Dynamic observation and risk factors analysis of deep vein thrombosis after hip fracture.

OBJECTIVE: To dynamically observe the occurrence of deep vein thrombosis (DVT) after a hip fracture and analyze of the risk factors affecting the dynamic alteration of DVT. METHODS: Data of patients with hip fractures from January 1, 2017 to August 31, 2021 were collected. Patients were divided into DVT and non-DVT groups according to their daily Doppler ultrasonography findings. Survival analysis was used to describe dynamic changes in DVT occurrence with time. Log-rank tests were used to compare the influence of individual factors of patients with DVT occurrence, and a Cox proportional hazards regression model was used to identify the risk factors affecting the dynamic alteration of DVT occurrence. RESULTS: A total of 331 patients were included: 148(44.7%) had preoperative DVT, and 143 (96.6%) had DVT in the first 3days after admission. The probability of DVT was 0.42 on Day 1, 0.11 on Day 2, 0.10 on Day 3, 0.08 on Day 4, 0.20 on Day 5, and 0.00 on Day 6-7, with a median survival time of 3.30 d. Age>70 years, intertrochanteric fracture, admission hemoglobin<130g/L, and admission hematocrit<40% had a significantly higher occurrence rate of DVT. A hematocrit level of <40% (Hazard Ratio 2.079, 95% Confidence Interval:1.148-3.764, P = 0.016) was an independent risk factor for DVT. CONCLUSION: DVT after hip fractures mainly occurred in the first three days after admission, the trend was stabilized within one week, and day 1 had the highest rate of DVT incidence. Age, fracture type, HGB level, and Hct level affected dynamic occurrence of DVT. At constant other factors, Hct<40% was 2.079-fold incidence in the risk of preoperative DVT formation than those with Hct≥40% after hip fracture.

Downregulation of extracellular matrix protein 1 effectively ameliorates osteoarthritis progression in vivo.

Osteoarthritis (OA) is the most common joint disease whose important pathological feature is degeneration of articular cartilage. Although extracellular matrix protein 1 (ECM1) serves as a central regulator of chondrocyte proliferation and hypertrophy, its role in OA remains largely unknown. This study aims to decipher the roles of ECM1 in OA development and therapy in animal models. In the present study, ECM1 expression was examined in clinical OA samples, experimental OA mice and OA cell models. Mice subjected to destabilised medial meniscus (DMM) surgery were intra-articularly injected with adeno-associated virus (AAV) expressing ECM1 (AAV-ECM1) or AAV containing shECM1 (AAV-shECM1). Histological analysis was performed to determine cartilage damage. mRNA sequencing was performed to explore the molecular mechanism. In addition, the downstream signaling was further confirmed by using specific inhibitors. Our data showed that ECM1 was upregulated in the cartilage of patients with OA, OA mice as well as OA cell models. Moreover, ECM1 over-expressing in knee joints by AAV-ECM1 accelerated OA progression, while knockdown of ECM1 by AAV-shECM1 alleviated OA development. Mechanistically, cartilage destruction increased ECM1 expression, which consequently exacerbated OA progression partly by decreasing PRG4 expression in the TGF-ß/PKA/CREB-dependent manner. In conclusion, our study revealed the important role of ECM1 in OA progression. Targeted ECM1 inhibition is a potential strategy for OA therapy.

Assessment of surgical management for locked fracture-dislocations of the proximal humerus in patients of different ages.

