A retrospective assessment of the clinical efficacy of different internal fixation methods in the treatment of distal fibula fractures in the elderly.

An ankle fracture is a fracture of the distal tibia or fibula that forms the ankle joint, usually associated with ligament and soft tissue injury, and is a common type of lower limb fracture and one of the most common types of fracture in the elderly. Although ankle fractures are one of the most common injuries seen by orthopedic trauma surgeons, there is no uniform protocol for the diagnosis and treatment of ankle fractures in the elderly, and there are many controversial indications for surgery. The aim of this study is to assess the clinical efficacy of different internal fixation methods in the treatment of distal fibular fractures in the elderly, in an effort to improve the rational selection and application of clinical acts. A retrospective analysis was performed on 68 cases of patients who suffered an ankle fracture and were treated with different internal fixation methods according to the fracture types and individual differences in distal fibula fractures. The postoperative therapeutic effect assessment was performed in terms of clinical examination, imaging evaluation, and AOFAS ankle-hind foot function scoring. There was no unhealed bone, ankle instability and loose/fractured internal fixation. Fracture healing time was 2.7 to 4.0 months (average 3.2 months). AOFAS score was 88.3 ± 6.2, of which, 34 excellent cases, 30 good cases, and 4 fair cases. Ankle activity dorsiflexion 6º~18º, average 15º; plantar flexion 26º~47º, average 37º. A good clinical efficacy could be achieved from the most appropriate individualized internal fixation for distal fibula fractures of elderly patients.

Discrimination of Geographical Origins of Wolfberry (Lycium barbarum L.) Fruits Using Stable Isotopes, Earth Elements, Free Amino Acids, and Saccharides.

To develop sophisticated approaches for distinguishing goji origins, 325 wolfberry fruit samples of a certain cultivar, plant age, drying method, and collection season were gathered from 26 producing areas across Northwest China in 2017 and 2018. We employed 49 indices, including stable isotopes, earth elements, soluble amino acids, and saccharides, to identify the regions of origin of these goji fruits. Analysis of variance (ANOVA) and heritability analysis were used to assess the effects of the environment (producing areas), cultivar, plant age, drying process, and collection season. Samples from the same place can be classified and partially discriminated using principal component analysis (PCA). We were able to distinguish fruits produced in Zhongning County from those produced in the other five producing provinces using orthogonal projection to latent structure-discriminant analysis (OPLS-DA). Calcium (Ca), manganese (Mn), ornithine (Orn), cystine (Cys-Cys), glutamate (Glu), phenylalanine (Phe), phosphoserine (Ps), serine (Ser), lysine (Lys), taurine (Tau), proline (Pro), and tyrosine (Tyr) indices were chosen using S-plots and heritability analysis, and their repeatability was established with samples collected in 2018. The indices selected in this study can distinguish goji berries produced in Zhongning County from fruits originating from five other Provinces with high repeatability, which was validated with various cultivars, drying methods, harvest seasons, and plant ages and with heritability analysis.

The facile synthesis of copper oxide quantum dots on chitosan with assistance of phyto-angelica for enhancing the human osteoblast activity to the application of osteoporosis.

Osteoblasts are an important key factor for the pathogenesis of several bone-related diseases, notably in osteoporosis. Osteoporosis is a disorder categorized based on the bone mineral density (BMD) and an alteration in the bone micro-architecture had been considered as the major determinant for increasing the fracture risk. The available medicine for curing the osteoporosis shows a minimal or no activity against the genesis or function of osteoblasts. The present study was conducted to determine the influence of phyto Angelica species (Ang.) mediated synthesized copper quantum dots decorated chitosan on human osteoblast cells for application of osteoporosis. The phyto compound of Angelica sp. was extracted by ethanol as solvent and it has been characterized through spectral analyses. An Angelica sp. mediated synthesized copper oxide quantum dots (CuO QDs) and the presence of CuO QDs on chitosan have been analyzed and exhibited by important spectral investigations. The morphological observation of CuO QDs on the chitosan (CS) was visualized by the microscopic analyses. The MTT assay results showed that cell growth of CuO QDs/CS-Ang. by the concentration dependent. The highest cell growth (87%) was noted at 5 µg/mL followed by 80 and 77% at 15 and 25 µg/mL respectively. The functional groups and potential compounds of Angelica sp. with CuO QDs/CS has been improved the osteoblast cell activity as prophylactic potentials against osteoporosis.

