Percutaneous reduction and cannulated screw fixation assisted by 3D printing technology of calcaneal fractures in children.

BACKGROUND: Percutaneous reduction and cannulated screw fixation (PR + CSF) for treatment of calcaneal fractures in pediatric patients has been proven to achieve satisfactory outcomes with few complications. But it is also a difficult technology due to the limited exposure and surgeons are unable to reduce articular surface under direct vision. The purpose of this study was to analyze the outcomes of applying 3D printing technology to preoperative preparation and Intraoperative operating for the treatment of calcaneal fractures in children. METHODS: Pediatric patients with calcaneal fractures from January 2010 to December 2018 were reviewed during study period. Preoperative radiographs and computed tomography scans were collected to classify the fractures, reconstruct 3D printed model and evaluate postoperative outcomes. The blood loss, operative time, number of fluoroscopies, surgeon and patient satisfaction were used to assess the effectiveness, feasibility and safety of 3D printing technology. Functional results were measured by American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score. RESULT: 12 patients (10 boys and 2 girls) with 17 fractures were involved in our study. There were significant differences in the average Böhler angle before operation compared with that after operation and at last follow-up (P < 0.001). Similarly, the calcaneal height and length postoperatively and at the end of follow-up time were proved to have significant difference (P < 0.05) compared to preoperative. CT scan showed good reduction of the posterior facet according to Goldzak index. The average subjective AOFAS hindfoot score was 94.1. Both patients and surgeon made sense of the 3D printed model that can help them getting more information about the factures and making preoperative plans. No wound complication was found in this study. CONCLUSION: This study indicated that percutaneous reduction and cannulated screw fixation (PR + CSF) assisted by 3D printing technology in the treatment of calcaneal fractures in pediatric patients achieve good outcomes, with specific preoperative preparation, satisfactory functional recovery and fewer complications. LEVEL OF EVIDENCE: III.

Percutaneous reduction, cannulated screw fixation and calcium sulfate cement grafting assisted by 3D printing technology in the treatment of calcaneal fractures.

BACKGROUND: Percutaneous reduction, cannulated screw fixation and calcium sulfate cement grafting (PR + CSC) for treatment of displaced and intra-articular calcaneal fractures (DIACFs) is a difficult technique, because the minimally invasive treatment has limited exposure and cannot be used to reduce articular surface under direct vision. The goal of this study was to apply 3D printing technology to preoperative planning and surgery of DIACFs, and to evaluate its effectiveness, feasibility and safety in fracture repair. METHODS: We enrolled 81 patients with DIACFs in the study from August 2015 to August 2017. Patients with DIACFs in our hospital were randomly divided into the 3D printing group (40 cases) and the conventional group (41 cases). The operation duration, blood loss volume and the number of fluoroscopy were compared. Radiological results were evaluated using radiographs and functional results were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) score. The complications were also assessed. In addition, we made a questionnaire to verify the usefulness of the 3D printed model for both doctors and patients. RESULTS: The operation duration, blood loss volume and the number of fluoroscopy in 3D printing group were significantly less than that in the conventional group. Besides, 3D printing group achieved significantly better radiological results than conventional group both postoperatively and at the final follow-up except the calcaneal width at the final follow-up. The AOFAS score in the 3D printing group was significantly higher than that in the conventional group. In addition, the questionnaire from doctors and patients exhibited high scores of overall satisfaction of the 3D printed models. As for complications, there was no significant difference among the two groups. CONCLUSION: This study suggested the clinical feasibility of PR + CSC assisted by 3D printing technology in the treatment of DIACFs. LEVEL OF EVIDENCE: II.

Catastrophic costs of tuberculosis care in a population with internal migrants in China.

