The clinical outcomes and complications of combined fixation with cannulated screws and the modified Pyrford technique for the treatment of transverse patellar fractures: a case series study.

BACKGROUND: Transverse patellar fractures can be fixed using various techniques. The purpose of the current study was to assess the clinical outcomes and complication rate of a combined fixation technique using cannulated screws and the modified Pyrford technique with nonabsorbable polyester sutures. METHODS AND PATIENTS: Between January 2015 and February 2021, 26 transverse patellar fractures were fixed with this combined technique. Preoperative data were collected from patients with transverse patellar fractures who were followed up for at least 12 months. At each follow-up visit, plain radiographs were taken. At the 12-month postoperative follow-up, range of motion of the affected knee joint and clinical outcomes, as evaluated by the Bostman scoring system, were recorded. RESULTS: The average Bostman score at the 12-month postoperative follow-up was 28.3 ± 1.5. Furthermore, the average extension and flexion of the knee joint were 1.2 ± 2.1 and 125.6 ± 6.7 degrees, respectively. One patient experienced delayed bone union and one experienced superficial wound infection. There were no other postoperative complications. One patient required removal of the device for social-psychological reasons. CONCLUSIONS: The combined fixation technique with cannulated screws and the modified Pyrford technique with suture materials produced excellent clinical outcomes and a low rate of complications in the treatment of transverse patellar fractures.

Risk factors for clavicular midshaft fractures after hook plate fixation for the treatment of Neer type II clavicular fractures.

OBJECTIVE: Neer type II fractures are common, and hook plate fixation is one of the recommended treatments. Although clavicular midshaft fractures after hook plate fixation are rare, such fractures increase patients' suffering and worsen their functional outcomes. This study was performed to identify the risk factors for this complication. METHODS: From 2009 to 2018, 425 patients were admitted with Neer type II clavicular fractures. According to the selection criteria, 352 patients were included in this retrospective observational study. All patients were divided into either the complications group (patients with midshaft fractures) or the control group (patients without midshaft fractures). Data collected included patient demographics and surgical, hook plate, and screw characteristics. The chi-square test was used to conduct between-group comparisons of risk factors. Statistically significant variables were included in a logistic regression model. RESULTS: In both the complications group (n = 21) and control group (n = 331), significantly more patients of advanced age and significantly more patients treated with hook plates that were not bent during surgery developed midshaft fractures. CONCLUSION: The risk of a clavicular midshaft fracture after hook plate fixation may be significantly increased by advanced age or a lack of hook plate bending.

Comparison of the Posterior and Anterolateral Surgical Approaches in the Treatment of Humeral Mid-Shaft Fractures: A Retrospective Study.

BACKGROUND The aim of this study was to retrospectively assess and compare the functional outcomes and complications following anterolateral versus posterior surgical approaches for the treatment of mid-shaft fractures of the humerus. MATERIAL AND METHODS This study included 107 patients treated for mid-shaft fractures between May 2015 and July 2018. Demographic and surgical data were collected for each patient. During follow-up visits, radiographs were acquired and evaluated. The clinical outcomes of the involved joints were assessed by the Constant scoring system, range of motion (ROM), and the Mayo Elbow Performance Scoring system at the 12-month follow-up. RESULTS The posterior approach was performed in 57 patients with type A fractures (group I, n=28) and type B or C fractures (group III, n=29). The anterolateral approach was performed in 50 patients with type A fractures (group II, n=32) and type B or C fractures (group IV, n=18). There were no significant differences between group I and group II nor between group III and group IV with respect to patient demographic data, surgical data, Constant score, ROM, or Mayo Elbow Performance score. A significant difference in the total complication rate was observed between group I and II. CONCLUSIONS The anterolateral approach showed an advantage over the posterior approach for treating simple humeral mid-shaft fractures. However, this advantage was not observed in treating comminuted fractures.

A clinical pathway for pre-operative screening of COVID-19 and its influence on clinical outcome in patients with traumatic fractures.

