Imaging Classification by Column and Type of the Generalized Distal Radius Die-punch Fractures.

BACKGROUND: Generalized distal radius die-punch fractures (GDP) can involve three columns. However, there is no three-column classification for GDP. The aim of this study was to introduce a three-column classification for GDP, and to investigate the application effect of the classification. METHODS: 613 patients with GDP accrued from January 2013 to December 2021 were classified by column and fracture type based on imaging findings. First, the GDP was categorized into single-, double-, or three-column fractures. Second, the intermediate column fractures were divided into volar, dorsal, split, collapse, or mixed types; the radial column fractures were divided into metaphyseal, articular or mixed types; and the ulnar column fractures were divided into apical or basal types of the styloid process. The intra- and inter-observer consistency between the two assessors was analyzed with kappa statistics. 227 patients with less fracture displacement were treated conservatively, whereas 386 patients with increased fracture displacement were treated surgically, and the selection of surgical approaches and fracture reduction-fixation methods was guided by the classification. The differences in incidence, gender, age, treatment methods, and functional recovery were compared among the three categories, and the characteristics of different types were observed. The wrist joint function was evaluated according to the Sarmiento-modified Gartland- Werley method. RESULTS: The intra- and the inter-observer kappa coefficients were obtained as ≥ 0.810. There were significant differences in the incidence (12.7%, 68.5%, and 18.8%, respectively) and age (39.8, 46.6, and 47.1 years, respectively) for single-, double- and three-column fractures (P<0.05). However, there was no significant difference in terms of gender among the three (P>0.05). The mixed, collapse, split, dorsal, and volar types accounted for 28.7%, 27.7%, 21.9%, 15.5%, and 4.5%, respectively. The metaphyseal, articular surface, and mixed types accounted for 35.9%, 33.1%, and 31.0%, respectively. The apical and base types were 81.7% and 18.3%, respectively. Among the cases of volar and dorsal types, the missed diagnosis rate of X-ray alone was 28.5%, but it was confirmed by subsequent CT. In the last follow-up of 12.2 months (range, 6 to 24 months), the excellent plus good rate was 82.7% and 82.6%, respectively, in total and among patients undergoing surgical treatment; the excellent plus good rate of the single column fractures was 96.2%, significantly higher than that of double- and three-column fractures (80.0% and 83.5%, respectively) (P<0.05). All patients with fair or poor wrist function had collapse or mixed-type intermediate column fractures. CONCLUSION: Different categories/types of GDP have significant differences in terms of incidence, age, efficacy, and prognosis. Imaging classification by column and type of GDP better reflects the features and injury mechanism of the fractures with good consistency. Therefore, it has important reference value for the surgical modality and prognosis evaluation.

Interwoven Molecular Chains Obtained by Ionic Self-Assembly of Two Iron(III) Porphyrins with Opposite and Mismatched Charges.

We report ionic self-assembly of positively charged FeIII meso-tetra(N-methyl-4-pyridyl) porphyrin (FeIIINMePyP) with negatively charged FeIII meso-tetra(4-sulfonatophenyl) porphyrin (FeIIITPPS4), leading to the formation of flower-like nanostructures composed of unprecedented three-dimensional (3D) entangled chains of porphyrin dimers. Molecular dynamics (MD) simulations show that the 3D entanglement of porphyrin chains closely correlates to mismatched charges present in porphyrin dimers like [FeIII(H2O)2NMePyP]5+/[FeIII(H2O)2TPPS4]3- that requires extra interactions or entanglement with neighboring ones to achieve electric neutrality. Interestingly, the interwoven chains bring in excellent thermal stability as evidenced by well maintenance of the flower-like morphology after pyrolysis at 775 °C in argon, which is in good agreement of high-temperature MD simulations. Meanwhile, heat treatment of the flower-like porphyrin nanostructure leads to the formation of a non-noble metal electrocatalyst (NNME) with largely inherited morphology. This exemplifies a new approach by combining ionic self-assembly with subsequent pyrolysis for the synthesis of NNMEs with desired control over the morphology of template-free NNMEs that has rarely been achieved prior to this study. Furthermore, our electrocatalyst exhibits excellent activity and durability toward oxygen reduction reaction as well as much better methanol tolerance compared with commercial Pt/C in alkaline solutions.