BACKGROUND: The internal rural-to-urban migration is one of the major challenges for tuberculosis (TB) control in China. Patient costs incurred during TB diagnosis and treatment could cause access and adherence barriers, particularly among migrants. Here, we estimated the prevalence of catastrophic costs of TB patients and its associated factors in an urban population with internal migrants in China. METHODS: A cross-sectional survey was conducted to enroll culture-confirmed pulmonary TB patients in Songjiang district, Shanghai, between December 1, 2014, and December 31, 2015. Consenting participants completed a questionnaire, which collected direct and indirect costs before and after the diagnosis of TB. The catastrophic cost was defined as the annual expenses of TB care that exceeds 20% of total household disposable income. We used logistic regression to identify factors associated with catastrophic costs. RESULTS: Overall, 248 drug-susceptible TB patients were enrolled, 70% (174/248) of them were from migrants. Migrant patients were significantly younger compared to resident patients. The total costs were 25,824 ($3689) and 13,816 ($1974) Chinese Yuan (RMB) in average for resident and migrant patients, respectively. The direct medical cost comprised about 70% of the total costs among both migrant and resident patients. Overall, 55% (132 of 248) of patients experienced high expenses (>10% of total household income), and 22% (55 of 248) experienced defined catastrophic costs. The reimbursement for TB care only reduced the prevalence of catastrophic costs to 20% (49 of 248). Meanwhile, 52% (90 of 174) of the internal migrants had no available local health insurance. Hospitalizations, no available insurance, and older age (> 45-year-old) contributed significantly to the occurrence of catastrophic costs. CONCLUSIONS: The catastrophic cost of TB service cannot be overlooked, despite the free policy. Migrants have difficulties benefiting from health insurance in urban cities. Interventions, including expanded medical financial assistance, are needed to secure universal TB care.

Biomechanical Analysis of a Novel Syndesmotic Plate Compared With Traditional Screw and Suture Button Fixation.

Many lateral malleolus fractures have been found to have syndesmosis injuries after anatomic reduction. The main methods for the treatment of syndesmosis injuries are screw fixation and suture-button flexible fixations. In pursuit of innovation, we have designed a novel syndesmotic plate (NSP) for simultaneous fixation of lateral malleolus fractures and distal tibiofibular syndesmosis injuries. The purpose of this study is to compare the biomechanical characteristics of the NSP to syndesmotic screw and suture-button fixations. Twelve adult cadaveric specimens were used in this experiment. Axial loading as well as rotation torque were applied in 3 different ankle positions: neutral, dorsiflexion, and plantarflexion. After the initial specimens were tested, they were made into a pronation-abduction III fracture model as described by Lauge-Hansen. Subsequently, the specimens were fixed sequentially using a distal fibular anatomic locking plate (DFALP) combined with syndesmotic screws, DFALP combined with suture button, and NSP. Then the above tests were repeated. The syndesmotic displacement and the strain of the tibia and fibula were recorded during the experiment. In most cases, the displacements and strains of the NSP group and the screw group were smaller than the suture button groups and the native (SBGAN) (p < .05), and the displacements and strains of the NSP group were also slightly smaller than the screw group in most cases, and there was no significant difference between the 2 groups. The NSP we developed has a fixed strength no less than the traditional syndesmotic screw fixation. This provides us a new idea for the treatment of distal tibiofibular syndesmosis injuries.

Interference Screw for the Treatment of Pediatric Flexible Flatfoot.

Flexible flatfoot is a common deformity in the pediatric population and can cause a range of symptoms and reduce the quality of life. Subtalararthroereisis may be appropriate for pediatric population whose conservative management had failed to relief their symptoms typically for at least 6 months. Subtalararthroereisis has been developed for a long time, but the use of interference screw for the treatment of pediatric flexible flatfoot has not been reported. From January, 2016 to June, 2017, we operated on 21 children (39 feet) between the ages of 8 and 14 years. The clinical assessment was based on the American Orthopedic Foot and Ankle Society (AOFAS) hind-foot scale and the Chippaux-Smirak Index (CSI) measurements. And the anatomical parameters assessment was based on the radiographs and photographs. The postoperative AOFAS scores and CSI measurements were improved compared with preoperative AOFAS scores and CSI measurements. Postoperative anatomical parameters achieved significantly better results than preoperative anatomical parameters. In conclusion, the use of interference screw in subtalararthroereisis for the treatment of pediatric flexible flatfoot deformity is an effective, simple and minimally invasive solution.

Acute acromioclavicular joint dislocation treated with tightrope : Mini-open versus percutaneous stabilization.

