Long stem revision versus short stem revision with plate osteosynthesis for Vancouver type B2 periprosthetic femoral fracture: a comparative study of eighty five cases.

PURPOSE: Periprosthetic femoral fractures (PPFs) around the hip are challenging complications in orthopaedic surgery, particularly Vancouver type B2 (VTB2) fractures. The surgical management of these fractures is crucial and depends on various factors. Cementless short taper stem with plate osteosynthesis is an alternative surgical technique. This study aims to compare the outcomes of this surgical technique with revision arthroplasty (RA) with long stem in the treatment of VTB2 PPFs. METHODS: This retrospective study was conducted in a single medical institute from February 2010 to May 2019. Patients who had received either total hip arthroplasty or bipolar hemiarthroplasty and subsequently developed a VTB2 PPF were included; patients who sustained intra-operative fractures or received a cemented stem previously were excluded from the analysis. The patients were divided into two groups: group I received RA with cementless long stem, while group II underwent RA with cementless short taper stem with plate osteosynthesis. Demographic data, radiographic and functional outcomes, and complications were analyzed between the two groups. RESULTS: A total of 85 patients diagnosed with VTB2 PPFs were included in the study. There were no significant differences between the two groups in terms of demographic data, including age, gender, mean follow-up times, estimated blood loss, and operative times. The radiographic results showed that there was no significant difference in the incidence of subsidence and implant stability between the two groups. However, group II tended to have less subsidence and periprosthetic osteolysis. Patients in group II had significantly better functional scores (mean Harris hip score: post-operative: 60.2 in group I and 66.7 in group ii; last follow-up: 77.4 in group 1 and 83.2 in group II (both p < 0.05)). There were no significant differences in the overall complication rate, including infection, dislocation, re-fracture, and revision surgery, between the two groups. CONCLUSIONS: Both surgical techniques, cementless long stem and cementless short taper stem with plate osteosynthesis, are effective in the treatment of Vancouver B2 PPFs, with no significant differences in outcomes or complications. However, patients in cementless short taper stem with plate osteosynthesis had better functional scores at both post-operative and the last follow-up.

Low Shear Stress Attenuates COX-2 Expression Induced by Resistin in Human Osteoarthritic Chondrocytes.

Low shear stress has been proposed to play a reparative role in modulating cartilage homeostasis. Recently, epidemiological studies have found a positive correlation between the resistin level in serum and synovial fluid and osteoarthritis (OA) severity in patients. However, the effect of moderate shear stress on the catabolic stimulation of resistin in OA chondrocytes remains unclear. Hence, this study was to investigate whether low shear stress could regulate resistin-induced catabolic cyclooxygenase (COX)-2 expression in human OA chondrocytes and the underlying mechanism. Human OA chondrocytes and SW1353 chondrosarcoma cells were used in this study. Two modes of low shear stress (2 dyn/cm2 ), pre-shear and post-shear, were applied to the chondrocytes. A specific activator and siRNAs were used to investigate the mechanism of low shear stress-regulated COX-2 expression of resistin induction. We found that human OA chondrocytes exposed to different modes of low shear stress elicit an opposite effect on resistin-induced COX-2 expression: pre-shear for a short duration attenuates the resistin effect by inhibiting the transcription factor nuclear factor (NF)-κB-p65 subunit and the cAMP response element binding protein; however, post-shear over a longer duration enhances the resistin effect by activating only the NF-κB-p65 subunit. Moreover, our results demonstrated that the regulation of both shear modes in resistin-stimulated COX-2 expression occurs through increasing AMP-activated protein kinase activation and then sirtuin 1 expression. This study elucidates the detailed mechanism of low shear stress regulating the resistin-induced catabolic COX-2 expression and indicates a possible reparative role of moderate shear force in resistin-stimulated OA development. J. Cell. Physiol. 232: 1448-1457, 2017. © 2016 Wiley Periodicals, Inc.

A comparative study of the hemodynamic and clinical effects of using or not tourniquet in total knee arthroplasty.

