[Retracted] Mitochondrial DNA induces inflammation and increases TLR9/NF­κB expression in lung tissue.

Following the publication of this paper, it was drawn to the Editor's attention by a concerned reader that several of the western blotting images shown in Fig. 4 on p. 822 were strikingly similar to data which had appeared in Fig. 5A of the following paper: Fan J, Frey RS and Malik AB: TLR4 signaling induces TLR2 expression in endothelial cells via neutrophil NADPH oxidase. J Clin Invest 112: 1235­1243, 2003. Owing to the fact that the contentious data in the above article had already been published elsewhere prior to its submission to International Journal of Molecular Medicine, the Editor has decided that this paper should be retracted from the Journal. The authors were asked for an explanation to account for these concerns, but the Editorial Office did not receive a reply. The Editor apologizes to the readership for any inconvenience caused. [International Journal of Molecular Medicine 33: 817­824, 2014; DOI: 10.3892/ijmm.2014.1650].

Characteristics and proposed classification system of posterior pilon fractures.

Posterior pilon fractures involve the medial malleolus (MM). Our purpose was to define the characteristics of posterior pilon fractures, and propose a classification system based on fracture morphology and type of management.The records of patients with posterior pilon fractures treated from 2011 to 2015 were retrospectively reviewed. The injury mechanism, fracture morphology, surgical approach, and follow-up results were reviewed and analyzed. This study was approved by the Institutional Review Board of PLA Army General Hospital.Thirty-six patients, 18 males and 18 females (mean age: 48.9 years) were included in the study. Four characteristics were used to define posterior pilon fractures. A simple posterolateral approach or a combined posterolateral and posteromedial approach was used for reduction and fixation in all patients. The mean follow-up time was 28.2 months, and at the end of follow-up, the mean American Orthopedic Foot and Ankle Society Score (AOFAS) was 82.5 points (range: 35-100 points). Based on injury mechanism and fracture morphology, we classified posterior pilon fractures into 3 types that suggest the optimal surgical approach: type I, a single complete fracture fragment; type II, a posterior malleolus fracture with 2 subtypes; type III, a posterior malleolus fracture associated with complete MM fracture with 2 subtypes.The proposed classification system based on injury mechanism and fracture morphology can guide the surgical approach to maximize outcomes.

Early surgery increases mitochondrial DNA release and lung injury in a model of elderly hip fracture and chronic obstructive pulmonary disease.

Hip fractures are one of the most common injuries in elderly individuals and are associated with a high incidence of complications and mortality. Clinical guidelines recommend early reparative surgery within 24-48 h from hospital admission; however, it is currently unknown whether this principle of early surgery is applicable for patients with hip fracture and chronic obstructive pulmonary disease (COPD). To investigate the systemic inflammatory response and lung injury as a result early surgery in elderly patients with hip fracture and COPD, a COPD model was created, by daily exposure to cigarette smoke, and evaluated. Rats (5 months of age) were exposed to cigarette smoking for 37 weeks to create a COPD group. Rats not exposed to cigarette smoke formed the control group. All rats experienced hip fracture, which was subsequently treated with surgery at 24 h (early fixation; EF) or 72 h (late fixation; LF) after fracture, respectively. Serum mitochondrial DNA (mtDNA), tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and IL-10 were measured at 2 and 24 h after surgery. Cytokine and myeloperoxidase (MPO) activity in the lung tissue were measured and assessed via bronchoalveolar lavage. The serum mtDNA, IL-6 and IL-10 levels in the control group and in the COPD group increased rapidly at 2 h and peaked at 24 h, while TNF-α levels peaked at 2 h and subsequently decreased. Rats that received EF in the COPD group demonstrated a significant increase of TNF-α (P<0.001 at 2 h), IL-6 (P<0.001 at 2 and 24 h), IL-10 (P=0.010 at 2 h and P=0.001 at 24 h) and mtDNA (P<0.001 at 24 h) compared with the rats that received LF. LF in experimental rats also significantly reduced the severity of MPO activity (P<0.001 and P=0.001) and permeability (P=0.009 and P=0.018) in pulmonary samples at 2 or 24 h, respectively, compared with EF. However, LF in the control group did not demonstrate a significant advantage at reducing MPO and permeability in serum and pulmonary samples. The present study indicated that early surgery increased mtDNA and cytokine release in a model of elderly hip fracture with COPD, and LF may reduce the severity of the inflammatory response and degree of permeability in pulmonary tissues.