The purpose of this study was to compare prospecti- vely the radiographic and clinical results of patients treated with tightrope through either mini-open or percutaneous stabilization for acute AC joint injuries. Eighty patients were included in this study and were randomly divided into two groups. Group A included 40 injuries treated with mini-open repair. Group B consisted of 40 injuries treated with percutaneous stabilization. Demographic and clinical data were comparable between the two groups before surgery (P>0.05). Peri-operative data, complications and clinical outcomes between the two groups were compared. The average follow-up time of Group A, was 26.5±4.3 months and Group B, was 25.2±5.6 months (P>0.05). The mean operative time was 63.2±9.6 minutes and 45.6±7.1 minutes, and the mean incision length was 6.0±1.5 cm and 4.0±0.8 cm, respectively. The operative time and incision length were significantly longer in Group A (both P<0.05). However, the radiological assessment revealed no significant difference in the coracoclavicular (CC) distance between the two groups (P>0.05). The rate of loss of reduction in the Group A was similar to that in Group B (6/40 vs. 5/40, P>0.05). Both methods were efficient methods for acute AC joint dislocation. However, percutaneous fixation had the advantages of a shorter surgical time and smaller incision length.

Effect of Hypoxia on Self-Renewal Capacity and Differentiation in Human Tendon-Derived Stem Cells.

BACKGROUND Hypoxic conditions play roles in functioning of human tendon-derived stem cells (hTSCs). The goal of this study was to investigate the effect of various hypoxic conditions in self-renewal capacity and differentiation of TSCs. MATERIAL AND METHODS hTSCs was obtain from supraspinatus tendon donors. Colony formation and cell proliferation assay were used to assess the self-renewal of hTSCs. qRT-PCT and Western blot analysis were used to examine stemness and multi-differentiation potential of hTSCs. RESULTS We found that culturing at 5% O2 is more beneficial for the self-renewal of hTSCs than the other 3 culture conditions, with larger colony size and numbers. The proliferation of hTSCs in 5%, 10%, and 20% O2 cultures increased after seeding. The number of cells in the 5% O2 condition was higher than that in other culture; however, self-renewal capacity of hTSCs in 0.5% O2 was inhibited. The expression levels of stem cell markers, including NS, Nanog, Oct-4, and SSEA-4, were highest in 0.5% O2 culture. Furthermore, hTSCs cultured in 20% O2 exhibited significantly higher expression of the 3 markers (PPAR-γ, Sox-9, and Runx-2). CONCLUSIONS Hypoxic condition of culture encouraged self-renewal capacity of hTSCs, but inhibited their multi-differentiation potential, compared to normoxic condition of culture. Moreover, excessively low oxygen concentration impaired the capacity of hTSCs.

Comparison of percutaneous cannulated screw fixation and calcium sulfate cement grafting versus minimally invasive sinus tarsi approach and plate fixation for displaced intra-articular calcaneal fractures: a prospective randomized controlled trial.

BACKGROUND: The management of displaced intra-articular calcaneal fractures (DIACFs) remains challenging and controversial. A prospective randomized controlled trial was conducted to compare percutaneous reduction, cannulated screw fixation and calcium sulfate cement (PR+CSC) grafting with minimally invasive sinus tarsi approach and plate fixation (MISTA) for treatment of DIACFs. METHODS: Ultimately, 80 patients with a DIACFs were randomly allocated to receive either PR+CSC (N = 42) or MISTA (N = 38). Functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores. Radiological results were assessed using plain radiographs and computed tomography (CT) scans, and postoperative wound-related complications were also recorded. RESULTS: The average time from initial injury to operation and the average operation time in the PR+CSC group were both significantly shorter than those in the MISTA group (p < 0.05). There were significantly fewer complications in the PR+CSC group than those in the MISTA group (7.1 % vs 28.9 %, p < 0.001). The calcaneal width immediate postoperatively and at the final follow-up in the MISTA group were obviously improved compared to those in the PR+CSC group (p < 0.001). The variables of sagittal motion and hindfoot motion of the AOFAS scoring system in the PR+CSC group were significantly higher than those in the MISTA group (p < 0.05). The good and excellent results in the two groups were comparable for Sanders Type-II calcaneal fractures, but the good to excellent rate in the MISTA group was significantly higher for Sanders Type-III fractures (p < 0.05). CONCLUSION: The clinical outcomes are comparable between the two minimally invasive techniques in the treatment of Sanders Type-II DIACFs. The PR+CSC grafting is superior to the MISTA in terms of the average time between initial injury and operation, operation time, wound-related complications and subtalar joint activity. However, the MISTA has its own advantages in improving the calcaneal width, providing a more clear visualization and accurate reduction of the articular surface, especially for Sanders Type-III DIACFs. TRIAL REGISTRATION: ChiCTRIOR16008512 . 21 May 2016.