BACKGROUND: Pneumatic tourniquet is widely used in lower limb surgery to provide a bloodless operating field. Previous studies on total knee arthroplasty (TKA) in which tourniquets have been applied during surgery have reported some vascular and soft-tissue complications. Nevertheless, it is still not well known exactly how use of tourniquets contributes to hemodynamics of the lower limb and its clinical relevance following TKA. In this prospective study, we wished to determine whether tourniquet affects the hemodynamics and postoperative healing of the lower limb in the first few weeks and its clinical relevancies following TKA. METHODS: We prospectively collected consecutive 110 patients with advanced osteoarthritis of the knee. All the subjects were randomly assigned to one of two TKA procedures: TKA with (Group T) or without (Group O) tourniquets. The hemodynamics of each operated leg was assessed by Doppler, first before the operation, then postoperatively on days 2, 6, 14, and 28. The operative and postoperative managements were done the same as those described in the papers done by the author. Parameters during the operative and postoperative course, including, demography, pre- or postoperative knee score, tourniquet time, operation time, estimated blood loss, perioperative blood transfusion, hospital course, and complications will all be recorded and compared in detail. All patients were measured for all response variables, which included demographic variables, results of Doppler, and important surgical outcomes. Fisher's exact test was used to compare differences between the two groups for each discrete variable, and a Mann-Whitney Rank Sum Test was used to analyze each continuous variable. The p value was set for each test at 0.05 before analysis took place. In accordance with the repeated measures, the venous hemodynamic parameters were checked. If any significant differences appeared in the overall test, values were then compared in pairs using two sample t-tests for all statistical tests. The level of significance was set at p < 0.05. RESULTS: In our 110 patients (55 with tourniquet, 55 without), all checked clinical parameter were without significant difference except postoperative quadriceps muscle recovery. This implied tourniquet use influenced postoperative rehabilitation program. Blood loss amount were similar in both groups. There was only one DVT found. CONCLUSION: Tourniquet use in TKA must be managed very carefully. Not only because of immediate complication resulted from tourniquet but also influence on post-operational functional recovery, especially in quadriceps muscle function. According to this study, TKA without tourniquet use preserves better quadriceps muscle function to provide faster recovery and less transfusion need. It avoids complications from tourniquets as well.

The safety and cost-analysis of simultaneous versus staged bilateral total knee arthroplasty in a Taiwan population.

BACKGROUND: In patients with advanced osteoarthritis (OA) of the bilateral knees, uncertainty remains as to whether simultaneous bilateral total knee arthroplasty (SiTKA) or staged TKA (StTKA) is the treatment of choice. The purpose of this study was to investigate the safety and relative cost of SiTKA vs StTKA in Taiwan patients. METHODS: Using the Big Data Center of Taipei Veterans General Hospital, we retrospectively reviewed all patients who underwent SiTKA or StTKA due to OA or spontaneous osteonecrosis of the knee from January 2011 to December 2016. We assessed length of stay, transfusion rate, early postoperative complications, 30- and 90-day readmission rate, 1-year reoperation rate, and the indication for reoperation. Furthermore, we analyzed the total cost of the two groups, including reimbursement from the national health insurance (NHI), cost of the procedures, and net income from each case. RESULTS: A total of 2016 patients (1565 SiTKA and 451 StTKA) were included in this study. The two groups had no significant differences in rates of complications, 30- and 90-day readmission, or 1-year reoperation. The length of stay was on average 5.0 days longer for StTKA ( p < 0.01). In terms of cost, all categories of medical costs were significantly lower for SiTKA, while the net hospital income was significantly higher for StTKA. CONCLUSION: SiTKA is a safe and cost-effective surgery. Both SiTKA and StTKA have similar rates of postoperative complications, readmission and reoperation, but SiTKA significantly reduces medical expenses for both the patient and the NHI.

Comparison of articulating and static spacers regarding infection with resistant organisms in total knee arthroplasty.