[EFFECTIVENESS COMPARISON OF PROXIMAL FEMORAL NAIL ANTI-ROTATION IN SUPINE "SCISSORS" POSITION AND IN LITHOTOMY POSITION TO TREAT FEMORAL INTERTROCHANTERIC FRACTURES OF OLD PATIENTS].

OBJECTIVE: To compare the effectiveness of proximal femoral nail anti-rotation (PFNA) between in the supine "scissors" position and in the lithotomy position for treating femoral intertrochanteric fractures of old patients. METHODS: A retrospective study was performed on 58 patients with femoral intertrochanteric fractures treated with PFNA between January 2013 and January 2015. Fracture was treated with PFNA in the lithotomy position in 28 cases (group A) and in the supine "scissors" position in 30 cases (group B). There was no significant difference in gender, age, side, cause of injury, fracture type, and interval from injury to operation between 2 groups (P>0.05). The incision length, operation time, perspective times, intraoperative blood loss, complications, and fracture healing time were recorded; Harris hip score was used to access the effectiveness. RESULTS: The wound healed by first intention without infection, pressure sores, deep vein thrombosis of lower extremity, and other complications. There was no significant difference in incision length between 2 groups (t=1.313, P=0.212). Group B was significantly better than group A in operation time, perspective times, and intraoperative blood loss (P<0.05). All patients were followed up 10-31 months (mean, 15.3 months). Stretch injury at normal side and perineal discomfort occurred in 1 case and 5 cases of group A respectively, and no nonunion and other complications was observed in the other patients. There was no significant difference in fracture healing time and Harris hip score at last follow-up between 2 groups (P>0.05). CONCLUSION: PFNA in the supine "scissors" position has exact effectiveness and advantages of shorter operation time, less intraoperative blood loss, less perspective times, and fewer complications.

[A COMPARATIVE STUDY ON TREATMENT OF MID-THORACIC OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURE USING PERCUTANEOUS KYPHOPLASTY WITH UNILATERAL AND BILATERAL APPROACHES].

OBJECTIVE: To compare the effectiveness of percutaneous kyphoplasty (PKP) between by unilateral approach and by bilateral approaches for treating mid-thoracic osteoporotic vertebral compression fracture (OVCF). METHODS: A prospective randomized controlled study was performed on 22 patients with mid-thoracic OVCF between September 2012 and June 2014. PKP was performed by unilateral approach in 11 cases (group A) and by bilateral approaches in 11 cases (group B). There was no significant difference in gender, age, causes of injury, disease duration, affected segment, preoperative bone mineral density, Cobb angle, compression rate of the anterior verterbral height, and Visual analogue scale (VAS) score between 2 groups (P > 0.05). The operation time, perspective times, hospitalization expenses, the leakage of cement, the sagittal Cobb angle, compression rate of the anterior vertebral height, and VAS scores were compared between 2 groups. RESULTS: The operation time, perspective times, and hospitalization expenses of group A were significantly less than those of group B (P < 0.05). Twenty-two patients were followed up 13-34 months (mean, 15.3 months). Primary healing of incision was obtained in all patients, and no early complication of cement leakage, hypostatic pneumonia, or deep vein thrombosis occurred. At last follow-up, no new fracture occurred at the adjacent segments. The Cobb angle, compression rate of anterior verterbral height, and VAS score at 1 week and last follow-up were significantly improved when compared with preoperative ones in 2 groups (P < 0.05), but no significant difference was found between at 1 week and at last follow-up (P > 0.05). There was no significant difference in Cobb angle, compression rate of the anterior vertebral height, and VAS score between 2 groups at each time point (P > 0.05). CONCLUSION: PKP by both unilateral approach and bilateral approaches has the same effectiveness, but unilateral approach has shorter operation time, less perspective times, and less hospitalization expenses than bilateral approaches.

[EFFECTIVENESS COMPARISON OF CORACOCLAVICULAR LIGAMENT RECONSTRUCTION BETWEEN BY AUTOLOGOUS AND ALLOGENEIC TENDON GRAFTS COMBINED WITH HOOK PLATE FIXATION FOR TREATING ACROMIOCLAVICULAR JOINT DISLOCATION].