Background: Locked fracture-dislocation of the proximal humerus (LFDPH) is a very severe complex injury; neither arthroplasty nor internal plating are fully satisfactory. This study aimed to evaluate different surgical treatments for LFDPH to determine the optimal option for patients of different ages. Methods: From October 2012 to August 2020, patients who underwent open reduction and internal fixation (ORIF) or shoulder hemiarthroplasty (HSA) for LFDPH were retrospectively reviewed. At follow-up, radiologic evaluation was performed to evaluate bony union, joint congruence, screw cut-out, avascular necrosis of the humeral head, implant failure, impingement, heterotopic ossification, and tubercular displacement or resorption. Clinical evaluation comprised the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and Constant-Murley and visual analog scale (VAS) scores. Additionally, intraoperative and postoperative complications were assessed. Results: Seventy patients (47 women and 23 men) with final evaluation results qualified for inclusion. Patients were divided into three groups: group A: patients aged under 60 years who underwent ORIF; group B: patients aged ≥60 years who underwent ORIF; and group C: patients who underwent HSA. At a mean follow-up of 42.6 ± 26.2 months, function indicators, namely shoulder flexion, and Constant-Murley and DASH scores, in group A were significantly better than those in groups B and C. Function indicators in group B were slightly but not significantly better compared with group C. Regarding operative time and VAS scores, there were no significant differences between the three groups. Complications occurred in 25%, 30.6%, and 10% of the patients in groups A, B, and C, respectively. Conclusions: ORIF and HSA for LFDPH provided acceptable but not excellent results. For patients aged <60 years, ORIF might be optimal, whereas, for patients aged ≥60 years, both ORIF and HSA provided similar results. However, ORIF was associated with a higher rate of complications.

Extra-articular locking plate and trans-articular clavicle hook plate for displaced medial clavicle fractures.

INTRODUCTION: Fracture of the medial end of the clavicle is very rare. There is no consensus on the standard surgical strategy for medial clavicle fracture, and treatment is challenging. This study aimed to retrospectively evaluate the efficacy of internal plate fixation for displaced medial clavicle fracture. METHODS: Patients who underwent internal plating of a displaced medial clavicle fracture were included in this retrospective study. Each patient underwent open reduction and fixation with an internal extra-articular locking plate or trans-articular hook plate based on their fracture type. Postoperative follow-up included radiographs for assessment of bone union, Constant-Murley score for shoulder function, Disability of the Arm, Shoulder, and Hand (DASH) questionnaire for upper limb function, and visual analog scale (VAS) for pain. Any complications were also recorded. RESULTS: Between May 2014 and July 2021, 34 patients (9 females, 25 males; mean age, 50.0 ± 14.8 years) were treated with internal plate fixation and included in this study. The fracture line was located in the medial fifth of the clavicle in 32 patients, and 20 patients had intra-articular fracture. Eighteen patients had the fracture fixed with a locking plate, namely an inverted distal clavicle plate (n = 7), straight locking plate (n = 3), distal fibular plate (n = 3), and T-plate (n = 5); the other 16 patients were treated with a clavicle hook plate. During a mean follow-up of 30.7 ± 26.5 months, 33 patients achieved bone healing, the average Constant-Murley score was 90.9 ± 11.0 points, the mean DASH score was 6.0 ± 6.6 points, and the mean VAS was 0.4 ± 1.1 points. Complications occurred in five patients. CONCLUSIONS: Both locking plates and hook plates are effective in treating displaced medial clavicle fracture. A locking plate is recommended when there is enough bone stock in the medial fragment for stable fixation. A clavicle hook plate is recommended for cases in which the medial clavicle fracture is too small, comminuted, or has signs of sternoclavicular joint instability.

Simultaneous bilateral traumatic clavicle fractures: incidence, characteristics, and surgical outcomes.

BACKGROUND: Although clavicle fractures are common injuries in adults, simultaneous bilateral clavicle fractures are rarely reported. The present report describes 13 patients with simultaneous bilateral traumatic clavicle fractures who were treated with surgical management and followed for more than 12 months postoperatively. METHODS: This retrospective chart review involved skeletally mature patients with traumatic clavicle injuries. Patients with bilateral clavicle fractures who were followed up for at least 12 months after surgery were included. Data regarding the patients' demographics, injury characteristics, fracture classification, comorbidities, concomitant injuries, and treatment strategies were collected. Each displaced fracture was managed with open reduction and internal fixation. Postoperative follow-up included radiographs for assessment of bone union; calculation of the Constant-Murley score for shoulder function; administration of the Disability of the Arm, Shoulder, and Hand questionnaire for upper limb function; determination of the visual analogue scale score for pain; and assessment of complications. RESULTS: From October 2013 to November 2021, 15 patients (10 men, 5 women) were diagnosed with bilateral clavicle fractures among 1542 patients with clavicle injuries (overall incidence of 1.0%). Of these 15 patients, this study included 13 patients (8 men, 5 women; mean age, 38.3 ± 15.3 years) who were followed up for more than 12 months postoperatively. Among the 13 patients, 10 (77.0%) had associated concomitant injuries, and 25 sides were fixed with internal plate fixation. After a follow-up period of 29.9 ± 28.5 months, all fractures achieved bone healing. Eleven patients attained excellent shoulder function on both sides and returned to their pre-injury daily activities, and the remaining two patients had unilateral shoulder dysfunction. No complications occurred. CONCLUSIONS: Bilateral clavicle fractures are extremely rare and associated with polytrauma. Open reduction and internal fixation is recommended for such patients, especially those with severe chest injuries, because osteosynthesis of the clavicle can improve respiratory function and reduce the duration of functional disability.