Sanders type IIIAB calcaneal fracture without broken lateral wall: A case report and review of literature.

RATIONALE: The calcaneal fracture without broken lateral wall is rare and the open anatomic reduction and internal fixation (ORIF) is necessary when the subtalar joint articular surface is broken and collapsed. PATIENT CONCERNS: A 45-year-old male was admitted to our department with complaints of heel pain and swelling after falling down from 1-m-high stone. He was unable to bear weight on his right foot. DIAGNOSES: Imaging studies confirmed that it was a sanders type IIIAB calcaneal fracture without broken lateral wall and the middle part of the posterior calcaneal articular facet collapsed. INTERVENTIONS: ORIF of intraarticular calcaneal fracture with the locking calcaneal plate was performed. OUTCOMES: The patient recovered completely after 16 weeks and was able to participate in his usual work. LESSONS: Based on this case and literature we reviewed, computed tomography scan (CT scan) should be used to diagnose and evaluate the severity of calcaneal fractures. Currently, ORIF was the preferred surgical treatment option when dealing with displaced intraarticular calcaneal fractures.

4-Phenylbutyric acid presents therapeutic effect on osteoarthritis via inhibiting cell apoptosis and inflammatory response induced by endoplasmic reticulum stress.

Osteoarthritis (OA) is a common bone and joint disease with a wild range of risk factors, which is associated with endoplasmic reticulum (ER) stress. The aim of our study was to discuss the possible mechanism of ER stress associated with OA in vivo and explore novel therapeutic method against OA. OA-induced damages in cartilage tissues were evaluated by HE, Safranin O/fast green, and TUNEL staining. The inflammatory factors concentration and the expression of FAP, MMP2, MMP9, Bax, Bcl-2, CHOP, and GRP78 were evaluated by ELISA, real-time PCR, and Western blot analyses. As results, 4-phenylbutyric acid (4-PBA)-treated OA cartilage tissues presented alleviated tissue damage with less apoptotic cells and cytokine production in comparison with advanced-OA tissues. Downregulation of Bax/Bcl-2, CHOP, GRP78, inflammatory factors, and reactive oxygen species generation, and the increase of MMP level detected after 4-PBA treatment indicated an inhibitory effect of 4-PBA on cell apoptosis, inflammatory response, and ER stress in OA. In conclusion, we indicate that ER stress causes cell apoptosis and inflammatory response, resulting in the tissue damage within OA. At the same time, 4-PBA exhibited protective effect on cartilage cells against OA through the inhibition of ER stress.

ß­Ecdysterone promotes autophagy and inhibits apoptosis in osteoporotic rats.

Osteoporosis is an aging process of skeletal tissues with characteristics of reductions in bone mass and microarchitectural deterioration of bone tissue. The present study aimed to investigate the effects of glucocorticoid­induced osteoporosis on osteoblasts and to examine the roles of ß­ecdysterone (ß­Ecd) involved. In the present study, an in vivo model of osteoporosis was established through the subcutaneous implantation of prednisolone (PRED) into Sprague­Dawley rats, with or without a subcutaneous injection of ß­Ecd (5 or 10 mg/kg body weight). Expression of Beclin­1 and microtubule­associated protein 1A/1B­light chain 3I/II and apoptosis in lumbar vertebrae tissues was measured by immunofluorescence and TUNEL assays, respectively. Serum concentration of calcium and phosphorus, and the activity of tartrate­resistant acid phosphatase (TRAP) and alkaline phosphatase (ALP) were measured by biochemical assay. Reverse transcription­quantitative polymerase chain reaction and western blotting was used for detect the expression of related genes and proteins. PRED treatment inhibited bone formation by decreasing bone mineral density, and suppressing the expression of Runt­related transcription factor 2 and bone morphogenetic protein 2, while enhancing the activity of alkaline phosphatase, upregulating the expression of receptor activator of nuclear factor-κB ligand, and increasing the serum content of calcium, phosphorus and tartrate­resistant acid phosphatase in rats. Additionally, PRED was revealed to inhibit autophagy through the downregulation of Beclin­1, autophagy protein 5 and microtubule­associated protein 1A/1B­light chain 3I/II expression, whereas it induced the apoptosis, through the activation of caspase­3 and the suppression of apoptosis regulator BCL2 expression. Notably, the PRED­induced alterations in bone formation, autophagy and apoptosis were revealed to be attenuated by ß­Ecd administration. In conclusion, the findings of the present study suggested that ß­Ecd may be a promising candidate for the development of therapeutic strategies for the treatment of osteoporosis, through the induction of autophagy and the inhibition of apoptosis in vivo.