Poor prognosis after surgery for intertrochanteric fracture in elderly patients with clopidogrel treatment: A cohort study.

Choice of surgical approach in patients under clopidogrel treatment is controversial. Intertrochanteric fractures are common in the elderly, who also suffer from a number of comorbidities.The aim of this study is to assess the prognosis of elderly patients with clopidogrel treatment after surgery for intertrochanteric fracture.This was a cohort study of 238 elderly patients who underwent proximal femur intramedullary nailing for intertrochanteric fracture between January 2012 and December 2013 at the Geriatric Trauma Center of the Beijing Army General Hospital. The patients were divided into the clopidogrel (n = 32) and control (n = 206) groups according to their history of long-term clopidogrel treatment before surgery. Demographic and clinical characteristics, intraoperative parameters, postoperative complications, and 1-year survival were compared between the 2 groups.Preoperative American Society of Anesthesiologists (ASA) grade and the frequency of arterial stenting were different between the 2 groups (P = .002 and P < .001, respectively). The rate of intraoperative blood transfusion, ICU stay, and hospital stay were higher in the clopidogrel group compared with the control group (all P < .001). Postoperative complications were similar in the 2 groups. The 1-year mortality rate after surgery was significantly higher in the clopidogrel group compared with the control group (37.5% vs 20.3%, P = .030).Prognosis after surgery for intertrochanteric fracture was poorer in elderly patients with clopidogrel treatment; these patients had lower 1-year survival, more intraoperative blood transfusion, longer ICU stay, and longer hospital stay. ASA grade, arterial stenting, and anesthesia mode were prognostic factors.

Incidence of and Factors Influencing Femoral Neck Shortening in Elderly Patients After Fracture Fixation with Multiple Cancellous Screws.

BACKGROUND To study the incidence of and factors influencing "neck shortening" in elderly patients treated for femoral neck fractures using multiple cancellous screws. MATERIAL AND METHODS Of the 197 femoral neck fracture cases treated via closed reduction and cancellous screws fixation from January 2006 to February 2010, 110 were followed up. Patient age, gender, operative time, implantation method, reduction quality, fracture type, bone mineral density, loading time, length of hospital stay, and Harris hip score 12 months after operation were recorded. The patients were divided into two groups (shortening and non-shortening) based on their X-ray performance during follow-up. The healing rates and Harris hip scores of the two groups were compared, and the influencing factors of femoral neck shortening were analyzed. RESULTS Of the 110 cases followed up, 94.5% (104/110) were healed and neck shortening occurred in 41.8% (46/110) within 12.5 months (mean) after treatment. The Harris hip score of the shortening group was lower than that of the non-shortening group (78±17 vs. 86±23, p=0.048). The fracture healing rates of the two groups were not significantly different (p=0.068). The factors influencing neck shortening were significantly correlated with bone mineral density, patient age, gender, and type of fracture. CONCLUSIONS The incidence of neck shortening in elderly patients treated for femoral neck fracture using cancellous screws was high. Bone mineral density, patient age, gender, and type of fracture were the influencing factors of neck shortening.

Plasma mitochondrial DNA levels were independently associated with lung injury in elderly hip fracture patients.