Characteristics of subsequent contralateral proximal femoral fracture: more convenient access is needed to treat osteoporosis.

BACKGROUND: Patients with proximal femoral fracture (PFF) have high mortality and many complications. Osteoporosis increases the risk of subsequent fractures, leading to subsequent contralateral PFF. This study was performed to analyze the features of individuals with subsequent PFF following surgical therapy of first PFF and to ascertain whether such patients received an examination or treatment of osteoporosis. The reasons for lack of examination or treatment were also analyzed. METHODS: This retrospective study involved 181 patients with subsequent contralateral PFF who underwent surgical treatment in Xi'an Honghui hospital from September 2012 to October 2021. The patients' sex, age, hospital day, mechanism of injury, surgical procedure, fracture interval, fracture type, fracture classification, and Singh index of the contralateral hip at the time of the initial and subsequent fractures were recorded. Whether the patients took calcium and vitamin D supplements, used anti-osteoporosis medication, or underwent a dual X-ray absorptiometry (DXA) scan was recorded, as was the start time of each. Patients who had never undergone a DXA scan or received anti-osteoporosis medication took part in a questionnaire. RESULTS: The 181 patients in this study comprised 60 (33.1%) men and 121 (66.9%) women. Patients with initial PFF and subsequent contralateral PFF had a median age of 80 years (range 49-96 years) and 82 years (range 52-96 years), respectively. The median fracture interval was 24 (7-36) months. Contralateral fractures occurred at the highest incidence between 3 months and 1 year (28.7%). The Singh index was not significantly different between the two fractures. In 130 (71.8%) patients, the fracture type was the same. No significant difference was found in the fracture type or fracture stability classification. A total of 144 (79.6%) patients had never received a DXA scan or anti-osteoporosis medication. The main reason for not treating osteoporosis further was concern about the safety of drug interactions (67.4%). CONCLUSIONS: Patients with subsequent contralateral PFF were of advanced age, had a higher proportion of intertrochanteric femoral fractures, had more severe osteoporosis, and had longer hospital stays. The difficulty managing such patients requires multidisciplinary involvement. Most of these patients were not screened or formally treated for osteoporosis. Advanced-age patients with osteoporosis need reasonable treatment and management.

Proportion of stable femoral neck fracture types in different age groups: a population-based study.

OBJECTIVE: The treatment and incidence of femoral neck fracture (FNF) in older patients is controversial. We investigated the new AO (Arbeitsgemeinschaft für Osteosynthese) classification in patients with FNF by age to determine the proportions of stable fracture and change trends according to patients' age. METHODS: We divided patients with FNF hospitalized in Xi'an Honghui Hospital from 2018 to 2020 into five groups according to age: young (<50 years), middle-aged (50-59 years), young-elderly (60-69 years), middle-elderly (70-79 years), and very elderly (≥80 years) groups. We retrospectively collected data of patients' sex, admission date, fracture side, mechanism of injury, and new AO classification. RESULTS: In total, 2071 patients were included for analysis, with 1329 women (64.2%); 1106 patients (53.4%) had left-side fracture. The main mechanism of injury was falling. In the young-elderly, middle-elderly, and very-elderly groups, 33.3%, 29.2%, and 24.1% had stable fracture type, respectively). The proportion of patients with FNF did not show a change trend by age during the 3-year investigation period. CONCLUSION: In our study, the proportion of older patients with FNF did not increase, and as many as a third of patients with FNF aged 50 to 70 years had stable fracture.

Clinical analysis of the acromial height-measuring device combined with new-type clavicular hook plate and standard clavicular hook plate in the treatment of Neer type II distal clavicle fractures.

