Open reduction through original fracture line and fixation with locking plate is a feasible approach for extra-articular distal radius fracture malunion.

OBJECTIVES: This study aims to investigate the effectiveness of open reduction through original fracture line and fixation with locking plate in treatment of extra-articular distal radius fracture (DRF) malunion. PATIENTS AND METHODS: Between January 2015 and December 2018, a total of 69 patients (27 males, 42 females; mean age: 62.0±8.9 years; range, 46 to 70 years) suffering from symptomatic extra-articular DRF malunion were included. All patients were followed for more than six months. Patient's demographics, hand dominance, data including Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, pain on a Visual Analog Scale (VAS) score, radius height, ulnar variance, wrist range of motion, volar tilt and radial inclination before and after surgery were analyzed. RESULTS: The median follow-up was 14.13 months, and the median time to fracture healing after the operation was 14.25 weeks. The mean QuickDASH score and VAS score were significantly reduced from 63.4±13.97 and 4.6±1.23 preoperatively to 7.8±4.67 and 1.3±0.76 at the final follow-up, respectively. Radius height, ulnar variance, volar tilt, radial inclination and wrist range of motion (flexion, extension, pronation, supination) were all significantly improved (p<0.001). Images showed good radius height, ulnar variance, volar tilt and radial inclination. The range of motion of wrist and forearm were improved substantially. Among 69 patients, two patients received allograft due to osteoporotic bone collapse. No serious complication was developed, except for minor pain in three patients during follow-up. CONCLUSION: Open reduction through original fracture line and fixation with locking plate is a feasible and effective treatment for selective DRF malunion.

MutiLoc Nail Versus Philos Plate in Treating Proximal Humeral Fractures: A Retrospective Study Among the Alderly.

BACKGROUND: Proximal humeral fractures (PHFs) account for 4-5% of all fractures in the elderly. There is still a controversy among the treatments in the displaced PHFs. Our aim was to explore the clinical outcome of PHFs with the treatment of MultiLoc nail or Philos plate in the elderly patients. METHODS: A total of 82 sustained elderly patients with PHFs were finally recruited between Dec 2016 and Dec 2017. 34 patients were treated with MultiLoc nail and 48 patients were treated with Philos plate. The demographics, fracture types, blood loss, operation time, union time, postoperative complications, visual analog scores (VASs), Constant scores, American Shoulder and Elbow Scores (ASESs), and neck-shaft-angle (NSA) between the two groups were compared. RESULTS: No differences were observed in the demographics, fracture types, VAS, Constant scores, and ASES scores between the two groups at final follow-up. Compared with the plate group, the blood loss, operation time, and union time were significantly lower in the nail group (all P < .05). The rate of general complications was 54.17% in the plate group, which was higher than that in the nail group (26.47%, P = .01). Three patients experienced reoperation in the plate group (3/48; 6.25%), but none in the nail group. Although there were no significant differences in intraoperative NSA between the two groups, the NSA at final follow-up in the nail group was much higher than the plate group (137.55 ± 5.53°vs 134.47 ± 5.92°, P = .02). CONCLUSIONS: Multiloc intramedullary nail showed the similar effectiveness of final VAS, final Constant scores, and ASES scores in PHFs treatment with Philos plate. However, MultiLoc nail is superior to Philos plate in blood loss, operation time, complications, reoperation rate, and the change of NSA.

A novel classification for medial malleolar fracture based on the 3-D reconstruction CT.

BACKGROUND: Fracture of the medial malleolus is one of the most frequent injuries treated surgically; however, the classification of the fracture has not attracted much attention and a good classification system is still lacking. METHODS: Consecutive cases of medial malleolus fractures were prospectively enrolled. Based on the 3-D reconstruction CT morphology and centered on the posterior colliculus of the medial malleolus, we classified the fractures into 4 types: type 1 with no involvement of the posterior colliculus, type 2 with partial involvement of posterior colliculus, type 3 with the entire involvement of posterior colliculus, and type 4 with the fracture line 4 vertically extended from the intercollicular groove to the comminuted fracture of the posterior malleolus. Statistical analyses were performed to evaluate the clinical significance of the classification. RESULTS: There were 273 cases prospectively enrolled. The distribution of the cases was type 1 of 12.1%, type 2 of 41.0%, type 3 of 30.0%, and type 4 of 16.8%. Statistics showed that the new classification had significant associations but did not totally depend on the classical ankle fracture classifications. Results showed that the new classification had implications in the severity of ankle fractures. From type 1 to type 4, the ankle joint was more and more unstable. Furthermore, comminuted medial malleolar fractures could be subdivided, and the new classification could provide useful information for surgical decision-making. CONCLUSIONS: The novel classification was a useful system to describe the 3-D geometry of the fractured medial malleolus.

