Is traumatic meniscal lesion associated with acute fracture morphology changes of tibia plateau? A series of arthroscopic analysis of 67 patients.

BACKGROUND: Computed tomography (CT) has become a routine preoperative examination for tibial plateau fractures (TPFs). Assessing the location of the fragment and intercondylar eminence fracture can provide clinicians with valuable information; however, the evaluation of traumatic meniscal lesion (TML) and arthroscopic management are controversial. AIM: To predict TML by three-dimensional skeletal anatomy changes in unilateral TPF and bilateral TPF on preoperative thin layer CT. METHODS: Acute fracture of tibial plateau patients undergoing arthroscopic surgery between December 2017 and December 2019 were included in this retrospective study. The type, zone, and location of TMLs were diagnosed based on the operation records and/or arthroscopic videos. Measurement of three-dimensional fracture morphology included the following: Frontal fragment width of plateau, sagittal fragment subsiding distance (FSD), sagittal fracture line distance, sagittal posterior tibial slope, and transversal area ratio of fragment area) on preoperative CT three-dimensional plane. The correlation of TML with skeletal values was calculated according to unicondylar TPFs and bicondylar TPFs. RESULTS: A total of 67 patients were enrolled in this study, among which 30 patients had TMLs, lateral/medial (23/7). FSD was a particularly positive factor to predict TML, with odds ratio of 2.31 (1.26-5.63). On sagittal view of CT, FSD degree of 8 mm and posterior tibial slope exceeding 11.74° implied enhanced risk of TML in bicondylar TPFs. On coronal view, once fragment width of plateau surpassed 3 cm, incidence of TML reached 100%. On transverse view, area ratio of fragment as enhanced risk of 5.5% and FSD > 4.3 mm for predicting TML were observed in unicondylar TPFs. CONCLUSION: TML can be predicted by different parameters on preoperative CT views according to unicondylar fractures and bicondylar TPFs.

Gadolinium-chelate functionalized bismuth nanotheranostic agent for in vivo MRI/CT/PAI imaging-guided photothermal cancer therapy.

Multifunctional nanomaterials with simple structure and good biosafety, integrating multimodal imaging and therapeutic functions, can facilitate the development of clinical cancer treatments. Here, a simple but powerful pure bismuth based nanoparticle (Gd-PEG-Bi NPs) was developed from pure Bi NPs and gadolinium-diethylenetriaminepentaacetic acid-bis-tetradecylamide, which not only shows high quality MRI/CT/PAI triple-modal imaging, but can also be a potent photothermal therapy agent under the guidance of the triple-modal imaging. The Gd-PEG-Bi NPs showed good stability and excellent biocompatibility. In vitro and in vivo study demonstrated that Gd-PEG-Bi NPs have ultrahigh X-ray attenuation coefficient, short T1 relaxation time in MRI, and strong PAI signal. Following the imaging diagnosis, the excellent light-to-heat conversion efficiency of Gd-PEG-Bi NPs was capable of suppressing the tumor growth effectively under near-infrared laser radiation in vivo. Such multifunctional nanoparticles were ideal candidates for cancer diagnosis and treatment.

Comparison of outcomes after bilateral simultaneous total knee arthroplasty using posterior-substituting versus cruciate-retaining prostheses.

OBJECTIVES: To compare the effectiveness and safety of posterior-substituting (PS) with cruciate-retaining (CR) total knee prostheses after the elimination of confounding variables. METHODS: Between January 2008 and June 2012, a total of 32 subjects who had bilateral arthritis of the knees agreed to have one knee replaced with a PS total knee design and the other with a CR design. In addition to postoperative complications, clinical outcomes (Knee Society Score, Range of Motion, Western Ontario and McMaster Universities Arthritis Index, as well as radiographic findings) were evaluated preoperatively, and at 2-week, 3-month, 12-month, and 24-month follow-up. RESULTS: At the 24-month follow-up interval, no benefit of CR design was observed over PS design regarding functional assessment, patient satisfaction, or postoperative complication. However, the PS total knee design did display statistically significant improvements in range of motion as compared with the CR design. CONCLUSION: While comparable regarding supporting good clinical outcomes, the PS design does appear to support significantly improved postoperative range of motion when compared with the CR design.