INTRODUCTION: The result of treatment of infections involving antibiotic-resistant organisms in total knee arthroplasty (TKA) is often poor. We evaluated the efficacy of 2-stage revision in TKAs infected with resistant organisms and compared the clinical outcomes with articulating and conventional static spacers, in terms of both infection control and function. METHODS: In a prospective manner, from June 2003 to January 2007 selected patients with a TKA infected with resistant organisms were enrolled and treated with 2-stage re-implantation. The 45 patients were divided into 2 groups: group A (23 patients) implanted with the articulating spacers and group S (22 patients) implanted with static spacers. All patients followed the same antibiotic protocols and had the same re-implantation criteria. The efficacy of infection control was evaluated using re-implantation rate, recurrence rate, and overall success rate. The functional and radiographic results were interpreted with the Hospital of Special Surgery (HSS) knee score and the Insall-Salvati ratio. RESULTS: With mean 40 (24-61) months of follow-up, 22 of 23 knees were re-implanted in group A and 21 of 22 were re-implanted in group S. Of these re-implanted prostheses, 1 re-infection occurred in group A and 2 occurred in group S. Range of motion after re-implantation, the final functional scores, and the satisfaction rate were better in group A. One third of the patients in group S, and none in group A, had a patella baja. INTERPRETATION: After 2-stage re-implantation of TKAs originally infected with resistant organisms, the clinical outcome was satisfactory-and similar to that reported after treatment of TKAs infected with low-virulence strains. Treatment with an articulating spacer resulted in better functional outcome and lower incidence of patella baja.

Early full weight-bearing in patients with isolated displaced lateral malleolar fracture after rigid internal fixation with locking plates.

BACKGROUND: The timing of post-operative full weight-bearing in patients of isolated displaced lateral malleolar fractures remains controversial. The aim of this study was to evaluate the outcomes of early full weight-bearing after rigid internal fixation of such fractures with locking plates. METHODS: From 2012 to 2018, 46 patients who had closed isolated displaced lateral malleolar fractures were included in the study. All fractures were managed with open reduction and internal fixation with locking plates. The patients were allowed to walk bearing their full weight 2 weeks after the operation. The follow-up period was 41.5 months on average (range: 12-70 months). The patients were available to evaluate union conditions, functional results, and complications. RESULTS: The fractures united smoothly with an average union time of 10.5 weeks (range: 8-16). At the final follow-up, the average American Orthopaedic Foot and Ankle Score Ankle-Hindfoot Score was 91 (range: 85-98). No complications were observed. CONCLUSION: For patients with isolated displaced lateral malleolar fractures, full weight-bearing is safe and effective, without an increase in the rate of complications, 2 weeks after open reduction and rigid fixation with locking plates.

A surgical protocol of ankle arthrodesis with combined Ilizarov's distraction-compression osteogenesis and locked nailing for osteomyelitis around the ankle joint.

BACKGROUND: Managing refractory osteomyelitis around the ankle joint has been challenging. Destruction of both the ankle and the subtalar joints was common in cases of open fracture. For those who already had multiple surgeries, it would be tough to salvage the limb. Our goal was to set up a staged surgical protocol aiming in treating the aforementioned clinical issue. METHODS: Twelve male patients underwent our protocol since year 2000. All patients presented refractory osteomyelitis, ankle and subtalar joint destruction, and poor soft tissue condition. All cases had internal fixation for open fractures followed by multiple debridement surgery before. The mean age was 50.8 years (range, 37-71 years), and the median follow-up time was 61 months (range, 48-96 months). The surgical protocol consisted of radical debridement, distraction osteogenesis for segmental bone transport, and tibia lengthening to avoid leg length discrepancy followed by intramedullary nailing for tibio-talo-calcaneal arthrodesis. RESULTS: The external fixation period averaged 24.7 weeks (range, 12-36 weeks). The mean duration to solid union of the arthrodesis and the bridging callus was 18.3 weeks (range, 16-20 weeks). Mild surgical site infection occurred in four cases but all subsided after removal of the nail and oral antibiotics use. At latest follow-up, all patients were infection free and could walk with plantigrade feet. The mean American Orthopaedic Foot and Ankle Society hindfoot score rising from 21.5 points (range 20-24 points) preoperatively to 65.5 points (range, 60-72). CONCLUSIONS: This study has shown our staged surgical protocol may be effective in solving complicated osteomyelitis around the ankle, although salvaging the limb with successful ankle arthrodesis and minimized limb length inequality, yet improving the patients' ambulation level.

Risk factors in cutout of sliding hip screw in intertrochanteric fractures: an evaluation of 937 patients.