BACKGROUND: Distal clavicular fracture is a shoulder joint injury that is common in clinical settings and is generally surgically treated using the clavicular hook plate technique with a confirmed curative effect. However, symptoms, such as shoulder abduction limitation, shoulder discomfort, and postoperative joint pain, may occur in some patients. To overcome these problems, after a previous study we developed an acromial height-measuring device and a new type of clavicular hook plate. This study aimed to investigate whether an acromial height-measuring device combined with an improved new-type clavicular hook plate can better reduce the incidence of complications and improve postoperative function. To provide patients with better treatment effects, an acromion gauge and clavicular hook plate are used. METHODS: A retrospective analysis was performed on 81 patients with distal clavicular fractures admitted to our hospital. They were divided into experimental and control groups according to different plates, and the Constant-Murley score, visual analogue scale score, incidence of acromion osteolysis, and incidence of subacromial impingement syndrome were compared. RESULTS: Compared with the standard clavicular hook plate, the acromial height-measuring device combined with the new-type clavicular hook plate in the treatment of distal clavicle fractures has a lower incidence of subacromial impingement syndrome with better postoperative functional recovery and quality of life. CONCLUSIONS: We considered the acromial height-measuring device combined with the new clavicular hook plate to be a safe and promising alternative to distal clavicular fractures.

A novel bone graft technique combined with plating for aseptic recalcitrant long bone nonunion.

BACKGROUND: To evaluate the outcomes and efficacy of a new technique of autogenous iliac crest bone grafting combined with locking compression plate (LCP) vertical fixation for aseptic recalcitrant long bone nonunion. METHODS: From July 2010 to September 2020, 36 aseptic recalcitrant long bone nonunions were treated with a bone-forming channel technique and internal LCP fixation. All the patients had received one or more failed treatments. The injury mechanism, nonunion type and duration, and prior treatments were recorded pre-operation. The routine treatment process included nonunion area exposure, previous implant removal, sclerotic bone debridement, LCP fixation, bone-forming channel creation, and iliac bone grafting, and a second LCP fixation when required. At follow-up, X-ray images were obtained to assess bone healing and implant failure. Visual analog scale (VAS), fracture site stability, limb function, activity, muscle strength, limb length, and complications were recorded. RESULTS: A total of 34 patients (24 males and 10 females) were finally enrolled, with a mean age of 49.8 ± 12.3 years. At a mean follow-up of 35.6 ± 22.0 months, 32 patients displayed bone union, with a healing rate of 94.1% and mean union time of 6.8 ± 2.4 months. The VAS score was 0.7 ± 1 at the final follow-up. The functional results showed that 19 patients were excellent, 11 patients were good, 2 patients were poor, and 2 patients did not heal. CONCLUSION: Bone-forming channel technique combined with LCP vertical fixation is an excellent option to treat recalcitrant long bone nonunion. LEVEL OF EVIDENCE: Therapeutic Level IV.

Correlation Between the Fracture Line Plane and Perioperative Deep Vein Thrombosis in Patients with Tibial Fracture.

OBJECTIVE: To explore the correlation between the fracture line inferior plane and perioperative deep venous thrombosis (DVT) in patients with tibial fractures. METHODS: Data was collected from the medical records of 536 consecutive patients with tibial fractures at Xi'an Honghui Hospital. The patients were divided into distal, shaft, and proximal segment groups according to the fracture line inferior plane on radiographs. Multivariate logistic regression models were used to identify the role of the inferior plane of the fracture line in perioperative DVT. RESULTS: A total of 431 patients were included in the study and 226 patients had perioperative DVT in the lower extremities, including 11 proximal and 215 distal DVTs. Univariate regression analysis showed a significant correlation between the proximal segment and perioperative DVT; however, no correlation was found in the shaft segment group. Additionally, age, coronary heart disease, associated injuries, and time to operation ≥6 days were risk factors for perioperative DVT. However, fixation with intramedullary nails may be a protective factor for perioperative DVT compared with plates. After adjusting for potential confounding factors, the proximal segment group had an increased incidence of perioperative DVT compared to the distal segment group. CONCLUSIONS: The proximal segment may be correlated with an increased incidence of perioperative DVT by 7.30-fold in patients with tibial fractures compared to that in the distal segment. In clinical practice, surgeons should be vigilant for DVT formation in these patients.

