A Network Meta-analysis of Outcomes of 7 Surgical Treatments for Distal Radius Fractures.

To determinate the optimal treatment for distal radius fractures (DRF) by comparing the pin-track infection (PTI) rates in patients treated with 7 surgical techniques [bridging external fixation (EF), nonbridging EF, K-wire fixation, plaster fixation, dorsal plating, dorsal and volar plating, and volar plating]. After an exhaustive search of electronic databases for relevant published studies, high-quality randomized controlled trails were selected for the present network meta-analysis based on predefined selection criteria. Statistical analyses of the extracted data were conducted using Stata 12.0 software. After careful selection, 19 randomized controlled trails were included in our network meta-analysis and contained a combined total of 1805 subjects who underwent various surgical procedures. The network meta-analysis results showed that compared with bridging EF for treating DRF, the nonbridging EF, plaster fixation, volar plating, and dorsal and volar plating showed statistically significant differences in PTI rates. Importantly, the surface under the cumulative ranking curve values of the surgical interventions revealed that the PTI rates of plaster fixation and of dorsal and volar plating were the lowest, suggesting that these 2 surgical techniques are optimal for DRFs treatment, compared with the other methods. Our results suggest that plaster fixation and dorsal and volar plating are the best surgical treatments for DRFs compared with 5 other most common techniques. Thus, plaster fixation and dorsal and volar plating emerge as the most effective and credible treatments in consideration of PTI rates.

Antibiotic-impregnated cement spacer as definitive management for osteomyelitis.

BACKGROUND: Osteomyelitis is a challenge for orthopaedic surgeons. There is a lack of scientific evidence to guide treatment. The purpose of this study was to report the clinical outcome of unplanned retention of antibiotic-impregnated cement spacer (ACS) in the management of osteomyelitis. METHODS: Eight patients (7 with tibial infections and 1 with a calcaneal infection) with osteomyelitis received radical debridement and insertion of an ACS into the bone defect as the definitive management. The mean follow-up period was 2 years (6 months to 4 years). All of these patients had a cement spacer in place. RESULTS: No patient exhibited radiographic evidence of excessive bone loss. The patients reported no or occasional mild pain and exhibited complete weight-bearing abilities, with the exception of one patient who required a crutch because of a spinal cord injury. Signs of recurrence of the osteomyelitis were not noted in any of the patients, and no fractures occurred at last follow-up. CONCLUSION: Our study suggests that a proportion of patients with unplanned retention of ACS appear to function well without necessarily requiring further surgical intervention.

Diagnostic value of platelet indices in infected nonunion: a retrospective study.

BACKGROUND: The diagnostic value of platelet indices has been evaluated in various infectious diseases but not in infected nonunion. The purpose of this study was to assess the usefulness of platelet indices for diagnosis of infected nonunion after open reduction and internal fixation. METHODS: This retrospective study was performed in patients who underwent primary fracture nonunion revision surgeries from January 2016 to December 2021. A total of 297 patients were included in the study: 96 with infected nonunion (group A) and 201 with aseptic nonunion (group B). Receiver operator characteristic (ROC) curve analysis was performed to evaluate diagnostic value of each index. Area under the curve (AUC), sensitivity, specificity, and positive and negative predictive values were calculated and compared. RESULTS: Demographic characteristics were comparable between the two groups. White blood cell (WBC) count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), plasma fibrinogen, plasma D-dimer, platelet count (PC), plateletcrit, and ratio of platelet count to mean platelet volume (PC/MPV) were significantly higher, and MPV and platelet distribution width (PDW) significantly lower, in group A than in group B (P < 0.05). ROC analysis showed PC/MPV and plasma fibrinogen to have better diagnostic value than the other coagulation indicators (AUC of 0.801 and 0.807, respectively). The combination of ESR, plasma fibrinogen, and PC/MPV had good sensitivity and specificity for diagnosis of infected nonunion. PC/MPV had better diagnostic value than ESR and plasma fibrinogen in the subgroup of patients with coagulation-related comorbidities. CONCLUSIONS: Plasma fibrinogen and PC/MPV ratio might be useful parameters for early diagnosis of infected nonunion.

[Turning over rough surface of aponeurosis of gastrocnemius with fascia lata graft for Achilles tendon rerupture].

OBJECTIVE: To explore clinical effects of turning over rough surface of aponeurosis of gastrocnemius with fascia graft for Achilles tendon rerupture. METHODS: From July 2013 to April 2017, 11 patients with Achilles tendon reruptures were repaired by turning over rough surface of aponeurosis of gastrocnemius with fascia graft, including 10 males and 1 female aged from 25 to 48 years old. The patients were all manifested weakness of plantar flexion strength injured foot, and positive of single heel rise test before operation. Postoperative complications was observed, and AOFAS score at 6 months after operation was applied to evaluate clinical efficacy. RESULTS: All patients were followed up for 6 to 11 months. All wound were healed at stage I without skin necrosis, wound infection, deep vein thrombosis and rerupture. The length of tendon defect ranged from 4 to 7 cm, the full weight-bearing time ranged from 8 to 11 weeks. Postoperative AOFAS score at 6 months was for 79 to 100, and 9 patients got excellent results, and 2 good. CONCLUSIONS: For patients with recurrent ruptures of Achilles tendon, turning over rough surface of aponeurosis of gastrocnemius with fascia graft has advantages of stable repair, less complications and good recovery of function.

Common polymorphism in the LRP5 gene may increase the risk of bone fracture and osteoporosis.

The low-density lipoprotein receptor-related protein 5 gene (LRP5) was identified to be linked to the variation in bone mineral density and types of bone diseases. The present study was aimed at examining the association of LRP5 rs3736228 C>T gene with bone fracture and osteoporosis by meta-analysis. A systematic electronic search of literature was conducted to identify all published studies in English or Chinese on the association of the LRP5 gene with bone fracture and osteoporosis risks. All analyses were calculated using the Version 12.0 STATA software. Odds ratios (ORs) and their corresponding 95% confidence interval (95% CI) were calculated. An updated meta-analysis was currently performed, including seven independent case-control studies. Results identified that carriers of rs3736228 C>T variant in the LRP5 gene were associated with an increased risk of developing osteoporosis and fractures under 4 genetic models but not under the dominant model (OR = 1.19, 95% CI = 0.97~1.46, and P = 0.103). Ethnicity-subgroup analysis implied that LRP5 rs3736228 C>T mutation was more likely to develop osteoporosis and fractures among Asians and Caucasians in majority of subgroups. These results suggest that there is a modest effect of the LRP5 rs3736228 C>T on the increased susceptibility of bone fracture and osteoporosis.