The aim of this study was designed to assess the risk factors of lag-screw cutout in the treatment of intertrochanteric fracture with a dynamic hip screw (DHS). From 2003 to 2007, 1,150 patients who had acute unilateral intertrochanteric fractures of the femur were enrolled to the study. All fractures were managed by closed reduction and internal fixation with 135° DHS devices. Patient demographics, fracture patterns, reduction and fixation and perioperative course parameters were all recorded. The follow-up period was 38 months on average (range 16-60 months). Finally, 937 patients were available for evaluation of final results in which we focused on lag-screw cutout. Excluding complications not related to screw position, 64 patients (6.8%) with screw cutout were encountered, and the remaining 873 patients had uneventful union, with the average union time of 17.5 weeks (range15-24 weeks). Upon analysis with logistic regression, the tip-apex distance (TAD) was shown to be the most important predictive factor for cutout, followed by screw position, fracture pattern, reduction and patient age. In order to decrease the risk of lag-screw cutout, it is important to ensure good fracture reduction and to place the lag screw in either the middle/middle or inferior/middle position with appropriate TAD.

Revision with dynamic compression plate and cancellous bone graft for aseptic nonunion after surgical treatment of humeral shaft fracture.

BACKGROUND: We evaluated the effect of revision with dynamic compression plate (DCP) and cancellous bone graft for aseptic nonunion after surgical treatments of humeral shaft fracture. METHOD: Eighty-six patients with aseptic nonunion of humeral shaft fracture after various surgical treatments were reviewed and analyzed retrospectively between January 1982 and August 2006. There were 59 men and 27 women with the average age of 42 years (range, 19-81 years). Thirty-one fractures were defined as atrophic nonunion, 45 fractures were hypertrophic nonunion, and 10 fractures could not be defined clearly. All the fractures were managed with removal of previous implants, open reduction and internal fixation with DCP, supplemented by cancellous bone graft. The follow-up period was 38 months in average (range, 12-288 months). Functional evaluations were done by Mayo Elbow Performance Index and the modified scale of Constant and Murley. RESULTS: All the nonunions united with the average union time of 18 weeks (range, 14-26 weeks). Complications included five temporary radial nerve palsies and two wound infections. In final follow-up, the shoulder and elbow functions of the operated limbs were all noted to be good or excellent. CONCLUSION: DCP with cancellous bone graft is a reliable and an effective treatment for revision of aseptic nonunion of humeral shaft fracture after surgical treatment.

Outcomes of common peroneal nerve lesions after surgical repair with acidic fibroblast growth factor.

BACKGROUND: There have been no clinical trials concerning the effect of acidic fibroblast growth factor (aFGF) on human peripheral nerve lesions. Our interest was focused on the question of whether a repair strategy incorporating growth factors could be applied to repair of common peroneal nerve lesions. METHODS: This study involved three groups of patients with common peroneal nerve lesions: group 1 (n = 21) received surgical repair with fibrin glue added with aFGF; group 2 (n = 8) received surgical repair only; group 3 (n = 16) did not receive any surgical intervention. All patients received electrophysiologic examinations and physical examination at baseline, 6 months, and 12 months postsurgically. RESULTS: Group 1 demonstrated significantly increased average muscle strength score by 0.4299 and 0.5045 at 6 and 12 months after the operation (p = 0.0197 and 0.0297, respectively). In groups 2 and 3 patients, however, significant increase of average muscle strength scores was not achieved either at 6 or 12 months postoperatively. During the first follow-up evaluation the average muscle strength score in group 1 (3.06 +/- 1.60) was significantly higher than those in group 2 (1.04 +/- 0.86) and group 3 (1.65 +/- 1.43) (p = 0.005). However, significant difference was not achieved during the second follow-up evaluation. CONCLUSION: This study demonstrated the potential of this innovative repair strategy with aFGF treatment to facilitate nerve regeneration and motor function recovery following peripheral nerve lesions.

Displaced isolated greater tuberosity fractures of elder adults treated with plate osteosynthesis.