[Extensor digitorum communis split approach combined with loop-plate technique for treatment of ulnar coronoid fracture in terrible triad of elbow].

OBJECTIVE: To explore the effectivenesss of simple lateral extensor digitorum communis (EDC) split approach combined with loop-plate fixation in the treatment of ulnar coronoid fracture in terrible triad of elbow (TTE). METHODS: The clinical data of 60 patients with TTE who met the selection criteria between January 2015 and May 2018 were retrospectively analyzed. There were 48 males and 12 females, aged from 18 to 60 years (mean, 37.4 years). All the patients were closed fractures. Injury causes included fall injury in 28 cases, falling from height in 20 cases, and traffic accident injury in 12 cases. All patients had no vascular and nerve injury, and the time from injury to operation was 1-14 days, with an average of 4.8 days. The height and size of the fracture of the coronal process were measured by CT and accurate classifications were made. All the 60 patients were treated with simple lateral EDC split approach combined with loop-plate to fix the ulnar coronoid fracture; 20 patients of radial head fracture were fixed with hollow screw, 32 patients with mini-plate fixation, 8 patients with radial head prosthesis replacement; 16 patients with suture and 44 patients with suture anchor to reconstruct lateral collateral ligament complex; 10 patients with residual instability of elbow joint were fixed with hinge external fixator, and others were fixed with adjustable tension brace after operation. Postoperative imaging examination was performed to evaluate fracture healing and complications, such as loosening or breakage of internal fixator, osteoarthritis, and heterotopic ossification, etc. During follow-up, the range of motion (ROM) of the elbow joint was recorded, including elbow flexion, extension, and forearm pronation, supination. Mayo elbow function score system (MEPS) was used to evaluate elbow joint function at last follow-up. RESULTS: All patients were followed up 16-24 months (mean, 20.2 months). All incisions healed by first intention after operation, and no complications such as vascular nerve injury, elbow joint instability, internal fixation failure, and infection occurred; the fracture healing time was 9-17 weeks (mean, 11.7 weeks). Four cases developed elbow stiffness after operation, and all underwent elbow joint lysis with internal fixator removal within 12-15 months after operation; 10 cases developed heterotopic ossification without special treatment. At last follow-up, the ROM of elbow flexion ranged from 85° to 135° (mean, 116°), the ROM of elbow extension ranged from 0° to 20° (mean, 11°), the ROM of forearm pronation ranged from 55° to 75° (mean, 70°), and the ROM of forearm supination ranged from 60° to 90° (mean, 83°). The MEPS score ranged from 55 to 100 (mean, 86.1); the effectiveness were excellent in 40 patients, good in 10 patients, fair in 6 patients, and poor in 4 patients, with an excellent and good rate of 83.3%. CONCLUSION: The simple lateral EDC split approach is fully exposed, and the loop-plate can fix the ulnar coronoid fractures firmly and stably, which can restore the stability of the elbow joint, and the effectiveness is satisfactory.

Double plating with autogenous bone grafting as a salvage procedure for recalcitrant humeral shaft nonunion.

BACKGROUND: Although most cases of humeral shaft nonunion respond well to surgical intervention, surgeons still encounter patients with humeral shaft nonunion who have already undergone repeated surgeries for nonunion. This study retrospectively analyzed the efficacy of double locking compression plate (LCP) fixation in combination with autogenous iliac crest bone grafting for recalcitrant humeral shaft nonunion. METHODS: A consecutive series of patients with aseptic recalcitrant humeral shaft nonunion underwent surgical treatment between May 2010 and August 2017 in our institution. Standardized treatment included thorough debridement, double LCP and screw fixation, and autogenous iliac bone grafting. The injury type and the duration of nonunion were recorded for all patients. The main outcome measurements were the Constant and Murley scale for shoulder function, Mayo elbow performance index (MEPI) for elbow function, and visual analog scale (VAS) for pain. In addition, all complications were documented. RESULTS: The study cohort comprised six females and nine males with a mean age of 45.3 ± 13.1 years. Each patient had already undergone at least one failed surgery for humeral shaft nonunion. The average duration of nonunion before the index intervention was 126.8 ± 124.2 months. All patients achieved bone union without implant failure. At final follow-up, the mean Constant and Murley score and mean MEPI were significantly improved, and the mean VAS score was significantly decreased. Each patient was very satisfied with the treatment. Four patients had complications, including one with a superficial wound infection, one with radial nerve palsy, one with ulnar nerve palsy, and one with discomfort at the iliac crest. CONCLUSION: Double plate fixation combined with autogenous iliac crest bone grafting results in successful salvage of humeral shaft nonunion after prior failed surgical interventions.