Effect of ß­ecdysterone on glucocorticoid­induced apoptosis and autophagy in osteoblasts.

The aim of the present study was to investigate the effect of glucocorticoids in osteoblasts and to examine the role of ß­ecdysterone in the pathogenesis of glucocorticoid­induced osteoporosis. Osteoblasts were induced from bone marrow mesenchymal stem cells, which were isolated from C57BL/6 mice. Cell viability and apoptosis of osteoblasts were measured by Cell Counting Kit­8 and flow cytometry analysis, respectively. The expression of related genes and proteins was measured by reverse transcription quantitative polymerase chain reaction and western blot analysis respectively. Dose­dependent decreases in the cell proliferation and differentiation were observed in dexamethasone (Dex)­treated osteoblasts, evidenced by downregulation in the activity of alkaline phosphatasedecreased expression levels of Runt­related transcription factor 2 and osteocalcin, and upregulated expression of RANK ligand. Dex also induced apoptosis and inhibited autophagy of osteoblasts, evidenced by upregulated B­cell lymphoma 2 (Bcl­2)­associated X protein/Bcl­2 ratio and the activation of mammalian target of rapamycin (mTOR), and decreased expression levels of Beclin­1, autophagy protein 5 and microtubule­associated protein 1 light chain 3 II. The effects on cell proliferation, apoptosis and autophagy induced by Dex were reversed by ß­ecdysterone in a dose­dependent manner. Therefore, ß­ecdysterone may be a promising candidate drug for the treatment of osteoporosis through inducing osteoblast autophagic activity by inactivating mTOR.

Lipoma of the middle finger: A case report and review of literature.

RATIONALE: Lipomas originated from fingers are rare and the dissection is necessary when the lipomas limit the finger movement or cause pain. PATIENT CONCERNS: A 57-year-old male was admitted to our department due to a painless swelling on the volar side of the middle finger of the right hand. The flexion movement of the distal interphalangeal joint was limited. DIAGNOSES: Imaging studies and open biopsy confirmed that it was a finger lipoma. INTERVENTIONS: An excisional biopsy was performed. OUTCOMES: The patient recovered completely after two weeks. LESSONS: Based on this case and literature we reviewed, ultrasound and MRI should be used to diagnose the finger lipoma and excision was the main treatment option.

[Surgical treatment of grade III pronation-external rotation fractures of ankle].

Objective: To summarize the short-term effectiveness of the surgical treatment for grade III pronation-external rotation ankle fractures. Methods: Between October 2011 and May 2015, 36 patients with pronation-external rotation ankle fractures (grade III) were treated with internal fixation and repair of the anterior lower tibiofibular ligament, including 21 males and 15 females with an average age of 45.2 years (range, 21-72 years). Injury was caused by sprain in 19 cases, by traffic accident in 6 cases, and by falling from height in 11 cases. All patients had closed fractures, with no blood vessel and nerve injury. The locations were the left ankle in 13 cases and the right ankle in 23 cases. The time from injury to operation was 3 to 10 days (mean, 6.5 days). At last follow-up, ankle function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-foot score, and the improvement of pain was evaluated by visual analogue scale (VAS). Results: Primary healing of incision was obtained in all patients, no incision infection and skin necrosis occurred. Twenty-eight patients were followed up 12-36 months (mean, 17.5 months). X-ray films showed bone union was achieved within 2.6-5 months (mean, 3.2 months). No fracture of internal fixation and disruption of tibiofibular diastasis occurred. At last follow-up, according to AOFAS score for ankle function evaluation, the pain score was 36.3±2.9, the function score was 44.3±3.2, the ligament condition score was 9.2±0.5, and the total score was 89.8±6.6; the results were excellent in 11 cases, good in 15 cases, and fair in 2 cases. VAS score was 1.6±0.5. The range of motion of the ankle was (13±5)° in dorsiflexion and (38±9)° in planteroflexion. Conclusion: Repair of anterior tibial ligament is an effective method to treat tibiofibular diastasis injury in the surgical treatment of grade III pronation-external rotation ankle fractures, with convenient operation, and satisfactory short-term effectiveness.