[Prevalence and risk factors of latent tuberculosis infection in close contacts of tuberculosis patients among non-resident populations in Shanghai, China].

OBJECTIVE: To investigate the prevalence of latent tuberculosis (TB) infection (LTBI), and to identify the risk factors in close contacts of pulmonary TB patients among non-resident population in Shanghai. METHODS: The study subjects were the close contacts of pulmonary TB patients among non-resident populations in Xuhui, Minhang and Songjiang Districts in Shanghai from 2013 to 2014.Questionnaire interview was applied to collect the socio-demographics, TB-related clinical and TB exposure information from the enrolled TB patients and their close contacts. The T-SPOT.TB test was used to identify the infection of M. TB. LTBI was defined as a positive T-SPOT.TB result inthe absence of signs and symptoms related to TB. RESULTS: In total, 182 pulmonary TB patients and 360 close contacts were enrolled in the present study. The mean age of the close contacts was (34±14) years(range, 2-83 years), including 160 men and 200 women. The T-SPOT.TB test and TB related examination revealed that 17.2% (62/360) of the close contacts were latently infected with M. TB. All the LTBI subjects were household contacts (χ(2)=16.814, P<0.001). In multivariate analysis, the risk of LTBI was statistically associated with the presence of TB symptoms of the index case (OR=2.696, 95%CI: 1.060-6.857) and duration of exposure (OR=1.007, 95%CI: 1.001-1.014); whereas there were no statistically significant associations among age, gender, diagnostic delay of index case, environment of contact place and the risk of LTBI among the studied close contacts. CONCLUSIONS: The prevalence of LTBI in close contacts of pulmonary TB patients among non-resident population in Shanghai is 17.2%.Contact with patients with TB symptoms and longer duration of exposure might increase the risk of LTBI.

Transmission of Mycobacterium tuberculosis in China: a population-based molecular epidemiologic study.

BACKGROUND: Understanding the transmission of Mycobacterium tuberculosis is essential for the development of efficient tuberculosis control strategies. China has the second-largest tuberculosis burden in the world. Recent transmission and infection with M. tuberculosis, particularly drug-resistant strains, may account for many new tuberculosis cases. METHODS: We performed a population-based molecular epidemiologic study of pulmonary tuberculosis in China during 1 July 2009 to 30 June 2012. We defined clusters as cases with identical variable number tandem repeat genotype patterns and identified the risk factors associated with clustering, by logistic regression. Relative transmission rates were estimated by the sputum smear status and drug susceptibility status of tuberculosis patients. RESULTS: Among 2274 culture-positive tuberculosis patients with genotyped isolates, there were 705 (31.0%) tuberculosis patients in 287 clusters. Multidrug-resistant (MDR) tuberculosis (adjusted odds ratio [aOR], 1.86; 95% confidence interval [CI], 1.25-2.63) and infection with a Beijing family strain (aOR, 1.56; 95% CI, 1.23-2.96) were associated with clustering. Eighty-four of 280 (30.0%) clusters had a putative source case that was sputum smear negative, and 30.6% of their secondary cases were attributed to transmission by sputum smear-negative patients. The relative transmission rate for sputum smear negative compared with sputum smear-positive patients was 0.89 (95% CI, .68-1.10), and was 1.51 (95% CI, 1.00-2.24) for MDR tuberculosis vs drug-susceptible tuberculosis. CONCLUSIONS: Recent transmission of M. tuberculosis, including MDR strains, contributes substantially to tuberculosis disease in China. Sputum smear-negative cases were responsible for at least 30% of the secondary cases. Interventions to reduce the transmission of M. tuberculosis should be implemented in China.

Piperine inhibits LPS induced expression of inflammatory mediators in RAW 264.7 cells.