BACKGROUND: We elucidated the effect of open reduction and internal fixation with locking plate for acute isolated displaced greater tuberosity fractures of humerus in elder adults (aged >60 years). METHODS: From 2009 to 2015, data from 32 patients, aged between 60 and 88 years, who had acute unilaterally displaced greater tuberosity fractures of humerus were collected and evaluated retrospectively. All the fractures were managed with open reduction and internal fixation with locking plate. The follow-up period was 50.8 months on an average (range 22-80 months). Finally, 25 patients were available for final evaluation of radiographic and functional results. RESULTS: All the 32 fractures had union with the average union time of 14 weeks (range 10-18 weeks) and with no complications. The average of preoperative Visual Analogue Scale (VAS) was 6.2 (range 4-8), ASES was 30.4 (range 13-45), and Constant score was 30.4 (range 20-45). At the last follow-up, the mean VAS was 1.3 (range 0-2.5), the mean ASES score was 90.1 (range 72-100), and the mean Constant score was 90.3 (range 80-100). There were statistically significant differences between preoperative and final follow-up in VAS, ASES, and Constant score. Hundred percent of patients had good or excellent results by Constant score, with excellent results (86-100) in 17 (68%) patients and good result (71-85) in 8 (32%). CONCLUSION: In conclusion, open reduction and internal fixation with locking plate is an effective treatment for acute displaced greater tuberosity fractures of humerus in elder adults.

Surgical treatment of basicervical fractures of femur--a prospective evaluation of 269 patients.

BACKGROUND: We elucidate the effect of surgical treatment of acute basicervical fractures of femur by closed reduction and internal fixation with dynamic hip screw (DHS). METHODS: From 1992 to 2004, 269 patients who had acute unilaterally basicervical fractures of femur were collected and evaluated prospectively. All the fractures were managed with closed reduction and internal fixation with DHS. The follow-up period was 74.7 months on average (range: 24-150 months). Finally, 241 patients were available for evaluation of union condition and 200 patients were available for evaluation of functional results and late complication. RESULTS: Five patients (1.66%) of nonunion and two patients (0.83%) of screw cutout were met. The other 235 patients had uneventfully union with the average union time of 16.5 weeks (range:14-24 weeks). No avascular necrosis of femoral head was noted. CONCLUSION: Surgical treatment of acute basicervical fractures of femur by closed reduction and internal fixation with DHS was shown to be very effective.

Chondrogenic Differentiation of Mesenchymal Stem Cells in Three-Dimensional Chitosan Film Culture.

Articular cartilage has a very limited capacity for self-repair, and mesenchymal stem cells (MSCs) have the potential to treat cartilage defects and osteoarthritis. However, in-depth mechanistic studies regarding their applications are required. Here we demonstrated the use of chitosan film culture for promoting chondrogenic differentiation of MSCs. We found that MSCs formed spheres 2 days after seeding on dishes coated with chitosan. When MSCs were induced in a chondrogenic induction medium on chitosan films, the size of the spheres continuously increased for up to 21 days. Alcian blue staining and immunohistochemistry demonstrated the expression of chondrogenic proteins, including aggrecan, type II collagen, and type X collagen at 14 and 21 days of differentiation. Importantly, chitosan, with a medium molecular weight (size: 190-310 kDa), was more suitable than other sizes for inducing chondrogenic differentiation of MSCs in terms of sphere size and expression of chondrogenic proteins and endochondral markers. We identified that the mechanistic target of rapamycin (mTOR) signaling and its downstream S6 kinase (S6K)/S6 were activated in chitosan film culture compared to that of monolayer culture. The activation of mTOR/S6K was continuously upregulated from days 2 to 7 of differentiation. Furthermore, we found that mTOR/S6K signaling was required for chondrogenic differentiation of MSCs in chitosan film culture through rapamycin treatment and mTOR knockdown. In conclusion, we showed the suitability of chitosan film culture for promoting chondrogenic differentiation of MSCs and its potential in the development of new strategies in cartilage tissue engineering.

Treatment of nonunion of humeral shaft fracture with dynamic compression plate and cancellous bone graft.