INTRODUCTION: Hip fracture in the elderly can induce systemic inflammatory response (SIRS) and lung injury which increases the risk of lung infection and death. Mitochondrial DNA (mtDNA) plays a role in SIRS and lung injury in patients with multi-trauma, and also in patients with hip fractures. This study evaluated the potential value of plasma mtDNA in the early prognosis of lung injury in elderly fracture patients. METHODS: This study enrolled 156 elderly patients with intertrochanteric fracture. Plasma mtDNA, IL-6, IL-10, prostaglandin E2 (PGE2) levels were measured at admission. Sixty-one and 31 patients were diagnosed with systemic inflammatory response syndrome (SIRS) and lung injury, respectively. RESULTS: Plasma mtDNA levels were higher in hip fracture patients compared to healthy controls (P<0.001) and significantly higher in the lung injury subgroup compared to the lung injury absent subgroup (P<0.001). MtDNA levels were correlated with the SIRS score (r=0.446, P<0.001), IL-6 (r=0.506, P<0.001), IL-10 (r=0.523, P<0.001), and PGE2 (r=0.360, P<0.001). Logistic regression analysis revealed that plasma mtDNA, IL-6, PGE2 and SIRS score were independent predictors of the risk of lung injury. CONCLUSION: Plasma mtDNA release induced by hip fracture in elderly patients, might be an early predictor of lung injury in these patients.

What Are the Risk Factors for Dislocation of Hip Bipolar Hemiarthroplasty Through the Anterolateral Approach? A Nested Case-control Study.

BACKGROUND: Hip dislocation after treatment of a femoral neck fracture with a hemiarthroplasty remains an important problem in the treatment of hip fractures, but the associations between patient factors and surgical factors, and how these factors contribute to dislocation in patients who have undergone bipolar hemiarthroplasty through an anterolateral approach for femoral neck fracture currently are only poorly characterized. QUESTIONS/PURPOSES: We evaluated patients with bipolar hemiarthroplasty dislocation after surgery for femoral neck fracture treated through an anterolateral approach and asked: (1) What are the frequency, characteristics, and risk factors of bipolar hemiarthroplasty dislocations? (2) What are the frequency, characteristics, and risk factors of bipolar hemiarthroplasty dissociations? METHODS: A review of hospital records for patients who underwent bipolar hip hemiarthroplasty for femoral neck fracture at one hospital between July 2004 and August 2014 was conducted. During that time, 1428 patients were admitted with a diagnosis of femoral neck fracture; 508 of these patients underwent bipolar hip hemiarthroplasty, of whom 61 died and 23 were lost to followup during the first year, leaving 424 (83%) available for analysis. The remainder of the patients during that time were treated with internal fixation (512), unipoloar hip arthroplasty (17), or THA (391). For each patient with dislocation, we selected five control patients from the cohort according to sex, age (± 3 years), and year of entry in the study to eliminate some confounding factors. We recorded patient characteristics regarding demographics, medical comorbidities, Katz score, American Society of Anesthesiologists score, Mini-Mental State Examination (MMSE) score, and anesthesia type. Medical comorbidities included diabetes, chronic pulmonary disease, heart disease, neuromuscular diseases, and dementia. Univariate analyses were used to search for possible risk factors. Conditional logistic regression analyses on dislocation or dissociation were performed to estimate hazard rates (HRs) and corresponding 95% CIs with covariates of a probability less than 0.1 in univariate analysis. RESULTS: In this cohort, there were 26 dislocations including four that were also dissociations. The proportion of patients experiencing a dislocation was 6% (26 of 424). The mean interval from surgery to dislocation was 56 weeks (range, 0-433 weeks), and 18 dislocations (69%) occurred within 3 months after surgery. Three variables were independently associated with an increased risk of hip dislocation: dementia (HR, 3.51; 95% CI, 1.19-10.38; p = 0.02), discrepancy of offset (HR, 1.72; 95% CI, 1.15-2.58; p = 0.008), and lower MMSE score (HR, 0.93; 95% CI, 0.88-0.98; p = 0.007). The proportion of patients experiencing a dissociation was 0.9% (four of 424). The result of conditional logistic regression for dissociation showed that cup size smaller than 43 mm was the risk factor (HR = 513.05). However, there was no statistical difference with the probability equaling 0.47. CONCLUSIONS: After the anterolateral approach for treatment of femoral neck fracture using bipolar hemiarthroplasty, 6% of hips dislocated and 0.9% experienced dissociation. Cognitive dysfunction and discrepancy of offset were independent risk factors associated with an increased risk of prosthetic dislocation. The small cup without a safety ring may be the risk factor of dissociation. Discrepancy of offset should be avoided during the operation by performing an accurate femoral osteotomy and choosing an adequate femoral stem neck length. For patients with cognitive dysfunction and a small cup, suturing the joint capsule during the operation and reinforcing protective measures after surgery might reduce the occurrence of dislocation and dissociation, however a study addressing this is necessary to confirm this. LEVEL OF EVIDENCE: Level III, therapeutic study.

