Perioperative Protocol of Ankle Fracture and Distal Radius Fracture Based on Enhanced Recovery after Surgery Program: A Multicenter Prospective Clinical Controlled study.

Background: The enhanced recovery after surgery (ERAS) program is aimed to shorten patients' recovery process and improve clinical outcomes. This study aimed to compare the outcomes between the ERAS program and the traditional pathway among patients with ankle fracture and distal radius fracture. Methods: This is a multicenter prospective clinical controlled study consisting of 323 consecutive adults with ankle fracture from 12 centers and 323 consecutive adults with distal radial fracture from 13 centers scheduled for open reduction and internal fixation between January 2017 and December 2018. According to the perioperative protocol, patients were divided into two groups: the ERAS group and the traditional group. The primary outcome was the patients' satisfaction of the whole treatment on discharge and at 6 months postoperatively. The secondary outcomes include delapsed time between admission and surgery, length of hospital stay, postoperative complications, functional score, and the MOS item short form health survey-36. Results: Data describing 772 patients with ankle fracture and 658 patients with distal radius fracture were collected, of which 323 patients with ankle fracture and 323 patients with distal radial fracture were included for analysis. The patients in the ERAS group showed higher satisfaction levels on discharge and at 6 months postoperatively than in the traditional group (P < 0.001). In the subgroup analysis, patients with distal radial fracture in the ERAS group were more satisfied with the treatment (P=0.001). Furthermore, patients with ankle fracture had less time in bed (P < 0.001) and shorter hospital stay (P < 0.001) and patients with distal radial fracture received surgery quickly after being admitted into the ward in the ERAS group than in the traditional group (P=0.001). Conclusions: Perioperative protocol based on the ERAS program was associated with high satisfaction levels, less time in bed, and short hospital stay without increased complication rate and decreased functional outcomes.

Correction to: Overexpression of CAV3 facilitates bone formation via the Wnt signaling pathway in osteoporotic rats.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: A meta-analysis of randomized controlled trails.

BACKGROUND: The purpose of this meta-analysis was to compare the effectiveness and safety of cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures. METHODS: We searched PUBMED, EMBASE, Cochrane Library, and Google Scholar from their inception to February 2016. All RCTs comparing cemented with uncemented hemiarthroplasty for displaced femoral neck fractures were eligible. The participants who underwent primary hemiarthroplasty for unilateral femoral neck fracture were older than 55 and the mean age of more than 75 years old. For the trials before 2006 used old designed prostheses, so we excluded trails before 2006 which used old designed prostheses. Outcomes of interest include postoperative hip function, Harris hip score (HHS), mortality, reoperation rate, complications, operation time, intraoperative blood loss. Two reviewers independently evaluated the included studies and extracted data into RevMan. Quality Assessments were classified by agreement of 2 authors based on the Cochrane tool. RESULTS: Seven trials were eligible. Postoperative hip function at 12 months cemented hemiarthroplasty was better than that in uncemented hemiarthroplasty (OR = 0.52, 95% CI, 0.31-0.88; P = .01). Postoperative fractures rates in cemented hemiarthroplasty were lower than that in uncemented hemiarthroplasty (OR = 0.09, 95% CI, 0.02-0.38; P = .001). Also, the interoperative fracture rates in cemented hemiarthroplasty were lower than that in uncemented hemiarthroplasty (OR = 0.29, 95% CI, 0.13-0.68; P = .004). Shorter operation time was achieved in uncemented hemiarthroplasty than that in cemented hemiarthroplasty (WMD = 8.22 min, 95% CI, 5.57-10.86 min; P<.00001). There was no significant difference between the 2 groups with HHS, mortality, wound infection, dislocation, general complications, reoperation rate, and intraoperative blood loss. CONCLUSION: The available evidence indicates that compared with uncemented hemiarthroplasty cemented hemiarthroplasty achieved better postoperative hip function, less postoperative, and interoperative fractures in displaced femoral neck fracture. Uncemented hemiarthroplasty achieved shorter operation time. There was no difference between the 2 groups with HHS at 1 year, mortality, and complications.

Overexpression of CAV3 facilitates bone formation via the Wnt signaling pathway in osteoporotic rats.

PURPOSE: Osteoporosis is a condition characterized by decreased bone density and bone strength, commonly observed among older individuals. Caveolin-3 (CAV3) is a principal structural protein of the caveolae membrane domains, which has been reported to participate in cell signaling as well as the maintenance of cell structure. The aim of the current study was to investigate the effects involved with the silencing of CAV3 on bone formation among osteoporotic rat models via the Wnt signaling pathway. METHODS: Osteoporosis was initially induced by means of ovariotomy among rat models in order to determine the expression of CAV3. Then, to confirm the specific function and mechanism of CAV3 from an osteoporosis perspective, the CAV3 expression vector was constructed and transfected into the osteoblasts of the osteoporotic rats. Afterward, the mRNA and protein expressions of CAV3, ß-catenin, low-density lipoprotein receptor-related protein 5 (LRP5), T-cell factor (TCF), and Wnt3a in addition to cell proliferation and apoptosis were detected accordingly. RESULTS: Positive expression of CAV3 exhibited diminished levels in the bone tissues of osteoporotic rats. The osteoblasts of the osteoporotic rats treated with overexpressed CAV3 displayed elevated mRNA and protein expression levels of ß-catenin, LRP5, TCF, and Wnt3a. Increased cell proliferation and decreased cell apoptosis were also observed, while the osteoblasts of the osteoporotic rats treated with si-CAV3 exhibited an opposite result. CONCLUSION: Overexpressed CAV3 promotes bone formation and suppresses the osteoporosis progression via the activation of the Wnt signaling in rat models, suggesting CAV3 as a potential target biomarker in the treatment of osteoporosis.

Combination prophylaxis versus pharmacologic prophylaxis alone for preventing deep vein thrombosis in hip surgery.

PURPOSE: To evaluate the comparative efficacy and safety of combination pharmacologic and graduated compression stockings (GCS) prophylaxis versus pharmacological prophylaxis alone for preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) in hip surgery. METHODS: Relevant publications indexed in PubMed, Cochrane Library, Embase, Web of Science, Wanfang Data, CNKI and Sinomed (CBM) were identified. Appropriate articles identified from the reference lists of the above searches were also reviewed. RESULTS: Significant differences in the rate of distal DVT were observed between combination prophylaxis and pharmacological groups. When data from Fredin 1989 was excluded no significant difference in the rate of distal DVT was seen between groups. No significant difference in the rate of proximal DVT or PE was observed between combination and pharmacologic prophylaxis groups. CONCLUSIONS: A combination of pharmacological prophylaxis and GCS can decrease distal DVT in the lower extremity when compare to pharmacological prophylaxis alone, but it is not useful in decreasing proximal DVT and PE. If we use currently recommended pharmacologic prophylaxis it is not necessary to combine this with GCS.