OBJECTIVE: To compare the effectiveness of coracoclavicular ligament reconstruction between by using autologous plantaris tendon graft combined with hook plate fixation and allogeneic tendon graft combined with hook plate fixation for treating acromiocavicular joint dislocation. METHODS: Thirty-three patients with acromioclavicular joint dislocation who accorded with the inclusion criteria between January 2013 and June 2014 were assigned into 2 groups. The patients were treated with autologous plantaris tendon graft combined with hook plate fixation in group A (n=17), and with allogeneic tendon graft combined with hook plate fixation in group B (n=16). Thirteen-one patients was followed up more than 12 months (15 in group A and 16 in group B). There was no significant difference in gender, age, cause of injury, sides, time between injury and surgery, and type of dislocation (P>0.05). The assessments included operation time, hospitalization time, hospitalization expenses, shoulder range of motion, gap of acromioclavicular, Constant-Murley scores, and visual analogue scale (VAS) for pain. RESULTS: The operation time of group A was significantly longer than that of group B, and the hospitalization expense was significantly lower than that of group B (P<0.05). There was no significant difference in hospitalization time (t=1.046, P=0.316). The incisions healed by first intention, and hook plate was removed after 3 months. The mean follow-up time was 21.3 months (range, 19-34 months) in group A and was 23.7 months (range, 18-37 months) in group B. X-ray examination showed no osteolysis. There was no significant difference in gap of acromiocavicular between 2 groups at preoperation, 1 week after operation, and last follow-up (P>0.05). No redislocation of acromioclavicular joint and rejection reaction occurred during follow-up. At last follow-up, there was no significant difference in shoulder range of motion, Constant-Murley score, and VAS score between 2 groups (P>0.05). CONCLUSIONS: Coracoclavicular ligament reconstruction by autologous plantaris tendon or allogeneic tendon graft combined with hook plate fixation for the treatment of acromioclavicular joint dislocation can achieve good effectiveness. The appropriate treatment should be chosen according to the patient's economic situation.

Fabrication of Efficient Hydrogenation Nanoreactors by Modifying the Freedom of Ultrasmall Platinum Nanoparticles within Yolk-Shell Nanospheres.

The synthesis of silica-based yolk-shell nanospheres confined with ultrasmall platinum nanoparticles (Pt NPs) stabilized with poly(amidoamine), in which the interaction strength between Pt NPs and the support could be facilely tuned, is reported. By ingenious utilization of silica cores with different surface wettability (hydrophilic vs. -phobic) as the adsorbent, Pt NPs could be confined in different locations of the yolk-shell nanoreactor (core vs. hollow shell), and thus, exhibit different interaction strengths with the nanoreactor (strong vs. weak). It is interesting to find that the adsorbed Pt NPs are released from the core to the hollow interiors of the yolk-shell nanospheres when a superhydrophobic inner core material (SiO2 -Ph) is employed, which results in the preparation of an immobilized catalyst (Pt@SiO2-Ph); this possesses the weakest interaction strength with the support and shows the highest catalytic activity (88 500 and 7080 h(-1) for the hydrogenation of cyclohexene and nitrobenzene, respectively), due to its unaffected freedom of Pt NPs for retention of the intrinsic properties.

Enhanced oxygen reduction activity and solid oxide fuel cell performance with a nanoparticles-loaded cathode.

Reluctant oxygen-reduction-reaction (ORR) activity has been a long-standing challenge limiting cell performance for solid oxide fuel cells (SOFCs) in both centralized and distributed power applications. We report here that this challenge has been tackled with coloading of (La,Sr)MnO3 (LSM) and Y2O3 stabilized zirconia (YSZ) nanoparticles within a porous YSZ framework. This design dramatically improves ORR activity, enhances fuel cell output (200-300% power improvement), and enables superior stability (no observed degradation within 500 h of operation) from 600 to 800 °C. The improved performance is attributed to the intimate contacts between nanoparticulate YSZ and LSM particles in the three-phase boundaries in the cathode.

Ulnius formation for forearm fracture with segmental radial defect.