PURPOSE: Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic. The toughest issue traumatic orthopaedic surgeons are faced with is how to maintain a balance between adequate COVID-19 screening and timely surgery. In this study, we described our experience with pre-operative COVID-19 screening in patients with traumatic fractures. Furthermore, we analysed the clinical results of fracture patients undergoing confined or emergency surgery during the COVID-19 outbreak. METHODS: This was a case series study. Patients with traumatic fractures who were admitted to our hospital for surgery were enrolled in this study during the COVID-19 outbreak from March to April 2020. All patients were enrolled and managed using the standardized clinical pathway we designed for preoperative COVID-19 screening. Clinical, laboratory and outcome data were analysed. RESULTS: The average surgery waiting time from injury to surgery was 8.7 ± 3.4 days. The average waiting time from admission to surgery was 5.3 ± 2.8 days. These average waiting times were increased by 4.1 days and 2.0 days, respectively, compared with 2019 data. Cardiovascular complications, venous thromboembolism and pneumonia occurred in one, two and one patient, respectively. Three and two patients developed pre-operative and postoperative fevers, respectively. CONCLUSIONS: We introduced a novel clinical pathway for pre-operatively screening of COVID-19 in traumatic orthopaedic patients. The delay in surgery caused by COVID-19 screening was minimized to a point at which reasonable and acceptable clinical outcomes were achieved. Doctors should pay more attention to perioperative complications, such as cardiovascular complications, venous thromboembolism, pneumonia and fever.

Comparison of Tension-Band Wiring With the Cable Pin System in Patella Fractures: A Randomized Prospective Study.

OBJECTIVES: To compare the outcome of tension-band wiring (TBW) with the cable pin system (CPS) for transverse fractures of the patella. DESIGN: Randomized prospective study. SETTING: Academic Level I trauma center. PATIENTS/PARTICIPANTS: From February 2008 to December 2011, 73 consecutive patients with transverse fractures of the patella were prospectively enrolled in this study. INTERVENTION: The patients were randomly divided into 2 groups: one group was treated using the CPS, and the other group was treated using the modified TBW. MAIN OUTCOME MEASUREMENTS: The clinical outcome assessment included analyses of the radiographic images, the modified Hospital for Special Surgery scoring system, and complications. RESULTS: The follow-up time ranged from 12 to 29 months. All fractures healed, with a union rate of 100%. The fracture healing time was significantly shorter in the CPS group (8.51 ± 2.59 weeks, n = 34) compared with the TBW group (11.79 ± 3.04 weeks, n = 39). Postoperative complications in the CPS and TBW groups were observed in 1 and 9 patients, respectively, a difference that was statistically significant. The mean Hospital for Special Surgery score for the CPS group (90.53 ± 5.19 points) was significantly higher than that for the TBW group (81.36 ± 12.71 points). CONCLUSIONS: The CPS is a viable option for transverse fractures of the patella and is associated with a shorter healing time, fewer complications, and better function than TBW. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

[Effects of calcitonin on osteoblast cell proliferation and OPG/RANKL expression: experiment with mouse osteoblasts].

OBJECTIVE: To investigate the effects of calcitonin on the proliferation of osteoblasts and the OPG/RANKL expression therein. METHODS: Osteoblasts were separated by enzyme digestion methods from the cranial bones of 30 newborn mice, cultured, and inoculated in 96-well plate. Calcitonin of the concentrations of 10, 40, and 80 IU/L was administrated into the culture medium for 24, 48, and 72 hours. The proliferation of osteoblasts was detected by MTT method. Flow cytometry was used to analyze the cell cycle. The mRNA expression of osteoprotegerin (OPG) and RANKL and protein expression of OPG were examined by RT-PCR and ELISA respectively. RESULTS: The proliferation rates of the osteoblasts exposed to the calcitonin of the concentrations of 40 and 80 IU/L for 24. 48, and 72 hours cell were all significantly higher than those of the blank control group (P < 0.05, P < 0.01). The index of osteoblasts at the G1 phase was significantly lower and the indexes of the osteoblasts at the S phase and G2-M phase were significantly increased after exposure to calcitonin (all P < 0.01). The OPG mRNA expression of the osteoblasts exposed to 80 IU/L calcitonin was significantly higher and the RANKL mRNA expression was significantly lower compared with the control group (P < 0.05). The OPG protein expression of the osteoblasts exposed to 80 LU/L calcitonin was significantly higher than that of the control group at different time points (P < 0.05, P < 0.01). CONCLUSION: Calcitonin increases the osteoblast proliferation and the OPG mRNA expression in the osteoblasts while RANKL mRNA expression in the osteoblasts is inhibited.