[Comparative study on reconstruction of anterior cruciate ligaments with allografts and hamstring tendon under arthroscopy].

OBJECTIVE: To evaluate the effect of reconstruction of anterior cruciate ligaments (ACL) with allogeneic tendon or autologous hamstring tendon under arthroscopy. METHODS: Thirty-two cases of ACL injury (3 cases compound with PCL injury) were reviewed. All the patients were divided into two groups randomly. Fifteen cases were reconstructed with hamstring tendon, including 12 male and 3 female with the age ranging from 23 to 61 years. Seventeen cases were reconstructed with allograft, including 11 male and 6 female with the age ranging from 17 to 57 years. The tendons were fixed with absorbable or Ti screws. All patients were recorded symptoms,physical signs and Lysholm Scores two weeks after operation,and functional rehabilitation of knee six months after operation. RESULTS: All cases were followed up from 6 to 8 months. Pain and clinical symptoms disappeared and the function of knee joint was improved in all patients. Five patients of allograft with positive Lachman test result,one with severe graft rejection was found complete absorption of allograft under arthroscopy. No significant differences were seen in Lysholm Score between the two groups,average (88.5 +/- 7.2), (93.2 +/- 8.5) after operation (P > 0.05). CONCLUSION: The effects of reconstruction of cruciate ligaments with allogeneic tendon or autologous hamstring tendon under arthroscopy are more satisfying. But there are more symptoms and obvious individual differences in the earlier stage of rehabilitation. So reconstruction of cruciate ligaments under arthroscopy using autologous hamstring tendon should be performed as far as possible.

[Clinical randomized controlled trial on splint external fixation combined with Chinese herbs in treating distal radius fractures of elderly patients].

OBJECTIVE: To explore the effects of Yishen Zhuanggu decoction ([Chinese characters: see text], YSZGD) on the fracture healing and function of wrist joint in osteoporotic distal radius fractures (ODRF) of elderly patients. METHODS: Ninety patients of ODRF were treated with splint external fixation and YSZGD, including 28 males and 62 females, with an average age of 63 years (ranged, 61 to 91 years). According to AO classification, all the patients were classified as type A or B1. Among the patients, 80 patients had a type of Colles fracture,7 patients were with a type of Smith fracture,and 3 patients had a type of Barton fracture. They were randomly divided into three groups included TCM, Western medicine and control group (30 cases each group) after the fractures were fixed manually by splint. Patients in TCM group took YSZGD orally, one potion and two time each day; the patients in Western medicine group treated with Calcitonin (50 units, intramuscular, 2 times each week), Caltrate D (1 tablets, taken orally, one time each day) and Alfacalcidol Soft Capsules (0.5 units, taken orally, one time each day); and the patients in control group took no medicine. X-ray examination on the fractured wrist was taken at the 4, 6, 8, 12th weeks after treating to observe, the fracture healings, the evaluation of wrist function and comparision of curative effects were taken at the 2nd month. RESULTS: The fracture healing time in TCM group was 7.12 +/- 2.32 weeks and that in the Western medicine group was 9.25 +/- 3.05 weeks, showing significant differences between them (PC < 0.05), and that in the control group was 11.57 +/- 1.93 weeks which was longer thant in that in the two medicine groups (P < 0.05); According to Dienst wrist rating system, the excellent and good rates of three groups were 93.3%, 86.7% and 60% respectively which showing significant differences between medicine groups and control group (P < 0.05), and the curative effects of medicine groups were more excellent than that of control group through Ridit analysis. CONCLUSION: YSZGD can promote the fracture healing evidently and shorten the healing time, whose curative effect surpassed Western medicine and promoted the restoration of wrist function.