[Surgical treatment for open tarsometatarsal joint injury].

OBJECTIVE: To discuss the surgical method and clinical efficacy for open tarsometatarsal joint injuries. METHODS: From March 2011 to January 2015, 21 patients with open tarsometatarsal joint injuries were treated with stage-surgery method, including 14 males and 7 females with an average age of 45.6 years old ranging from 20 to 75 years. Injury site occurred in the left foot of 13 cases and right foot of 8 cases. Traffic injury was in 5 cases, crush injury in 6 cases, heavy crushing was in 10 cases. According to Myerson to classify for tarsometatarsal joint injury, 5 cases were type B2, 9 cases were type C1, and 7 cases were type C2. And according to Gustilo to typing for soft tissue injury, 5 cases were type IIB, 10 cases were type IIIA, 6 cases were type IIIB. Fracture healingand complications were observed after operation and clinical effects were evaluated according to the midfoot score of AOFAS. RESULTS: All the patients were followed up from 11 to 40 months with an average of 16.2 months. The fracture healing time was from 10 to 16 weeks with an average of 12.3 weeks. No complications such as deep infection, nonunion and osteomyelitis were found. Midfoot score of AOFAS at last follow-up was 83.0±14.9, 9 cases got excellent results, 8 good, 2 fair, 2 poor. Two patients complicated with severe traumatic arthritis once again underwent tarsometatarsal arthrodesis. CONCLUSIONS: For the treatment of open tarsometatarsal joint injury, reasonable debridement, comprehensive assessment for the soft tissue injury, correctly grasp the surgical indications and time of internal fixation, can reduce the incidence of deep infection and osteomyelitis.

[Iindividual choice of distal fibula internal fixation for ankle fractures in elderly].

OBJECTIVE: To explore individual choice and therapeutic effect of distal fibula internal fixation in treating ankle fractures in elderly. METHODS: From May 2012 to April 2015, 68 elderly patients with ankle fractures were treated by surgical operation, included 37 males and 31 females with an average of 69.2 years old ranging from 62 to 81 years. According to Danis-Weber classification, there were 19 cases belong to type A, 31 cases belong to type B, and 18 cases belong to type C. According to Lange-Hanson classification, 22 cases were supinatio-extorsion, 18 were pronate-extorsion, 19 were supinatio-adduction, and 9 were pronate-abduction. All patients were performed individyually with different internal fixation methods for the treatment of distal fibula fracture according to different types of fracture. Clinical results were evaluated based on clinical examination, radiographic evaluation and AOFAS score. RESULTS: Twelve patients were treated with Herbert screw, 7 cases with Kirschner wire tension band, 5 cases with 1/3 tube plate, 6 cases with reconstruction plate, 17 cases with fibular end dissection steel plate composite, and 21 cases with distal fibula anatomic locking plate. All patients were followed up from 12 to 26 months with an average of 17.7 months. The operative incision of all patients were primary healed. And there was no bone nonunion, ankle instability, internal fixation loosening and fracture occurred. Fracture healing time ranged from 2.7 to 4 months with an average of 3.2 months, and had significant differences among different groups(P<0.05). There were no statistical differences in AOFAS score, VAS score and motion of ankle joint among different internal fixation groups(P>0.05). Dorsal stretch was 6° to 18° with an average of 15°, plantar flexion ranged from 26°to 47° with an average of 37°. AOFAS score at the latest following-up was 88.4±4.3, 34 patients got an excellent result, 30 good and 4 fair. CONCLUSIONS: Good clinical results could be obtained by using individualized internal fixation for distal fibula fracture for the treatment of the ankle fractures in elderly.