Impact of Cement Placement and Leakage in Osteoporotic Vertebral Compression Fractures Followed by Percutaneous Vertebroplasty.

STUDY DESIGN: Retrospective study. OBJECTIVES: Assessment of the impact of cement placement and leakage in osteoporotic vertebral compression fractures (OVCFs) followed by percutaneous vertebroplasty (PVP) on patient pain relief and new vertebral fracture occurrence. SUMMARY OF BACKGROUND DATA: Previous studies have not specifically addressed cement placement in the context of pain outcomes and subsequent vertebral fracture. METHODS: We included a total of 192 patients who underwent PVP for OVCFs. We assessed imaging data, and patients rated their pain over a 24-month period. The patients were divided into 3 groups based on image analysis: group 1 [31 cases: 5 thoracic, 15 thoracolumbar (TL) junction, 11 lumbar] included patients with no cement extension to the endplate(s), group 2 (121 cases: 19 thoracic, 64 TL junction, 38 lumbar) was comprised of patients with cement extension to the endplate(s) but no leakage into the disk space, and group 3 (40 cases: 8 thoracic, 21 TL junction, 11 lumbar) included patients with cement extension to the endplate(s) and leakage into the disk space(s). We assessed the correlation between cement location and pain ratings and changes in pain scores, as well as the proportions of new fracture. RESULTS: Postprocedure pain numeric scores and changes in pain scores were similar among the 3 groups (P>0.05). Cement location did not significantly correlate with pain ratings or changes in pain scores for any follow-up points. There was no significant difference in new adjacent fracture rate among the groups (P>0.05). CONCLUSIONS: Neither extension of cement to the endplate nor cement leakage into the disk space had a significant impact on postprocedural pain. Furthermore, intradisk cement leakage was not a risk factor for new fracture after PVP in patients with OVCF. However, lower fill volumes should be used to lessen the risk of leakage.

Results of Vertebral Augmentation Treatment for Patients of Painful Osteoporotic Vertebral Compression Fractures: A Meta-Analysis of Eight Randomized Controlled Trials.

BACKGROUND: In 2009 two RCTs were publicated to question the efficacy of vertebroplasty comparing with sham treatment (ST) in the New England Journal of Medicine (NEJM), which provoked an academic debate on the efficacy of PVA. The purposes of our study were to compare clinical differences in pain relief, spinal functional outcomes, and overall quality of life between PVA and CT for painful osteoporotic VCFs. METHODS: We searched PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and Web of Knowledge from January 1980 to June 2013 with Medical Subject Headings terms and keywords. Risk of bias in the included studies was assessed in accordance with the Cochrane risk of bias tool. In this Meta-analysis dichotomous and continuous variables were calculated using the risk ratio (RR) and standardized mean difference (SMD), respectively. RESULTS: Eight studies involving 987 patients met the criteria for inclusion. The VAS SMD was favoring the experimental group significantly (p < 0.001). Subgroup analysis suggested that the patients performed PVA with mean fracture age less than 3 months would got pain relief earlier and more durable than the control group (P <0.05). The SMD of spinal function assessed with RDQ and Oswestry LBP data was in favor of the experimental groups. QOL outcome improvement was demonstrated statistically significant at early, middle and late-term follow-up for PVA than the control group (P <0.05). CONCLUSIONS: In conclusion, this meta-analysis, which evaluated PVA for osteoporotic VCFs, demonstrated significant improvement regarding VAS, spinal function and QOL outcomes. The optimal fracture age was less than 12 weeks.

Comparison of lumbar spine stabilization exercise versus general exercise in young male patients with lumbar disc herniation after 1 year of follow-up.