[Effects of carbon monoxide on polymorphonuclear leukocyte apoptosis stimulated by limb ischemia-reperfusion patient serum and the role of nuclear factor-kappaB].

OBJECTIVE: To explore the role of exogenous carbon monoxide (CO) in apoptosis of polymorphonuclear leukocyte (PMN) stimulated by ischemia-reperfusion (IR). METHODS: PMNs isolated from the venous blood of a healthy volunteer, incubated, put in 24-well plates, and randomly divided into 4 groups of 8 wells: control group (exposed to 5% CO2), control + CO group (exposed to 0.025% CO and 5% CO2 for I hour and then serum of healthy person was used to replace the culture fluid), IR group (exposed to 5% CO2 and then IR serum was used to replace the culture fluid), and IR + CO group (exposed to 0.025% CO and 5% CO2 for I hour and then serum of healthy person was used to replace the culture fluid). The IR serum was obtained from 8 male patients with osteoarthritis of knee undergoing knee replacement. After 24-hour incubation the PMNs underwent flow cytometry and electrophoresis to examine the apoptosis of PMNs. Electrophoretic mobility shift assay (EMSA) was used to detect the NF-kappaB binding activity. RESULTS: The PMN apoptotic rate of the IR + CO group was 9.38% +/- 1.58%, significantly higher than that of the control group (4.18% +/- 1.02%, P < 0.05). The PMN apoptotic rate of the IR group was 2.15% +/- 1.02%, significantly lower than that of the control group (P < 0.05). However, the PMN apoptotic rate of the control + CO group was 4.16% +/- 1.12%, not significantly different from that of the control group (P > 0.05). Electrophoresis showed that PMN apoptosis DNA ladder was seen in the control, control + CO, and IR + CO groups, but not in the IR group. EMSA showed that after co-incubation of PMN nuclear extract and isotope- labeled NF-kappaB probe in term of the strength of radiation self-development band the result the IR group was significantly greater than that of the control group, and the result of the IR + CO group was significantly lower than that of the IR group, however, there was no significant difference between the control and control + CO groups. CONCLUSION: Exogenous CO improves the inhibitory effect of IR blood on the PMN apoptosis with a mechanism of suppressing the NF-kappaB binding activity.

[Effects of 1,25-dihydroxyvitamin D3 on the expressions of osteoprotegerin and receptor activator of NF-kappaB ligand in mouse osteoblasts].

OBJECTIVE: To study the effects of 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] on the expression of osteoprotegerin (OPG) and receptor activator of NF-kappaB ligand (RANKL) mRNA in mouse osteoblasts. METHODS: Calvariae derived from CD-1 neonatal mouse (after born 24 h). Bone samples were processed by the collagenase/trypsin digestion method. Mouse osteoblasts were cultured in vitro. After 48 hours of addition of 1,25(OH)2D3 (0, 10(-8), 10(-9), 10(-11) mol/L) to the culture medium of mouse osteoblasts, the content of the OPG protein in culture medium was estimated with enzyme linked immunosorbent assay. Total RNA was prepared from mouse osteoblasts. mRNA expression of OPG and RANKL were detected by reverse transcription-polymerase chain reaction. RESULTS: The mRNA expression of OPG in osteoblasts added with 1,25(OH)2D3 significantly decreased compared with the controls, which was markedly dose-dependent. OPG protein production in the medium decreased after treatment with 1,25(OH)2D3. In contrast, RANKL mRNA expression levels in osteoblasts significantly increased after 48 h of culture with 1,25(OH)2D3. CONCLUSION: 1,25 (OH)2D3 can stimulate RANKL mRNA expression, but decrease OPG mRNA levels in vitro in mouse osteoblasts.