The aim of the present study was to investigate the effects of piperine on the inflammatory responses to lipopolysaccharide (LPS) in RAW264.7 cells and the signal transduction pathways involved. RAW264.7 cells were pretreated with piperine at 10, 50 or 100 µg/ml and subsequently stimulated with LPS (1 µg/ml) for 24 h. We found that piperine inhibited the production of prostaglandin E2 (PGE2) and nitric oxide (NO) induced by LPS. Piperine significantly decreased LPS-stimulated gene expression and production of tumor necrosis factor-alpha (TNF), inducible NO synthase (iNOS) and COX-2 in RAW264.7 cells. Piperine inhibited the LPS-mediated activation of nuclear factor-kappa B (NF-kappaB) by suppressing the degradation of inhibitor-κB proteins (IκB) and the translocations of p65 subunit of NF-kB from the cytosol to the nucleus. Our results demonstrate the anti-inflammatory activity of piperine in RAW264.7 cells; suggesting that piperine may be a potential agent in the treatment of inflammation.

Endobutton technique for dynamic fixation of traumatic symphysis pubis disruption.

Plate fixation, the conventional treatment for traumatic symphysis pubis disruption, carries the risk of implant failure and demands extensive exposure. The goal of the present study was to evaluate the outcome of dynamic fixation with the Endobutton CL, which has a long successful record in anterior cruciate ligament reconstructions. Twenty-one APC-II injuries were treated from January 2006 to December 2009. The mean duration of follow-up was 23 months (18 to 26). All patients received Endobutton fixation. The incision length was 6.8 +/- 13 cm. The external blood loss was 106 +/- 15 mL. The average surgical time was 63 +/- 12 min. The symphysis distance after reduction was 4.1 +/- 1.2 mm. The symphysis distance at final visit was 4.2 +/- 1.2 mm. Loss of reduction was not significant during bone healing (p = 0.09). The Majeed scoring was excellent in 15 patients, good in 5 patients and fair in 1 patient. One malreduction was seen; there was no implant failure. Our results indicate that Endobutton fixation of the pubic symphysis might be used in the treatment of APC-II injuries.

Discrepancy in the transmissibility of multidrug-resistant mycobacterium tuberculosis in urban and rural areas in China.

The fitness of multidrug-resistant tuberculosis (MDR-TB) is thought to be an important determinant of a strain's ability to be transmitted. Studies in the laboratory have demonstrated that MDR-TB strains have reduced fitness but the relative transmissibility of MDR-TB versus drug-susceptible (DS) TB strains in human populations remains unresolved. We used data on genomic clustering from our previous molecular epidemiological study in Songjiang (2011-2020) and Wusheng (2009-2020), China, to compare the relative transmissibility of MDR-TB versus DS-TB. Genomic clusters were defined with a threshold distance of 12-single-nucleotide-polymorphisms and the risk for MDR-TB clustering was analyzed by logistic regression. In total, 2212 culture-positive pulmonary TB patients were enrolled in Songjiang and 1289 in Wusheng. The clustering rates of MDR-TB and DS-TB strains were 19.4% (20/103) and 26.3% (509/1936), respectively in Songjiang, and 43.9% (29/66) and 26.0% (293/1128) in Wusheng. The risk of MDR-TB clustering was 2.34 (95% CI 1.38-3.94) times higher than DS-TB clustering in Wusheng and 0.64 (95% CI 0.38-1.06) times lower in Songjiang. Neither lineage 2, compensatory mutations nor rpoB S450L were significantly associated with MDR-TB transmission, and katG S315 T increased MDR-TB transmission only in Wusheng (OR 5.28, 95% CI 1.42-19.21). MDR-TB was not more transmissible than DS-TB in either Songjiang or Wusheng. It appears that the different transmissibility of MDR-TB in Songjiang and Wusheng is likely due to differences in the quality of the local TB control programmes. Suggesting that the most effective way to control MDR-TB is by improving local TB control programmes.

Genotypic and spatial analysis of transmission dynamics of tuberculosis in Shanghai, China: a 10-year prospective population-based surveillance study.