OBJECTIVE: The safest and most effective conservative treatment for patients with lumbar disc herniation (LDH) has not been established. The purpose of this study was to evaluate the effect of lumbar spine stabilization exercise (LSSE) and general exercise (GE) on pain intensity and functional capacity in young male patients with LDH. METHODS: Sixty-three young male adults aged 20 to 29 years with the diagnosis of LDH were enrolled and divided into an LSSE group (n=30) and a GE group (n=33). Patients in both groups received low-power laser (LPL) therapy during the first week of the onset of LDH. Patients in the GE group underwent a GE program. Patients in the LSSE group followed an LSSE program for 3 months. All of the patients were subjected to pain intensity and functional capacity evaluations four times: at pre-and post-LPL therapy, and at 3 months and 1 year post-exercise. Pain intensity of the lower back and legs was evaluated with the visual analogue scale (VAS), and functional capacity was evaluated with the Oswestry Disability Index (ODI). RESULTS: Both groups showed a significant reduction in VAS and ODI scores at 3 and 12 months post-exercise compared with before treatment (P<0.001). The LSSE group showed a significant reduction in the average score of the VAS for low back pain (P=0.012) and the ODI (P=0.003) at 12 months post-exercise compared with the GE group. CONCLUSIONS: LSSE and GE are considered as effective interventions for young male patients with LDH. Moreover, LSSE is more effective than GE, and physical therapy, such as LPL, is required during acute LDH.

Mitochondrial DNA induces inflammation and increases TLR9/NF-κB expression in lung tissue.

Mitochondrial DNA (mtDNA) contains unmethylated CpG motifs that exhibit immune stimulatory capacities. The aim of this study was to investigate whether mtDNA activates the Toll-like receptor 9 (TLR9)/nuclear factor-κB (NF-κB) pathway, thereby contributing to post-traumatic systemic inflammatory response syndrome (SIRS) and lung injury in rats. The effects of mtDNA on macrophage culture were examined in order to elucidate the putative cellular mechanisms. Rats and macrophage cultures were treated with phosphate-buffered saline, nuclear DNA, or mtDNA for 2, 4, 8 and 24 h. Histological analysis of lung tissue was undertaken following hematoxylin and eosin staining, and cytokine levels were assessed by ELISA. NF-κB and IκB-α phosphorylation levels, as well as TLR9 protein expression were determined by western blot analysis; NF-κB, IκB-α and TLR9 mRNA levels were analyzed by RT-PCR. A greater degree of inflammation and lung injury was observed in response to mtDNA. In addition, mtDNA increased serum tumor necrosis factor-α, interleukin (IL)-6 and IL-10 levels in vivo and increased their secretion by cultured macrophages (p<0.05). In lung tissue, mtDNA increased NF-κB, IκB-α and TLR9 mRNA levels (p<0.05); it also increased phosphorylated NF-κB p65 and TLR9 protein levels in the macrophage cultures. Thus, mtDNA may be part of the danger-associated molecular patterns, contributing to the initiation of sterile SIRS through the activation of the TLR9/NF-κB pathway and the induction of pro-inflammatory cytokine production.

Relationship between nutritional status and mortality during the first 2 weeks following treatment for cervical spinal cord injury.

BACKGROUND: The effects of nutrition on the mortality of cervical spinal cord injury (CSCI) patients, unlike other risk factors, are poorly documented. Objective The relationship between dynamic nutritional status change and mortality in patients treated for CSCI was investigated. METHODS: A retrospective study of 128 patients treated for CSCI at the Beijing Army General Hospital was conducted between March 2006 and March 2011. Age, spinal segment damage (C1-C4 and C5-C7), American Spinal Injury Association (ASIA) grade, hospitalization duration, ventilatory support, and serum protein levels (total protein, serum albumin, and serum prealbumin) were assessed during early-stage treatment (<14 days). Survival (n = 109) and death (n = 19) groups were assigned by final disposition of acute hospitalization. RESULTS: The survival group evidenced no significant changes in total protein levels during early-stage treatment, although these values decreased in the death group. Serum prealbumin and albumin levels significantly declined by treatment day 1 and throughout treatment (P < 0.05). By days 3-5 and thereafter, significantly lower serum proteins were observed in the death group compared to the survival group (P < 0.05). Multiple segment damage, elevated ASIA, and longer ventilatory support duration were more prevalent in the death group (P < 0.001) CONCLUSIONS: Lower serum protein levels associated with hypoproteinemia and malnutrition are significant indicators of mortality in patients with CSCI, along with higher levels of lesions, elevated ASIA grades, and longer ventilatory support durations. Early corrective action for hypoalbuminemia may help to reduce mortality in patients with CSCI.