One-bone forearm functions best when the proximal ulna and distal radius are present and joined (the ulnius). Six open forearm fractures accompanied by segmental radial defect were treated by the ulnius formation in a one-stage procedure. All patients had a stable and pain-free forearm, and were satisfied with the function and cosmetic appearance of the forearm.

Carbonization of self-assembled nanoporous hemin with a significantly enhanced activity for the oxygen reduction reaction.

The scarcity and high cost of Pt-based electrocatalysts for the oxygen reduction reaction (ORR) hinder the practical application of proton exchange membrane fuel cells (PEMFCs). It is critical to replace platinum with non-noble metal electrocatalysts (NNMEs). Carbonized metalloporphyrins represent an important class of NNMEs, but most metalloporphyrins are costly and the corresponding NNMEs do not possess a high ORR activity. Herein, we report that the self-assembly of inexpensive hemin leads to porous nanomaterials in water under ambient conditions and subsequent heat-treatment of the unprecedented nanoporous hemin results in a magnetic NNME with a much enhanced ORR activity compared with directly carbonized hemin without self-assembly. The improvement of the ORR activity likely originates from the exposure of more ORR active sites, caused by the surface area increase of the nanoporous hemin after carbonization over that of micro-scale pristine hemin crystals. Moreover, the ORR activity of heat-treated nanoporous hemin is actually comparable to that of commercial Pt/C in alkaline solution. Additionally, the carbonized nanoporous hemin is much better than commercial Pt/C in terms of durability and tolerance to methanol. This study opens up a new avenue to the production of inexpensive metalloporphyrin-based NNMEs with a high ORR performance by using a self-assembly method in combination with traditional pyrolysis.

Effect of c-erbB2 overexpression on prognosis in osteosarcoma: evidence from eight studies.

C-erbB2 (HER-2/neu) plays an important role in the progression of several types of cancer by increasing tumor growth, migration, invasion, and metastasis and is associated with poor disease prognosis. Numerous studies examining the relationship between c-erbB2 expression and prognostic impact in patients with osteosarcoma have yielded inconclusive results. We therefore conducted a meta-analysis to provide a comprehensive evaluation of the prognostic role of c-erbB2 expression on 5-year survival, which compared the positive and negative expression of c-erbB2 in patients of the available studies. A detailed search was made in PubMed for relevant original articles published in English. Finally, a total of eight studies with 411 osteosarcoma patients were involved to estimate the relationship between c-erbB2 expression and 5-year overall survival. Positive expressions of c-erbB2 predicted poorer survival in osteosarcoma with the pooled RR of 1.53 (95 % CI 1.20-1.94, P = 0.0006). In conclusion, the findings from this present meta-analysis suggest that c-erbB2 overexpression is related to poor prognostic of osteosarcoma and can be a useful clinical prognostic factor for those patients.

Minimally invasive plate osteosynthesis for distal radius fractures.

BACKGROUND: Fractures of distal radius are common injury in all age groups. Cast treatment with or without close reduction is a viable option. However, the results are often unsatisfactory with restricted function. The open reduction and internal fixation often results in extensive soft tissue dissection and associated high rates of infect and delayed/nonunion. The distractor/external fixator have reported good functional and anatomical results but the incidence of pin traction infection nerve injury and cosmedic deformity are high. We introduced a modified operative technique for minimally invasive plate osteosynthesis (MIPO) for distal radial fracture and evaluated the functional outcomes and complications. MATERIALS AND METHODS: 22 distal radial fractures (10 left, 12 right) were treated using the MIPO technique and two small incisions with a palmar locking plate from August 2009 to August 2010. The wrist function was assessed according to Dienst wrist rating system, and postoperative complications were recorded. RESULTS: According to Dienst wrist rating system, 13 patients showed excellent results, 6 cases showed good results and 3 patients had moderate results. No patient had poor results. Thus, the excellent and good rate was 86.4%. One patient had anesthesia in the thenar eminence and this symptom disappeared after 3 months. One patient had delayed healing in the proximal wrist crease. Two patients had mild pain on the ulnar side of the wrist and two patients had limited wrist joint function. CONCLUSION: The MIPO technique by using two small palmar incisions is safe and effective for treatment of distal radial fractures.