Complications associated with hyperextension bicondylar tibial plateau fractures: a retrospective study.

BACKGROUND: Hyperextension bicondylar tibial plateau fracture (HBTPF) is a particular form of tibial plateau fracture which has gained increasing interest recently but were rarely documented. In this study, we reported the characteristics, clinical intervention, and therapeutic outcomes of HBTPF patients. METHODS: From May 2015 to October 2017, clinical data of consecutive patients with bicondylar tibial plateau fractures (BTPF) who underwent surgical treatment in our hospital were retrospectively studied. The patients were allocated to either the HBTPF group (study group) or the non-HBTPF group (control group) based on the radiological features, and inclusion and exclusion criteria. Demographics, characteristics of knee joint injuries, complications, and outcomes were compared between the two groups. RESULTS: In total, 59 patients were included in this study. Among them, 17 patients with HBTPF were identified and 42 patients were diagnosed as non-HBTPF. No differences in age, sex, cause of injury, side of injury, site of injury, nerve injury, operation time, and treatment time and incision complication between HBTPF and non-HBTPF group. The incidence rate of popliteal artery injury in HBTPF group was 29.4 %, which was significantly higher than that of non-HBTPF group. Small bone chips on the lateral film were found in 94.1 % of the patients in HBTPF group, which was significantly higher than that of non-HBTPF group. The range of motion (ROM) and hospital for special surgery (HSS) score of HBTPF group were significantly lower than those of non-HBTPF group. CONCLUSIONS: HBTPF is a severe injury with a higher incidence rate of popliteal artery injury and worse outcomes than non-HBTPF. Small bone chips at the anterior margin of the proximal tibia on the lateral plain film might be a characteristic of HBTPF.

Silencing long noncoding RNA colon cancer-associated transcript-1 upregulates microRNA-34a-5p to promote proliferation and differentiation of osteoblasts in osteoporosis.

Long noncoding RNAs (lncRNAs) have been revealed to be related to multiple physiological and pathology processes such as development, carcinogenesis, and osteogenesis. It is reported that lncRNAs might exert function in osteoblast differentiation and bone formation. Here, we determined this study to clarify whether lncRNA CCAT1 could regulate osteoblast proliferation and differentiation in ovariectomized rats with osteoporosis. The osteoporosis models were established by bilateral ovariectomy and treated with CCAT1 siRNAs to discuss the effect of CCAT1 on pathological changes and osteocyte apoptosis in ovariectomized rats with osteoporosis. The osteoblasts from ovariectomized rats were cultured in vitro, which were then treated with CCAT1 siRNAs to explore the role of CCAT1 in osteoblast proliferation and differentiation. Moreover, the relationships among CCAT1, miR-34a-5p, and SMURF2 were confirmed. CCAT1 and SMURF2 were amplified while miR-34a-5p expression was inhibited in bone tissues and osteoblasts of ovariectomized rats with osteoporosis. Inhibited CCAT1 improved pathology and restricted osteocyte apoptosis of bone tissues in ovariectomized rats with osteoporosis in vivo, and also enhanced differentiation, mineralization abilities, and proliferation, and suppressed apoptosis of osteoblasts from ovariectomized rats in vitro through upregulating miR-34a-5p expression. LncRNA CCAT1 could competitively bind with miR-34a-5p to prevent the degradation of its target gene SMURF2. Results of this research suggested that the CCAT1 inhibits the proliferation and differentiation of osteoblasts in rats with osteoporosis by binding to miR-34a-5p, providing novel biomarkers for osteoporosis treatment.

Clinical research of percutaneous spinal nerve posteromedial ramus destruction in treatment for chronic facet arthrogenic low back pain: a randomized trial.

BACKGROUND: To investigate the clinical effect of percutaneous spinal nerve posteromedial ramus destruction in treatment for chronic facet arthrogenic low back pain. METHODS: A total of 118 patients with chronic facet arthrogenic low back pain were enrolled in our hospital from October 2015 to October 2018 and randomly divided into two groups. Of these patients, 59 received conservative treatment as the control group while 59 patients were treated with percutaneous spinal nerve posteromedial ramus destruction as the observation group. Pain score (Visual Analogue Scale, VAS), functional score (Oswestry Disability Index, ODI), treatment score (Japanese Orthopaedic Association, JOA), life quality score (Short Form 36-item Health Survey, SF-36), and lumbar mobility (range of motion, ROM) were evaluated before and after treatment. The treatment effect between two groups was compared. RESULTS: The VAS score and ODI score at 2, 4, and 12 weeks after treatment and last follow-up in the observation group were lower than those of the control group (P<0.05). JOA score, SF-36, and ROM were higher than those of the control group (P<0.05). CONCLUSIONS: Percutaneous spinal nerve posteromedial ramus destruction has a significant effect in treatment for chronic facet arthrogenic low back pain, which can relieve pain, improve function, and enhance quality of life.

