Anatomic Repair vs Closed Reduction of the Syndesmosis.

BACKGROUND: The goal of the study was to compare radiographic and functional outcomes between conventional closed syndesmotic reduction and screw fixation with open reduction, direct repair of the anterior inferior tibiofibular ligament (AiTFL) and screw fixation. We hypothesized that open reduction with restoration of the AiTFL would provide an improved reduction with better radiographic and functional outcomes. METHODS: Fifty consecutive patients with OTA 44-C ankle fractures were enrolled. Treatment was nonrandomized and based on surgeon preference. Patients were treated with either open reduction, suture-anchor AiTFL repair, and screw fixation (ART group), or conventional closed reduction of the syndesmosis followed by screw fixation (CR group). The primary outcome measure was anteroposterior (AP) displacement of the fibula on CT scan at 3 months postoperatively. Secondary outcome measures included the Maryland Foot Score, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Score, and the Foot and Ankle Outcome Score (FAOS). RESULTS: Mean AP difference between injured and noninjured ankles was decreased in the ART group compared with the CR group (0.7 ± 0.3 mm vs 1.5 ± 0.3 mm, P = .008). No differences were observed between groups in overall scores for secondary outcome measures. The ART group displayed a significant difference in Maryland Foot Shoe subscore at 12 months (ART = 9.5 vs CR = 8.3, P = .03) and FAOS Quality of Life subscore at 12 months (64.1 compared to 38.3, P = .04). CONCLUSION: Open anatomic syndesmotic repair resulted in improved radiographic outcomes compared with closed reduction. Cosmesis was worse at 6 weeks compared to the CR group; however, quality of life and shoewear were improved in the ART group at 1 year postoperatively. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Transcription-dependent and transcription-independent functions of the classical progesterone receptor in Xenopus ovaries.

Two forms of the classical progesterone receptors (PR), XPR-1 and XPR-2, have been cloned in Xenopus laevis. Their relative roles in mediating progesterone action in the ovaries are not clear. Using antibodies generated against the cloned XPR-2, we demonstrated here that the somatic follicle cells expressed an 80-kDa PR protein, termed XPR-1. Treatment of follicle cells with progesterone resulted in disappearance of this protein, consistent with proteosome-mediated XPR-1 protein degradation. A smaller (approximately 70 kDa) PR protein, termed XPR-2, was expressed in the oocytes, but not in follicle cells. XPR-2 underwent progesterone-induced phosphorylation but not protein degradation. Treating isolated ovarian fragments with progesterone caused oocyte maturation and the release of the mature oocytes from the ovarian tissues ("ovulation"). Inhibition of transcription, with actinomycin D, did not interfere with progesterone-induced oocyte maturation but blocked "ovulation" so that mature oocytes were trapped in the follicles. These results suggest that the dual functions of progesterone, transcription-dependent follicle rupture and transcription-independent oocyte maturation, are mediated by the two forms of PR proteins differentially expressed in the follicle cells and the oocytes, respectively.