Background: With improved tuberculosis (TB) control programs, the incidence of TB in China declined dramatically over the past few decades, but recently the rate of decrease has slowed, especially in large cities such as Shanghai. To help formulate strategies to further reduce TB incidence, we performed a 10-year study in Songjiang, a district of Shanghai, to delineate the characteristics, transmission patterns, and dynamic changes of the local TB burden. Methods: We conducted a population-based study of culture-positive pulmonary TB patients diagnosed in Songjiang during 2011-2020. Genomic clusters were defined with a threshold distance of 12-single-nucleotide-polymorphisms based on whole-genome sequencing, and risk factors for clustering were identified by logistic regression. Transmission inference was performed using phybreak. The distances between the residences of patients were compared to the genomic distances of their isolates. Spatial patient hotspots were defined with kernel density estimation. Findings: Of 2212 enrolled patients, 74.7% (1652/2212) were internal migrants. The clustering rate (25.2%, 558/2212) and spatial concentrations of clustered and unclustered patients were unchanged over the study period. Migrants had significantly higher TB rates but less clustering than residents. Clustering was highest in male migrants, younger patients and both residents and migrants employed in physical labor. Only 22.1% of transmission events occurred between residents and migrants, with residents more likely to transmit to migrants. The clustering risk decreased rapidly with increasing distances between patient residences, but more than half of clustered patient pairs lived ≥5 km apart. Epidemiologic links were identified for only 15.6% of clustered patients, mostly in close contacts. Interpretation: Although some of the TB in Songjiang's migrant population is caused by strains brought by infected migrants, local, recent transmission is an important driver of the TB burden. These results suggest that further reductions in TB incidence require novel strategies to detect TB early and interrupt urban transmission. Funding: Shanghai Municipal Science and Technology Major Project (ZD2021CY001), National Natural Science Foundation of China (82272376), National Research Council of Science and Technology Major Project of China (2017ZX10201302-006).

Percutaneous treatment of calcaneus fractures associated with underlying bone cysts.

BACKGROUND: Calcaneal bone cysts with pathological fractures are rare. There is no clear consensus on their management with a few reports of open curettage, bone grafting and internal fixation in the treatment of pathological calcaneal fractures. No minimally invasive management has been reported before. METHODS: We reviewed our experience in treating five patients with pathologic calcaneus fractures associated with pre-existing bone cysts who underwent percutaneous cyst curettage, fracture reduction, screw fixation and calcium sulfate cement injection between 2004 and 2009. RESULTS: All of the pathologic fractures healed with satisfactory radiological results. There were no soft tissue complications or cyst recurrences. Partial weightbearing with plaster cast immobilization was allowed at 4 weeks postoperatively and full weightbearing was allowed at 6 weeks postoperatively. CONCLUSION: This percutaneous technique provided a minimally invasive option for treatment of a calcaneal bone cyst with pathologic fracture.

[Spatial distribution and risk factors of tuberculosis in Songjiang district, Shanghai during 2006 and 2009].

OBJECTIVE: To identify spatial distribution and risk factors among tuberculosis (TB) cases in Songjiang district, Shanghai, 2006 - 2009. METHODS: All active TB cases and all bacteriologically confirmed TB cases diagnosed during the period from 2006 to 2009 were recruited into the study. Spatial scan statistics were used to identify spatial clusters. Using logistic regression, we compared the demographic and clinical characteristics of TB cases in spatial clusters versus TB cases not in spatial clusters. RESULTS: A total of 1815 active TB cases and 730 bacteriologically confirmed TB cases were recruited during 2006 - 2009. Chedun township and Xinqiao township was detected to be a spatial cluste (RR = 1.38, LLR = 16.78, P < 0.01), which was the location of the municipal industrial zone. No spatial cluster was found during 2006 - 2007, while during 2008 - 2009 Chedun township was detected to be a spatial cluster (RR = 1.70, LLR = 15.06, P < 0.01). Among resident population, the spatial cluster of TB cases was located in the southwestern part of Songjiang district, which included five townships Xinbang, Shihudang, Xiaokunshan, Maogang and Yongfeng (RR = 1.49, LLR = 10.52, P < 0.01); while among migrant population, the spatial cluster of TB cases was located in Chedun township (RR = 1.55, LLR = 15.64, P < 0.01). There were higher proportions of resident TB cases who were farmers (AOR = 4.9, 95%CI: 1.9 - 12.3) or had other occupations (AOR = 2.6, 95%CI: 1.1 - 5.9) in the spatial cluster. There were higher proportions of migrant TB cases who lived here for less than 5 years (< 1 year: AOR = 5.9, 95%CI: 1.8 - 19.5; 1 - 5 years: AOR = 3.2, 95%CI: 1.0 - 9.9) or worked at other occupations (AOR = 2.8, 95%CI: 1.5 - 5.1) and lower proportions of migrant TB cases who came from Eastern region (AOR = 0.3, 95%CI: 0.1 - 0.8) or Middle region (AOR = 0.5, 95%CI: 0.3 - 0.9) in the spatial cluster. CONCLUSION: In Songjiang district there was a spatial cluster in TB cases, which was Chedun township. Local residents with TB who were farmers or had other occupations were more likely to be in the spatial cluster. Migrants with TB who lived here for less than 5 years or came from Western region were more likely to be in the spatial cluster.

