrochanteric fractures / 中华创伤骨科杂志

Surgical intervention is the first choice treatment for intertrochanteric fractures that are common in clinical practice. Cephalomedullary nailing with two parts inserted respectively into the femoral medullary cavity and femoral head has been the mainstream protocols for the elderly patients with intertrochanteric fracture, but insertion of the cephalomedullary nail may likely lead to the outward displacement of the femoral shaft and the inversion and rotation of the head and neck bone mass, namely the so-called wedge effect. However, few reports have dealt with how to prevent the wedge effect and reduce the complications it may cause such as coxa vara deformity. The present review expounds and analyzes the concept, biomechanical mechanism, influencing factors, measurements, and prevention methods of the wedge effect, hoping to help the surgeons who try to avoid the wedge effect in surgical treatment.

Research progress in judgment criteria for reduction of femoral intertrochanteric fractures / 中华创伤骨科杂志

With accelerated aging process of the population, femoral intertrochanteric fractures have gradually become another major social health problem in China. Internal fixation is still the gold standard treatment for the fractures. Fracture reduction is the first step of the treatment and also the first element that affects the treatment efficacy. It is still controversial in clinical practice how to evaluate the quality of fracture reduction during internal fixation of the fractures. This article systematically expounds and analyzes the 7 systems of judging criteria for the reduction of intertrochanteric fractures from the aspects of fracture alignment, fracture apposition, difference in judgment criteria, and difference in imaging methods, in order to provide a reference for reaching consensus and improving curative effects.

The effect of bone morphogenetic protein-2 and osteoprotegerin in trans-sutural distraction osteogenesis / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To determine if locally administered bone morphogenetic protein-2 (BMP-2) and osteoprotegerin (OPG) improved osteogenesis and new bone formation by trans-sutural distraction osteogenesis.</p><p><b>METHODS</b>Twenty four dogs were divided into three groups randomly and received new internal trans-sutural distraction osteogenesis treatment. Five days after operation, infusion apparatus with double-tube was inserted to submucosa near the distracted zone to deliver controlled release agent of recombinant human bone morphogenetic protein-2/poly (lactic-co-glycolic acid)/fibrin sealant (rhBMP-2/PLGA/FS) in group A and group C. Recombinant human osteoprotegerin/fibrin sealant (rhOPG/ FS) was injected three weeks later in group B and group C. Histology staining and bone histomorphometry were used to measure the changes of maxillary bone sutura after distraction for 1, 2, 4 and 6 weeks.</p><p><b>RESULTS</b>New bone formation observed in distracted zone showed a significant increase in group A and C. Transmission electron microscope showed the osteoblast and osteocyte were active with dilated rough endoplasmic reticulum and a large number of chondriosomes and Golgi complex. After distraction for 6 weeks, indexes of osteoblast of group A, B, and C were 38.5 +/- 7.7, 35.7 +/- 6.5, and 41.7 +/- 11.0, indexes of osteoclast (Ioc) were 5.9 +/- 1.0, 1.2 +/- 0.3, and 2.8 +/- 0.4, bone trabecula thicknesses were (38.36 +/- 13.28), (66.20 +/- 9.16), and (51.85 +/- 9.92) microm respectively. Increased bone density and decreased Ioc were found in group B and C.</p><p><b>CONCLUSION</b>The new elastic distractor is effective in inducing new bone formation. BMP-2 and OPG combination acts synergistically, and leads to significant enhancement of bone formation and remodeling.</p>

Relationship between malunion of distal radius fracture and functional recovery / 中国矫形外科杂志

Malunion is one of common complications after distal radius fractures.It is indicated that malunion plays an important role in fracture recovery in many studies.This article sums up the research data,from aspects of both biomechanical analysis and follows-up of clinical cases,of domestic and foreign scholars in recent years,and reviews the influences of malunion on wrist joint functional outcome.

Level of serum soluble CD44v6 in patients with oral and maxillofacial malignancy / 实用口腔医学杂志

0.05). Serum sCD44v6 levels in patients with OSCC decreased after treatment (P