[Metallic modular radial head prostheses for Mason III and IV unreconstructable radial head fractures].

OBJECTIVE: To assess the early efficacy of metallic modular radial head prostheses in patients with Mason III and IV unreconstructable radial head fractures. METHODS: The medical records of 16 patients (9 males, 7 females) with a mean age of 43 years old (31 to 57) with Mason III/IV unreconstructable radial head fractures requiring metallic modular radial head replacement between January 2009 and March 2012, were reviewed retrospectively. The functional results were assessed by range-of-movement, Mayo elbow performance score (MEPS). All patients underwent radiographic evaluation for radial head height and radiolucent lines. RESULTS: Fourteen patients were evaluated with follow-up for 12 to 33 months with an average of 23 months. Range of movement parameters was significantly lower in the affected elbow than in the unaffected side (P < 0.01). MEPS results were excellent in 9 cases, good in 2 cases, fair in 2 cases, and poor in 1 case. According to Grewal grading, there were 4 cases of periprosthetic lucencies of the radius and 1 case had significant clinical signs of loosening. CONCLUSION: Radial head replacement with the metallic modular prostheses yields satisfactory results regarding range of motion and function of the elbow joint in short term. The evolution of this prostheses needs to be evaluated with further studies to assess mid-term and long-term follow-up results.

Factors influencing postoperative mortality one year after surgery for hip fracture in Chinese elderly population.

BACKGROUND: Disability and death following hip fracture is becoming more common as the population ages. Previous reports have focused on the selection of internal fixation methods and the analysis of the perioperative therapeutic results in the Chinese population. Few studies have focused on factors influencing medium and long term survival after surgery for hip fracture. We conducted a retrospective study on the factors influencing survival one year after hip fracture surgery in our elderly Chinese population to provide a reference for improved treatment and to enhance efficacy. METHODS: Records from patients undergoing treatment for hip fracture at our hospital from October 2009 through June 2011 were retrospectively reviewed. Through telephone follow-up, the health condition of each patient was surveyed, and the 1-year postoperative mortality was analyzed. The patients' age, gender, fracture type, pre-injury health condition, mobility, complications, surgical timing, surgical types, methods of anesthesia, and postoperative complications were analyzed. Univariate and multivariate regression analysis was performed on relevant influencing factors. RESULTS: A total of 184 patients had complete data and were followed-up for 12-23 months (average, 16.5 months). There were 30 deaths (16.3%) at one-year. Univariate analysis revealed that factors such as age, gender, fracture-type, number of co-existing diseases, complications such as chronic obstructive pulmonary disease or sequelae of stroke, American society of Anesthesiology (ASA) scores, anesthesia methods, pre-injury activity, and post-operative complications were significantly different between survival versus mortality groups (P < 0.05). Multivariate regression analysis revealed that age, ASA score, pre-injury mobility and combined chronic obstructive pulmonary disease were independent risk factors for death. CONCLUSION: Full consideration of medium-/long-term risk factors in the treatment of hip fracture in the elderly, selection of appropriate anesthesia and treatment methods, and improved pre-surgical health conditions would reduce postoperative mortality and enhance surgical efficacy.

[Treatment of vertical unstable pelvic fracture by percutaneous iliosacral screws fixation].