Efficacy of bone marrow stem cells combined with core decompression in the treatment of osteonecrosis of the femoral head: A PRISMA-compliant meta-analysis.

BACKGROUND: This study used the meta-analytic approach to assess the safety and treatment efficacy of bone marrow stem cells (BMSCs) with core decompression (CD) for osteonecrosis of the femoral head (ONFH) based on randomized controlled trials (RCTs). METHODS: Electronic database of PubMed, Embase, Google Scholar, China National Knowledge Infrastructure (CNKI), and Wanfang database was searched up to December 26, 2019 for relevant RCTs about combined utilization of BMSCs and CD versus CD alone for ONFH. Gray literature sources were also searched. We conducted a meta-analysis following the guidelines of the Cochrane Reviewer's Handbook. Two independent reviewers performed the data extraction and assessed study quality. Our outcomes included the Harris hip scores (HHS) at 12 months, HHS at 24 months, necrotic area of femoral head, conversion to total hip arthroplasty (THA), visual analog pain scale at final follow-up, and adverse effects. The meta-analysis was performed with Stata 12.0. RESULTS: A total of 15 published studies with 688 patients fulfilled the requirements of inclusion criteria. Across all populations, participants in combined utilization of BMSCs group showed a statistical significance with higher HHS at 12 months (standard mean difference [SMD] 0.53, 95% confidence interval [CI] 0.29-0.77) and 24 months (SMD 0.57, 95% CI 0.36-0.77). Similarly, participants in combined utilization of BMSCs group had more advantages in reducing necrotic area of femoral head (SMD -1.05, 95% CI -1.73 to -0.38) and the rate of conversion to THA (risk ratio [RR] = 0.53, 95% CI 0.38-0.74, P = .000). No significant differences were identified regarding postoperative adverse effects postoperatively (RR = 1.03, 95% CI 0.64-1.67, P = .893). CONCLUSION: Compared with CD treated alone in the treatment of ONFH, combined utilization of CD and autologous BMSCs implantation has a better pain relief and clinical outcomes and can delay the collapse of the femoral head more effectively.

Type II Odontoid Fracture with Atlantoaxial Dislocation Presenting as Symptomatic Seizures: A Case Report.

OBJECTIVE AND BACKGROUND: To report symptomatic seizures of a patient with an old type II odontoid fracture with atlantoaxial dislocation. The type II odontoid fracture is a dangerous disease and presents as neurological deficits. Because of the compression of upper cervical cord, without timely diagnosis and treatment, a type II odontoid fracture may result in sudden death. Although it has been shown that epileptic seizures may lead to type II odontoid fracture, there is no report of symptomatic seizures in patients with odontoid fracture. METHODS: A 16-year-old adolescent boy with neurological deficits, especially grand mal seizures for duration of 5 years, was diagnosed as an old type II odontoid fracture with atlantoaxial dislocation and treated in our hospital. A 1-year follow-up was performed. RESULTS: Systematic analyses of the clinical history, manifestations, physical examination, and radiologic results of the patient revealed an old type II odontoid fracture. Magnetic resonance imaging showed spinal cord compression and degeneration. The patient received posterior atlantoaxial fixation and fusion procedure following successful closed reduction. The frequency of seizures was reduced to once a month and there was a thorough recovery in other neurological functions 1 year after the operation. CONCLUSIONS: Old type II odontoid fracture might present as symptomatic seizures in addition to other neurological deficits. Posterior atlantoaxial screw-plate fixation and fusion is an effective treatment for old type II odontoid fracture.

Efficacy and Safety of One-Stage Selective Discectomy Combined with Expansive Hemilaminectomy in the Treatment of Cervical Spondylotic Myelopathy.