Integrated Analysis of Competing Endogenous RNAs Network Reveals Potential Signatures in Osteosarcoma Development.

The purpose of this work was to extract key players such as mRNAs and long non-coding RNA (lncRNAs) in the etiopathogenesis of osteosarcoma (OS). The sequencing analyses (mRNAs and lncRNAs) of OS were conducted followed by differentially expressed mRNAs and lncRNAs (DEmRNAs and DElncRNAs) identification between U-2OS cells with has-miR-590-5p overexpression and negative control cells. Following this, the co-expression and functional enrichment analyses of DEmRNAs and DElncRNAs were carried out. Also, the miRNAs-DElncRNAs-DEmRNAs regulatory network was constructed with DElncRNAs-miRNAs and DElncRNAs-DEmRNAs pairs after the target gene analysis of miRNA. In addition, the ceRNA-has-miR-590-5p was further extracted based on the has-miR-590-5p-DElncRNAs and DElncRNAs-DEmRNAs interactions. Finally, the results of the bioinformatics analysis was verified by reverse-transcription polymerase chain reaction (RT-PCR). Totally, 980 DEmRNAs (539 up-regulated DEmRNAs and 441 down-regulated DEmRNAs) and 682 DElncRNAs (352 up-regulated DElncRNAs and 330 down-regulated DElncRNAs) were extracted between cells with hsa-miR-590-5p overexpression and normal cells. The functional analyses suggested that up-regulated genes were significantly enriched in several GO terms such as signal transduction and cytokine-cytokine receptor interaction pathway while down-regulated genes (SCUBE3, HIST1H4E and EDIL3) were associated with calcium ion binding, cell surface function and nucleosome assembly. Additionally, the miRNAs-DEmRNAs-DEmRNAs network represented 220 pairs among 41 miRNAs, 38 DElncRNAs and 61 DEmRNAs. Furthermore, the ceRNA-hsa-miR-590-5p network consisted of 70 interaction pairs including hsa-miR-590-5p-SCUBE3-CTB-113D17.1, hsa-miR-590-5p-EDIL3-CTB-113D17.1 and hsa-miR-590-5p-HIST1H4E-CTB-113D17.1) among hsa-miR-590-5p, 30 DEmRNAs and 4 down-regulated DElncRNAs. Meanwhile, the RT-PCR results incidated that compared with the blank (KB) and negative control (NC) group, the mRNA expression of SCUBE3, HIST1H4E, and EDIL3 were significantly descreased in mimics group (P value <0.05). The lncRNA CTB-113D17.1 might implicate with OS development probably via serving as a hsa-miR-590-5p sponge to regulate gene targets (SCUBE3, EDIL3 and HIST1H4E), which will facilitate the deep understandings of OS progression.

The effects of common variants in MDM2 and GNRH2 genes on the risk and survival of osteosarcoma in Han populations from Northwest China.

Accumulating evidence has shown that both MDM2 and GNRH2 might be related to Osteosarcoma (OS) susceptibility. The study aimed to evaluate the effects of common variants in MDM2 and GNRH2 genes on the risk and survival of osteosarcoma in Han populations from Northwest China. In the study, we recruited 2292 subjects including 596 OS patients and 1696 healthy controls and genotyped 16 selected tag SNPs (6 from GNRH2 and 10 from MDM2). Genetic association analyses were performed at the genotypic and allelic levels. Survival curves were made for OS patients with different genotypes. Two SNPs, rs1690916 (MDM2, P = 0.0002) and rs3761243 (GNRH2, P = 0.0004), were identified to be significantly associated with OS risk. Moreover, SNP rs3761243 was strongly associated with pathological fracture (P = 2.61 × 10-14), metastasis (P < 2.2 × 10-16), and Enneking stage (P < 2.2 × 10-16) in the OS group. Furthermore, survival curves based on different genotypes of SNP rs3761243 were found to be significantly different (P = 0.0003), suggesting increased risk with more copies of C alleles. Our results provide supportive evidence for genetic associations of MDM2 and GNRH2 genes with susceptibility to OS, and for the positive correlation of SNP rs3761243 in GNRH2 with the survival status of OS patients in Han populations from Northwest China.