OBJECTIVE: To retrospectively analyze the patients of vertically unstable pelvic fractures treated with percutaneous iliosacral screws fixation and to explore the operative techniques and its therapeutic efficacy. METHODS: From June 2002 to August 2009, 54 patients with vertical unstable pelvic fracture were fixed with percutaneous iliosacral screws. After operation, 46 patients were followed up more than 18 months. Among them, 32 patients were male and 14 patients were female, the average age was 36.4 years old (ranged from 19 to 64 years). The average time from injury to operation was 8.5 days (ranged from 7 to 11 days). All pelvic fractures had vertical dislocation ranging from 8 to 40 mm (averaged 28.5 mm). After admitted, all patients were applied bone traction. After recuction, the fractures were fixed with percutaneous iliosacral 7.3 mm cannulated screws, which crossed the iliac and sacral-iliac joint and sacral promontory to S(1)vertebrae. After operation, all patients took X-ray examination. The reduction and the fracture reduction were judged according to Matta criterion and clinical function was judged according to Majeed functional scoring. RESULTS: Forty-six patients were followed up from 1.5 to 3 years with an average of 29 months. Fracture uninon was achieved in all patients. All patients got clinical recovery at mean time of 5.2 months and returned to normal daily life. According to Matta criterion for fracture reduction, the results were excellent in 40 cases and good in 6 cases. According to Majeed functional scoring, 32 patients were excellent, 12 good and 2 normal. There were no serious complications of vascular damage. CONCLUSION: Percutaneous iliosacral screw fixation is an effective technique with advantages of minimal invasive and faster recovery in the management of vertically unstable pelvic fractures.

[Therapeutic efficacy of augmentative plate fixation in long-bone hypertrophic nonunion subsequent to intramedullary nailing].

OBJECTIVE: To determine the therapeutic efficacy of augmentation plate fixation in nonunion of long-bone fracture after interlocking intramedullary nailing. METHODS: From April 1998 to April 2009, 14 patients with long-bone hypertrophic nonunion after intramedullary nail internal fixation were treated with augmentative plate. There were nine patients with nonunion of femur, three of humerus and two of tibia. After implanting the intramedullary nail in situ, an augmentative plate fixation was applied to the fracture site to counter the rotational instability. A general plate with at least two screws reaching the opposite cortical bone above and below the fracture was fixated to the lateral side of bone shaft. In all patients, the rotational instability of fracture site was verified intra-operatively in all cases. However, motion disappeared after plate augmentation. RESULTS: All patients achieved radiological solid union at an average of 8 months (range: 6 - 11). Hardware was removed in six cases at 6-11 months post-operation. No infection, hardware loosening or rupture was found. CONCLUSION: The augmentative plate fixation can be applied at the fracture site to prevent the rotational instability. Augmentation plate fixation is indicated for femoral and tibial nonunion of proximal or distal metaphyseal-diaphyseal junctional areas, primary comminuted fracture and humeral nonunion after intramedullary nailing.

[The value of modified POSSUM scoring system in predicting mortality and morbidity for the intertrochanteric fracture in elder patients].

OBJECTIVE: To evaluate the value of modified physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) scoring system in predicting mortality and morbidity for the intertrochanteric fracture in elder patients. METHODS: A retrospective study was conducted over a period of nearly 2 years from January 2007 to December 2008. Complete data from 119 patients were analyzed to compare the mortality and morbidity predicted by the POSSUM and the observed mortality and morbidity. POSSUM risk was calculated using the original POSSUM equation. RESULTS: POSSUM predicted 11(9.2%) deaths, which had no statistical significance with the observed mortality 5 (4.2%) (chi² = 2.412, P = 0.120). The estimated incidence of postoperative complications was 42 (35.3%), which also has no statistical significance with the observed morbidity 39 (32.8%) (chi² = 0.168, P = 0.682). CONCLUSIONS: The modified POSSUM scoring system can predict accurately postoperative mortality and morbidity for the patients underwent intertrochanteric fracture and it predict more accurately in high risk band. The physiological score can be used to evaluate the physiological conditions preoperative and the pulmonary disease is the most important factor lead to death of the elder patients underwent intertrochanteric fracture.

[Augmentative plate fixation for the treatment of femoral hypertrophic nonunions subsequent to intramedullary nailing fixation].