BACKGROUND: This study was conducted to evaluate the treatment of aseptic nonunion of the humeral shaft with a dynamic compression plate (DCP) and cancellous bone graft. METHODS: One hundred and five cases of nonunion of a humeral shaft fracture between 1982 and 2001 were analyzed retrospectively. The study population comprised 66 males and 39 females with an average age of 46.2 years (range, 17-81 years). Sixty-seven fractures were defined as atrophic nonunion, and 20 as hypertrophic nonunion, whereas 18 could not be defined clearly. All the fractures were managed by open reduction and internal fixation with DCP and cancellous bone graft. The mean follow-up period was 20 months (range, 14-28 months). RESULTS: All nonunion fractures united within an average of 16 weeks (range, 10-26 weeks). Complications included 4 patients with temporary radial-nerve palsies, and 3 patients with wound infections. At the final follow-up, shoulder and elbow functions of the operated limbs were all satisfactory. CONCLUSION: Fixation by DCP with supplemental cancellous bone graft is a reliable and effective treatment for nonunion of a humeral shaft fracture.

Surgical treatment of open diaphyseal fractures of both the radius and ulna.

BACKGROUND: This study was designed to determine the effects of surgical treatment of acute, open and displaced diaphyseal fractures of both the radius and ulna by early debridement, reduction and internal fixation with a dynamic compression plate (DCP). METHODS: From 1991 to 2003, data from 25 patients with acute, open and displaced diaphyseal fractures of both the radius and ulna were collected and evaluated retrospectively. Twenty-four patients were managed with early surgical debridement, open reduction and internal fixation with a DCP, and 1 fracture was reduced and fixed 3 days after the initial injury. The mean follow-up period was 74.7 months (standard deviation [SD], 38.6 months; range, 16-150 months). All patients had complete functional and radiographic assessments. RESULTS: Twenty-four patients (96%) achieved normal union in a mean of 20.2 weeks (SD, 3.8 weeks; range, 12-24 weeks). One patient with an open type I fracture had nonunion. Functional outcomes showed that 15 patients had excellent results, 8 had satisfactory results, 1 had an unsatisfactory result, and there was 1 failure. There was 1 delayed superficial wound infection. CONCLUSION: Early meticulous debridement, good open reduction and internal fixation with a small DCP proved very effective in the management of type I and II open fractures of both the radial and ulnar diaphyses.

Operative treatment of intra-articular distal radius fractures using the small AO external fixation device.

BACKGROUND: A retrospective group study was done to evaluate the effect of the small AO external fixator in the management of acute intra-articular fractures of the distal radius. METHODS: Between January 1995 and December 1996, 70 consecutive patients with articular fractures of the distal radius were treated by closed reduction and external fixation with small AO external fixators. The mean age at the time of surgery was 58.9 years (range, 14-87 years). There were 58 Colles' Barton's fractures and 12 Smith's Barton's fractures. The follow-up period was 104 months (range, 92-118 months). RESULTS: All fractures united in a mean of 5.8 weeks (range, 4-10 weeks). At the final follow-up, the average range of motion was 56.3 +/- 11.6 degrees in flexion, 58.6 +/- 10.7 degrees in extension, 21.5 +/- 4.2 degrees in ulnar deviation, 9.1 +/- 2.9 degrees in radial deviation, 71.5 +/- 8.5 degrees in pronation, and 67.3 +/- 9.2 degrees in supination. Compared with the normal side, the average grip force was 87 +/- 6%. The overall clinical and functional outcomes, according to the scoring system of Gartland and Werley, showed that 22 patients (31.4%) had excellent results, 36 (51.4%) had good results, 9 (12.9%) had fair results, and 3 (4.3%) had poor results. CONCLUSION: Closed reduction and external fixation with the small AO external fixator is useful and effective in the management of displaced comminuted articular fractures of the distal radius.

Cementless Acetabular Reconstruction for Arthropathy in Old Acetabular Fractures.