Balser Plate Stabilization for Traumatic Sternoclavicular Instabilities or Medial Clavicle Fractures: A Case Series and Literature Review.

OBJECTIVE: This study was performed to observe the effect of internal Balser plate fixation for treating unstable sternoclavicular joints (SCJ) and displaced medial clavicle fractures. METHODS: From April 2009 to September 2016, 17 consecutive patients who underwent open reduction and internal Balser plate fixation for SCJ dislocations or medial clavicle fractures were retrospectively reviewed. There were 11 male and six female patients, with a mean age of 45.6 ± 15.5 years. Standardized treatment procedures consisted of reduction, creating a space posterior dorsal osteal face of the sternal manubrium, an inverted Balser plating, and postoperative immobilization. At follow-up, plain radiographs were assessed for fracture union, implant loosening, degenerative changes, and joint congruity. Clinical evaluation included: completion of the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire; determination of the Constant and Murley score and visual analog scale (VAS) score; and assessment of intraoperative and postoperative complications. RESULTS: All patients were followed up, at a mean follow-up of 20.1 ± 7.9 months, each fracture had a solid union, and each dislocation showed no sign of recurrent dislocation. The mean shoulder forward flexion was 162.9° ± 8.1°. The mean DASH score was 5.2 ± 5.2 points. The mean Constant and Murley joint function score was 93.7 ± 7.9 points, with 15 excellent cases and two good cases. The mean VAS score was 1.1 ± 1.4 points, showing significant improvement compared with the VAS score preoperatively. Postoperative complications included one wound hematoma which was healed after a debridement and one recurrent instability due to hook migration, which underwent revision reconstruction. All patients were satisfied with their treatment outcome at the final follow-up. CONCLUSION: Sternoclavicular joints dislocation or medial clavicle fractures can be treated successfully with Balser plate fixation. This technique permits early functional exercise while preserving the SCJ.

Progranulin modulates cartilage-specific gene expression via sirtuin 1-mediated deacetylation of the transcription factors SOX9 and P65.

Progranulin (PGRN) is an autocrine growth factor that exerts crucial roles within cartilage tissue; however, the molecular mechanisms underlying PGRN-mediated cartilage homeostasis remain elusive. In the present study, we investigated the role of PGRN in regulating chondrocyte homeostasis and its therapeutic potential for managing osteoarthritis (OA). We found that PGRN levels are significantly increased in human cartilage in mild OA and that its expression is decreased in the cartilage in severe OA. In vitro, treatment of primary rat chondrocytes with recombinant PGRN significantly enhanced the levels of collagen type II α 1 chain (COL2A1) and aggrecan, and attenuated TNFα-induced up-regulation of matrix metallopeptidase 13 (MMP13) and ADAM metallopeptidase with thrombospondin type 1 motif 5 (ADAMTS5) in chondrocytes. These effects were abrogated in SIRT1-/- cells, indicating a causative role of SIRT1 in the effects of PGRN on protein expression in chondrocytes. Mechanistically, PGRN increased SIRT1 expression and activity, which reduced the acetylation levels of SRY-box transcription factor (SOX9) and transcription factor P65 (P65) and thereby promoted nuclear translocation of SOX9 and inhibited TNFα-induced P65 nuclear accumulation to maintain chondrocyte homeostasis. In conclusion, our findings reveal a mechanism of action for PGRN that maintains cartilage homeostasis and supports the notion that PGRN up-regulation may be a promising strategy for managing OA.

Anti-sliding plate technique for coronal shear fractures of the distal humerus.