The percutaneous oval forceps suture-guiding method with anchor nails for Achilles tendon repair.

BACKGROUND: Acute Achilles tendon rupture (AATR) is a common injury of the foot and ankle. So far, the optimal management of AATR remains controversial. The target of the present retrospective study was to describe a new operative technique for percutaneous repair of AATR and evaluate efficacy of the technique. METHODS: In the present study, 32 patients were enrolled with AATR treated with the percutaneous oval forceps suture-guiding method with anchor nails from Jan 2014 to Jan 2017. The operation duration and length of incision were collected. The functional outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) score, Achilles tendon total rupture score (ATRS), range of motion (ROM) of the ankle and plantar flexion strength ratio at the last follow-up. The postoperative sports activity level and complications were also recorded. RESULTS: The mean operation duration and length of incision were 24.5 min and 2.0 cm. Whilst patient reported outcome questionnaires like AOFAS and ATRS showed good results, ROM of the ankle was quite low with only 16.5 degrees. Plantar flexion strength ratio was lower post surgery, as well. As for the postoperative sports activity level: 26/32 cases (81.3%) returned to former sports activity level; 4/32 cases (12.5%) showed a decline in sports activity level; 2/32 cases (6.2%) gave up on sports. The overall complication rate was 6.2%, one sural nerve damage and one fusiform thickening were found in the study. CONCLUSION: The percutaneous oval forceps suture-guiding method with anchor nails is a new considerable surgery method with adequate healing rates and an alternative to existing surgical procedures.

Comparison of percutaneous screw fixation and calcium sulfate cement grafting versus open treatment of displaced intra-articular calcaneal fractures.

BACKGROUND: The conventional treatment for displaced intraarticular fractures of the calcaneus (DIACF), with open reduction and internal plate fixation (ORIF), carries the risk of wound infection and delayed recovery. Alternatively percutaneous fixation techniques offer the possibility of equivalent outcomes in with a reduction in soft tissue complications. The goal of the present study was to evaluate the outcome of percutaneous reduction (PR), screw fixation, and calcium sulphate cement (CSC) grafting in the treatment of DIACF. METHODS: Ninety patients were randomly assigned to PR and CSC grafting or ORIF between January 2006 and August 2008. The blood loss, Böhler's angle, calcaneal width, length, height and articular congruity of the posterior facet, wound complication, range of joint motion were compared, function scores such as American Orthopaedic Foot and Ankle Society score (AOFAS) and Maryland foot score (MFS) were measured. RESULTS: The quality of reduction was not significantly different between the two groups. There were significant differences favoring PR in blood loss (p < 0.01), range of joint motion (p < 0.01), AOFAS (p < 0.01) and MFS (p < 0.01) between the two groups. Postop infection was 12% ORIF and 3% PC (p = 0.23). Earlier weightbearing in the PR group did not result in a greater frequency of redisplacement than in the OR group. CONCLUSION: Our results indicate that compared with ORIF, the percutaneous reduction, fixation and CSC grafting for treatment of DIACF might allow accelerated weightbearing activity, reduce joint stiffness and improve the patients' satisfaction.

[Comparison of two minimally invasive internal fixed methods for the treatment of distal tibio-fibula fractures].