This study was conducted to identify the factors influencing mechanical failure of cementless acetabular reconstruction for arthropathy after operative treatment of acetabular fractures. Fifty-six patients (56 hips) undergoing cementless total hip arthroplasty were enrolled and followed for a mean of 120 months (range, 60-180 months). The 10-year survival rate, with mechanical failure (radiographic loosening or revision due to aseptic loosening) as the endpoint, was analyzed with respect to sex, age, body mass index (BMI), acetabular bone deficiency, sclerotic changes to the acetabulum, and use of the Trabecular Metal (TM) cup (Zimmer, Inc, Warsaw, Indiana). Mean 10-year survival rates of the acetabular component were as follows: 80% (range, 65%-96%) in males and 100% in females (P=.032); 77% (range, 60%-95%) in patients younger than 50 years and 91% (range, 82%-100%) in older patients (P=.027); 88% (range, 78%-98%) in patients with a BMI less than 30 kg/m(2) and 81% (range, 74%-89%) in patients with a BMI of 30 kg/m(2) or higher (P=.068); 54% (range, 32%-76%) in patients manifesting large acetabular deficiency and 90% (range, 78%-100%) in the remaining patients (P<.001); 78% (range, 65%-91%) in patients with the presence of sclerotic acetabulum and 92% (range, 86%-100%) in patients with the absence of sclerotic acetabulum (P=.022); and 82% (range, 73%-100%) in patients who received a conventional shell and 100% in patients who received the TM cup (P=.039). Male sex, age younger than 50 years, large acetabular deficiency, and sclerotic changes of the acetabulum were significant factors contributing to the mechanical failure of cementless acetabular reconstruction performed for old acetabular fractures treated with open reduction and internal fixation. Use of the TM cup seemed able to prolong the endurance of the acetabular component in the subsequent reconstruction.

Concomitant hip and distal radius fractures.

BACKGROUND: Concomitant ipsilateral hip and distal radius fractures are uncommon, and little research has been published about these injuries. Our aim was to evaluate the characteristics and results of treatment for these injuries. METHODS: Between 2006 and 2012, 35 concomitant hip and distal radius fractures were identified, comprising the study group. The characteristics and results of treatment for these injuries were evaluated and analyzed. Another matched control group with isolated hip fractures was collected for comparison of patient characteristics, fall mechanism, fracture pattern, bone density, and functional recovery. RESULTS: For the patients with concomitant fractures, the average age was 77.6 years, and the female-to-male ratio was 6:1 (30:5). The majority (91.4%) of patients sustained ipsilateral injuries. Among the controlled pairs, 20 (57.1%) patients in the study group sustained a backward fall, and 25 (71.4%) patients in the control group had a sideways fall. With respect to the pattern of hip fracture, 22 (62.9%) patients in the study group had femoral neck fractures and 20 (57.1%) patients in the control group had pertrochanteric fractures. The average hospital stay was 15.3 days in the study group versus 10.2 days in the control group. Twenty-five (71.4%) patients in the study group and 27 (77.1%) patients in the control group had osteoporosis. The average Barthel index score was 75.1 in the study group and 75.7 in the control group. CONCLUSION: Concomitant hip and distal radius fractures were generally ipsilateral and involved the femoral neck after a backward fall. These patients were younger than and not more osteoporotic than the population with isolated hip fractures; however, the hospital stay was significantly increased. The functional outcome was not influenced by concomitant wrist fracture.

Upregulation of Bone Morphogenetic Protein-2 Synthesis and Consequent Collagen II Expression in Leptin-stimulated Human Chondrocytes.

Bone morphogenetic proteins (BMPs) play positive roles in cartilage development, but they can barely be detected in healthy articular cartilage. However, recent evidence has indicated that BMPs could be detected in osteoarthritic and damaged cartilage and their precise roles have not been well defined. Extremely high amounts of leptin have been reported in obese individuals, which can be associated with osteoarthritis (OA) development. The aim of this study was to investigate whether BMPs could be induced in human primary chondrocytes during leptin-stimulated OA development and the underlying mechanism. We found that expression of BMP-2 mRNA, but not BMP-4, BMP-6, or BMP-7 mRNA, could be increased in human primary chondrocytes under leptin stimulation. Moreover, this BMP-2 induction was mediated through transcription factor-signal transducer and activator of transcription (STAT) 3 activation via JAK2-ERK1/2-induced Ser727-phosphorylation. Of note, histone deacetylases (HDACs) 3 and 4 were both involved in modulating leptin-induced BMP-2 mRNA expression through different pathways: HDAC3, but not HDAC4, associated with STAT3 to form a complex. Our results further demonstrated that the role of BMP-2 induction under leptin stimulation is to increase collagen II expression. The findings in this study provide new insights into the regulatory mechanism of BMP-2 induction in leptin-stimulated chondrocytes and suggest that BMP-2 may play a reparative role in regulating leptin-induced OA development.