OBJECTIVES: We designed a novel surgical strategy named one-stage selective discectomy combined with expansive hemilaminectomy, which might theoretically reduce the postoperative complications of cervical spondylotic myelopathy (CSM). The objective of this study is to evaluate its efficacy and safety. METHODS: Sixty-two patients with CSM were enrolled in this study. The procedure includes selective discectomy with fusion at 1 or 2 segments of maximal cord compression and expansive hemilaminectomy on the symptomatic or severe side of the body. Neurologic function was evaluated using the Japanese Orthopedics Association Score before and after surgery. Midsagittal dural sac diameter, dural sac transverse area at segments of discetomy on magnetic resonance imaging, and lordosis of the cervical spine on lateral plain film were measured. All patients were followed up for more than 1 year. RESULTS: A total of 88 discs and 272 hemilaminas were resected from 62 patients. The Japanese Orthopedics Association Score improved from 8.7 ± 1.76 preoperatively to 13.4 ± 1.61 at 1 year follow-up (P < 0.001). The mean midsagittal dural sac diameter, dural sac area, and lordotic angle also increased from 0.45 ± 0.10 cm, 0.83 ± 0.14 cm2, and 7.9 ± 2.60° to 0.81 ± 0.08 cm, 0.96 ± 0.14 cm2, and 11.7 ± 3.06°, respectively (P < 0.05). No case of postoperative axial pain, C5 palsy, nonunion, or kyphosis was reported. CONCLUSIONS: One-stage selective discectomy combined with expansive hemilaminectomy is an effective surgical approach for the treatment of CSM in patients whose neurologic function, midsagittal dura sac diameter, and dura transverse area can be improved and has few postoperative complications.

Knockdown of CDC2 expression inhibits proliferation, enhances apoptosis, and increases chemosensitivity to temozolomide in glioblastoma cells.

Cell division cycle 2 (CDC2) is always overexpressed in malignant tumor cells and is correlated with chemosensitivity, but it is unclear whether CDC2 overexpression contributes to the chemoresistance potential of glioma cells. The aim of study was to determine the relationship of CDC2 expression with the prognosis and chemoresistance of glioblastoma. In this study, the glioblastoma U87 and U251 cell lines were steadily transfected with a lentivirus vector expressing a short hairpin RNA-targeting CDC2. Expression of CDC2 was evaluated in glioblastoma and cell lines by immunohistochemistry and Western blot analysis. The relationship between CDC2 expression and clinicopathological characteristics was analyzed. Using RNA interference, the effects of CDC2 on chemosensitivity to temozolomide (TMZ) were investigated in U87 and U251 cell lines in vitro. Combined CDC2 knockdown and TMZ treatment inhibited cell proliferation and induced apoptosis in vitro more effectively than either treatment alone. qRT-PCR and Western blot analysis showed that cells underexpressing CDC2 revealed lower expression of the anti-apoptotic protein B cell lymphoma-2 and increased expression of the apoptosis effector caspase-3 compared to U87 and U251 cells transfected with a control vector. Furthermore, expression levels of CDC2 in U87 and U251 cells were related to the IC50 of the antitumor drug TMZ. Knockdown of CDC2 expression was associated with decreased expression of Ral-binding protein 1, a classical chemotherapy drugs transporter. These results indicate that the ability to suppress the malignant phenotype by down-regulating CDC2 expression may provide a new gene therapy approach for overcoming CDC2-associated chemoresistance in patients with malignant glioma.

Association of follistatin-like 3 concentrations in serum and synovial fluid with the radiographic severity of knee osteoarthritis.

OBJECTIVE: Follistatin-like 3 (FSTL3), a circulating glycoprotein, is correlated with obesity and inflammation, which are potential mechanisms of osteoarthritis (OA). This study aims to determine the correlation of FSTL3 concentrations in serum and synovial fluid (SF) with the radiographic severity of OA. METHODS: This study consisted of 200 patients with knee OA and 148 healthy controls. The radiological grading of OA in the knee was performed in accordance with Kellgren-Lawrence (KL) grading system. RESULTS: Knee OA patients had higher serum FSTL3 concentrations compared with healthy controls. Knee OA patients with KL grade 4 showed significantly elevated FSTL3 concentrations in serum and SF compared with those with KL grades 2 and 3. Moreover, knee OA patients with KL grade 3 had significantly higher FSTL3 concentrations in serum and SF compared with those with KL grade 2. FSTL3 concentrations in serum and SF of knee OA patients were significantly correlated with KL grading criteria. CONCLUSIONS: FSTL3 concentrations in serum and SF are correlated with the radiographic severity of OA.

Tagging SNPs in the MTHFR gene and risk of ischemic stroke in a Chinese population.