OBJECTIVE: To compare the outcome of two minimally invasive internal fixed methods for the treatment of distal tibio-fibula fractures. METHODS: The clinical data of 50 patients with distal tibio-fibula fractures from March 2006 to March 2009 was analyzed retrospectively. Twenty-eight patients were treated with minimally invasive percutaneous locking compression plate fixing tibia combining elastic stable intramedullary nailing fixing fibular (Group P + E). There were 18 male and 10 female patients with a mean age of (45 ± 6) years. Twenty-two patients were treated with interlocking intramedullary nail fixing tibia combining elastic stable intramedullary nailing fixing fibular (Group N + E). There were 12 male and 10 female patients with a mean age of (43 ± 9) years. The index of peri-operation, pain score at 3 d postoperative, bone union time, the clinical outcomes and complications postoperative were statistically compared. RESULTS: There were no statistical significance on operation time, blood loss perioperative and pain score at 3 d postoperative. Bone union time in Group N + E was significantly longer than in Group P + E [(21.1 ± 3.0) weeks vs. (15.4 ± 2.9) weeks]. Meanwhile, the function of ankle score (44.3 ± 1.7 vs. 41.8 ± 2.5) and the line of foot score (8.6 ± 2.3 vs. 6.8 ± 3.6) in Group P + E were respectively significantly higher than that in Group N + E. However, there were no statistical difference on ankle pain, buckling add stretch restricted, turn inward add evaginate restricted and the rate of good and fair between the two groups. There were 3 cases of complications postoperation in Group P + E, significantly less than the 8 cases of Group N + E. CONCLUSIONS: Minimally invasive percutaneous locking compression plate fixing tibia combining elastic stable intramedullary nailing fixing fibular shows superiority in treatment of distal tibio-fibula fractures. However, interlocking intramedullary nail fixing tibia combining elastic stable intramedullary nailing fixing fibular has the advantages in worse soft tissue and multi-step tibio-fibula fractures.

Comparison between Percutaneous Screw Fixation and Plate Fixation via Sinus Tarsi Approach for Calcaneal Fractures: An 8-10-Year Follow-up Study.

OBJECTIVE: To assess the long-term outcomes after percutaneous reduction (PR) and screw fixation versus plate fixation via the sinus tarsi approach (STA) for displaced intra-articular calcaneal fractures (DIACF). METHODS: This retrospective study included a total of 150 patients (June 2008-August 2011), comprising 85 men and 65 women (mean age, 38.4 years), who were assigned to the PR group or the STA group. The inclusion criteria were DIACF (>2 mm) including Sanders type II and III, closed fracture, unilateral fracture, no history of smoking or no smoking during hospitalization and 3 months after surgery, and follow-up time not less than 8 years. The exclusion criteria were clear surgical contraindications (severe cardiovascular and cerebrovascular diseases), local or systemic infection symptoms, diagnosis with diabetes or lower extremity vascular disease, and Sanders type IV or open fractures. Outcomes were assessed by means of the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scores, radiographic images, and postoperative complications. RESULTS: The mean follow-up period was 8.7 years (range, 8.0-10.0 years). The AOFAS scores in the PR group during the follow-up period were 54.2 ± 5.1, 85.8 ± 4.0, 88.1 ± 3.8, 87.9 ± 3.6, 87.8 ± 3.9, 86.9 ± 3.9, respectively, and in the STA group were 55.0 ± 5.6, 84.5 ± 5.2, 87.1 ± 3.8, 86.9 ± 3.8, 87.7 ± 3.3, and 87.6 ± 2.8, respectively. There was no significant difference in AOFAS scores, Bohler's angle, Gissane's angle, calcaneal length, and height between the two groups (P > 0.05). The good to excellent rate of the PR group (80.8%) was less than that of the STA group (91.7%) (P = 0.055). For Sanders III fractures, the good to excellent rate of the PR group (33.3%) was less than that of the STA group (76.9%) (P = 0.029). For calcaneal width recovery, the STA group performed better than the PR group (P < 0.05). The incidence of postoperative complications in the PR group (12.8%) was lower than that in the STA group (27.8%) (P = 0.026), of which the incidence of wound complications was 3.8% in the PR group and 13.9% in the STA group (P = 0.041). In addition, there was no significant difference in other postoperative complications such as sural nerve injury, peroneus longus and brevis muscle injury, calcaneal valgus symptoms, lateral impingement symptoms, and subtalar arthritis (P > 0.05). CONCLUSION: From the 8-10-year follow-up results of PR and STA as surgical procedures for the treatment of DIACF, it was found that there was no significant difference in the overall efficacy between them. STA was found to be superior to the PR in terms of the recovery of calcaneal width, providing more stable fixation for Sanders III fractures. PR was found to be more effective in reducing wound complications.