PURPOSE: The purpose of this study is to discuss the surgical strategy, technical feasibility, and clinical efficacy of coronal shear fractures of the distal humerus using the anti-sliding plate technique. METHODS: Fifty-two patients (35 males and 17 females) were treated with the anti-sliding plate technique in our hospital from January 2012 to January 2017. The average age of the patients was 40.4 years. They were classified according to the Dubberley classification system and treated with the anti-sliding plate technique. The long-term functional scores represented by the Mayo Elbow Performance Index and complications were evaluated. RESULTS: Fractures were classified as follows: 11 type-IA, 5 type-IB, 16 type-IIA, 4 type-IIB, 13 type-IIIA, and 3 type-IIIB according to the Dubberley classification system. All patients were treated with open reduction and internal fixation by the extensile lateral approach and completed a clinical and radiographic follow-up (average, 17.6 months). The average Mayo elbow performance score was 90.6 points, with 36 excellent, 11 good, and 5 fair results. The average range of movement of the elbow joint was 3° (0-15°) for extension and 136° (90-150°) for flexion. CONCLUSIONS: The anti-sliding plate technique follows basic AO principles and neutralizes the shearing force combined with lag screws and/or Kirschner wires after the anatomic reduction of the fracture. It allows for the stable internal fixation of the fracture, which is critical for early mobilization and a good functional outcome. LEVEL OF EVIDENCE: Level IV, Case Series, Treatment Study.

[Treatment of aseptic ulnar diaphyseal nonunion with locking compression plate and autogenous iliac bone graft].

OBJECTIVE: To investigate the clinical results of locking compression plate combined with autologous iliac bone graft in the treatment of aseptic ulnar nonunion. METHODS: From March 2009 to July 2017, 22 patients with aseptic ulnar diaphyseal nonunion with complete follow-up data were treated with surgery, including 12 males and 10 females, aged from 16 to 58 (39.7±9.9) years old and ranging in course of disease from 10 to 192 (39.4±55.7) months. There were 15 atrophic nonunions, 5 hypertrophic nonunions and 2 synovial pseudo-articular nonunions. After debridement of the nonunion, locking compression plate was used to fix the nonunion and autogenous iliac bone graft was given. Bone healing rate, surgical complications and clinical results were evaluated. RESULTS: All the patients were followed up, and the duration ranged from 13 to 42 months, with a mean of (22.5±8.2) months, and 1 patient did not heal. Visual analogue pain scores ranged from 0 to 3 (0.9±0.9). Pronation of forearm was 47 to 86 (69.0±14.7) degrees, supination was 35 to 85 (63.0±9.4) degrees, wrist flexion was 20 to 80 (51.0±10.2) degrees, wrist flexion was 32 to 88 (71.0±11.7) degrees, elbow flexion contracture was 0 to 25 (9.0±5.6) degrees, further flexion was 105 to 150 (134.0±13.9) degrees, and grip strength was 87% on the opposite side. According to the Anderson scoring system, 8 cases were excellent, 11 were satisfied, 2 were not satisfied, and 1 was failed. CONCLUSIONS: LCP combined with autologous iliac bone graft can effectively treat aseptic ulna diaphyseal nonunion.

Prevalence of dementia in the People's Republic of China from 1985 to 2015: a systematic review and meta-regression analysis.

BACKGROUND: In China, the most populous developing country in the world, dementia represents a serious challenge. We performed a large-scale systematic review and meta-regression analysis to elucidate the prevalence of dementia and its subtypes and to identify potential factors underlying the differences between articles. METHODS: A comprehensive literature search was conducted in the following databases to identify studies published up to December 2015: Cochrane Library, CBMDISK, Chongqing VIP, CNKI, PubMed and EMBASE. All statistical analyses (including subtype and meta-regression analyses) were performed with R version 3.3.3. RESULTS: In total, 51 surveys were selected. The pooled prevalence rates of dementia and its main subtypes, namely, Alzheimer's disease (AD) and vascular dementia (VAD), for the population aged 55 years and older were 4.03, 2.44 and 1.09%, respectively. The outcomes showed that the meta-regression analysis was affected by the publication year, sample size, region and diagnostic criteria. CONCLUSIONS: Our analysis provided reliable estimates of the prevalence of dementia/ AD/ VD over the past 30 years, which may be affected by education level, and diagnostic criteria. The prevalence of AD/VAD was higher in northern than in southern China, which warrants further study.