OBJECTIVE: To investigate the effect of augmentative plate fixation to increase stability in the treatment of femoral shaft nonunions subsequent to intramedullary fixation. METHODS: Nine patients with femoral nonunions after intramedullary nail internal fixation were treated with augmentative plate internal fixation from April 1998 to Jane 2008, included 8 males and 1 female, with an average age of 32 years old ranging from 21 to 54 years. One case was upper 1/3 femoral fractures, 5 cases were middle 1/3 femoral fractures, 3 cases were lower 1/3 femoral fractures. The interspace of bone nonunion was more than 5 mm in 6 cases, of them, iliac bone grafting were applied in 4 cases, artificial bone combined with iliac bone grafting were applied in 2 cases; The interspace of bone nonunion was less than 5 mm in other 3 cases,artificial bone grafting was applied in 1 case, fitting bone callus were applied in 2 cases. All patients got protected weight loading preventing the main screw break. RESULTS: All patients achieved radiological solid union at an average of 8 months (ranged 6 to 11 months ). The fixation was removed during 6 to 11 months after operation in 5 cases. Donor site pain of iliac occurrenced on 4 cases,3 cases relieved 1 month later and 1 case relieved 3 months later. No infection, fixation loosening or breaking was observed. CONCLUSION: The augmentative plate fixation can be applied at the fracture site to prevent the rotational instability. The technique is simple and does not require any special instrument, which facilitates an early weight bearing and gives a quick recovery from nonunion.

[Biomechanical study and clinical application of cannulated compression screws with across solid frame for intertrochanteric fractures].

OBJECTIVE: To evaluate the safety and efficiency of treating the senile intertrochanteric fractures with cannulated compression screws (CCS) with across solid frame in femur head via biomechanical tests and clinical application. METHODS: Biomechanical tests: the fracture model was made in 31-A1.3 style, 6 pairs of flesh and embalmed cadaveric femurs were mechanically tested in a single-limb stance configuration. A material testing machine was used to apply vertical loads onto the femoral head. Both stiffness and reverse turn were recorded. Clinical application: from 1998 to 2006, According to damage control orthopedics (DCO) and American Society of Anesthesiologists (ASA) and the Evans classification, 51 patients received treatment with CCS with across solid flame in femur head. All the cases were followed up for 12 to 36 months (mean: 18 months). RESULTS: the differences between two groups in BMD (bone mineral density) were of statistical significance. And tensile rigidity and torsional rigidity of CCS were strong enough to bear weight. The CCS group had a lesser amount of blood loss or transfusion and lower treatment expenses. CONCLUSION: Cannulated compression screw with across solid flame is strong enough to be employed as an effective method to treat aged intertrochanteric hip fractures with the advantages of simple procedure, minimal invasion, stable fixation and weight bearing.

Ex vivo non-viral vector-mediated neurotrophin-3 gene transfer to olfactory ensheathing glia: effects on axonal regeneration and functional recovery after implantation in rats with spinal cord injury.

OBJECTIVE: Combine olfactory ensheathing glia (OEG) implantation with ex vivo non-viral vector-based neurotrophin-3 (NT-3) gene therapy in attempting to enhance regeneration after thoracic spinal cord injury (SCI). METHODS: Primary OEG were transfected with cationic liposome-mediated recombinant plasmid pcDNA3.1(+)-NT3 and subsequently implanted into adult Wistar rats directly after the thoracic spinal cord (T9) contusion by the New York University impactor. The animals in 3 different groups received 4x10(5) OEG transfected with pcDNA3.1(+)-NT3 or pcDNA3.1(+) plasmids, or the OEGs without any plasmid transfection, respectively; the fourth group was untreated group, in which no OEG was implanted. RESULTS: NT-3 production was seen increased both ex vivo and in vivo in pcDNA3.1(+)-NT3 transfected OEGs. Three months after implantation of NT-3-transfected OEGs, behavioral analysis revealed that the hindlimb function of SCI rats was improved. All spinal cords were filled with regenerated neurofilament-positive axons. Retrograde tracing revealed enhanced regenerative axonal sprouting. CONCLUSION: Non-viral vector-mediated genetic engineering of OEG was safe and more effective in producing NT-3 and promoting axonal outgrowth followed by enhancing SCI recovery in rats.