Stroke is currently the leading cause of functional impairments worldwide. Folate supplementation is inversely associated with risk of ischemic stroke. Methylenetetrahydrofolate reductase (MTHFR) is an important enzyme involved in folate metabolism. The aim of this study is to examine whether genetic variants in MTHFR gene are associated with the risk of ischemic stroke and fasting total serum homocysteine (tHcy) level. We genotyped nine tag SNPs in the MTHFR gene in a case-control study, including 543 ischemic stroke cases and 655 healthy controls in China. We found that subjects with the rs1801133 TT genotype and rs1801131 CC genotype had significant increased risks of ischemic stroke (adjusted odds ratio (OR)=1.82, 95% confidence interval (CI): 1.27-2.61, p=0.004; adjusted OR=1.99, 95% CI: 1.12-3.56, p=0.01) compared with subjects with the major alleles. Haplotype analysis also found that carriers of the MTHFR CTTCGA haplotype (rs12121543-rs13306553-rs9651118-rs1801133-rs2274976-rs1801131) had a significant reduced risk of ischemic stroke (adjusted OR=0.53, 95% CI: 0.35-0.82) compared with those with the CTTTGA haplotype. Besides, the MTHFR rs1801133 and rs9651118 were significantly associated with serum levels of tHcy in healthy controls (p<0.0001 and p=0.02). These findings suggest that variants in the MTHFR gene may influence the risk of ischemic stroke and serum tHcy.

Increased expression of netrin-1 and its deleted in colorectal cancer receptor in human diseased lumbar intervertebral disc compared with autopsy control.

STUDY DESIGN: The expression of netrin-1 and its deleted in colorectal cancer (DCC) receptor was investigated in human lumbar discs using immunohistochemistry. OBJECTIVE: To investigate the expression of netrin-1 and DCC receptor in human diseased and healthy lumbar intervertebral discs (IVDs) and to clarify the correlation between netrin-1 expression and the degree of neurovascular ingrowth. SUMMARY OF BACKGROUND DATA: Previous studies have shown neurovascular ingrowth into the inner regions of degenerated IVD and suggested that the ingrowth may contribute to discogenic low back pain. Netrin-1 is an axon guidance molecule that regulates axons seeking their final targets and has been identified as involved in various pathological conditions, so is its DCC receptor. However, the role of netrin-1 in diseased IVDs remains unknown. METHODS: Thirty-five diseased IVD specimens were collected from 34 patients with different lumbar diseases during posterior lumbar interbody fusion. Eight normal discs were obtained at autopsy as control. Using polyclonal or monoclonal antibody, the disc slides were immmunostained to detect the expression and distribution of netrin-1, the DCC, the neuronal marker (neurofilament), and the vascular endothelial cell marker (CD34). RESULTS: Netrin-1 and DCC immunopositive cells distributed substantially from the annulus fibrosus to the nucleus pulposus (NP), and the immunopositivity was detected in the disc cells, endothelial cells and granulation tissue cells in the diseased discs. The percentage of netrin-1 positive disc cells of the NP was more than that of the annulus fibrosus. The expression of netrin-1 and DCC was weak in the normal discs. A significant positive correlation between the percentage of netrin-1 immunopositive disc cells and neurovascular scores was found. CONCLUSION: The increased expression of netrin-1 and DCC in diseased IVDs compared with controls suggested that they might play an important role in the process of neurovascular ingrowth.

AQP9: a novel target for bone loss induced by microgravity.

The aim of current study was to elucidate whether aquaporin-9 (AQP9) expression was involved in the progression of bone loss induced by microgravity. We used the hind-limb suspension (HLS) mice model to simulate microgravity and induce bone loss. It was found that HLS exposure decreased femur bone mineral density (BMD), and enhanced femur AQP9 mRNA and protein levels. Then, the relationship between AQP9 mRNA expression and BMD was studied and it was showed that femur AQP9 mRNA level was negatively related to femur BMD in mice exposed to HLS. We sought to exam the function of AQP9 in the femur using the AQP9-null mice. It was found that AQP9 knockout attenuated bone loss and inhibited osteoclastogenesis under the condition of HLS exposure, but had no similar effect on bone under normal physiological conditions. In addition, it was found that exposure to simulated hypergravity or exercise training, main countermeasures against microgravity, reduced AQP9 mRNA and protein levels in femur of mice. Moreover, it was found that both aging and estrogen deprivation, another two risk factors of bone loss, had no significant effect on femur AQP9 expression. In conclusion, AQP9 plays an important role in the development of microgravity-induced bone loss, and may be a potential target for the prevention or management of microgravity-induced bone loss.