[EFFECTIVENESS COMPARISON OF USING BONE TRANSPORT AND BONE SHORTENING-LENGTHENING FOR TIBIAL BONE AND SOFT TISSUE DEFECTS].

OBJECTIVE: To compare the effectiveness using bone transport and bone shortening-lengthening by Ilizarov technique for tibial bone and soft tissue defects. METHODS: Between January 2004 and May 2012, 31 patients with tibial bone and soft tissue defects were managed by Ilizarov technique, the clinical data were retrospectively analyzed. Bone transport was used in 18 cases (group A), and bone shortening-lengthening in 13 cases (group B). There was no significant difference in age, gender, type of fracture, defect location, size of bone and soft defects, and time from injury to operation between 2 groups (P > 0.05). Postoperative complications were observed; Paley's criterion was used to assess the bone healing and function recovery of the limb. RESULTS: All the flaps survived and healing of wounds by second intention was obtained in all cases of group A; healing of wounds by first intention was obtained in 1 case, delayed healing in 3 cases, and healing by second intention in 9 cases in group B. All patients were followed up 1.5-4.5 years (mean, 2.4 years). Pin loosening or pin tract infection occurred in 15 cases of group A and in 10 cases of group B, and limb length discrepancy in 1 case of group B; there was no significant difference in the rate of complication (χ2 = 0.003, P = 0.955). In the distracted zone, all fractures healed naturally with excellent scale. The healing time was (251 ± 39) days in group A, and was (239 ± 45) days in group B, showing no significant difference (t = 0.800, P = 0.430); the healing index was (4.26 ± 0.19) d/mm in group A, and was (4.13 ± 0.19) d/mm in group B, showing no significant difference (t = 1.775, P = 0.086). In the bone defect zone, natural healing was obtained in 12 cases and healing after second operation or bone grafting in 6 cases, with healing time of (341 ± 55) days (excellent in 17 cases and good in 1 case) in group A; natural healing was obtained in 11 cases and healing after second operation or bone grafting in 2 cases, with the healing time of (295 ± 62) days (excellent in 12 cases and good in 1 case ) in group B; and there was significant difference in the healing time (t = 2.195, P = 0.036), but no significant difference in the healing scale (Z = -1.693, P = 0.091). At last follow-up, the function recovery was excellent in 7 cases, good in 6 cases, and fair in 5 cases in group A, and was excellent in 3 cases, good in 6 cases, and fair in 4 cases in group B, showing no significant difference (Z = -0.660, P = 0.509). CONCLUSION: Using bone transport or bone shortening-lengthening by Ilizarov technique for tibial bone and soft tissue defects, the overall outcomes are similar, but the healing of bone defect zone is faster when using bone shortening-lengthening.

[Case-control study on percutaneous compressing plating and proximal femoral nail antirotation in treating in tertrochanteric fracture with risk external wall].

OBJECTIVE: To compare clinical effects between percutaneous compressing plating (PCCP) and proximal femoral nail antirotation (PFNA) for the treatment of patients with intertrochanteric fracture with risk external wall. METHODS: From September 2007 to June 2010, 43 patients with intertrochanteric fracture with risk external wall were treated by PCCP or PFNA according to different kinds of internal fixations. There were 22 cases in PCCP, including 9 males and 13 females with an average age of 68.4 (ranged, 60 to 86) years old, and 13 cases with type A2.2 and 9 cases with type A2.3; while 21 cases in PFNA, including 7 males and 14 females with an average age of 67.7 (ranged, 57 to 93) years old, and 10 cases with type A2.2 and 11 cases with type A2.3. Blood loss, operation time, hospital stay, fracture healing time, complications and Harris score after 1 years' following-up were observed and compared. RESULTS: All patients were followed up for 12 to 22 (means 18.4) months, and all patients were obtained fracture healing, and recovered walking ability as before injury. There were no significant differences in blood loss, operation time, hospital stay, fracture healing time, complications and Harris score after 1 years' following-up (P>0.05). One case occurred displacement on the top of greater trochanter, and 1 case injuried weakness of hip abduction. One case occurred screw breakage in PCCP, while 1 case occurred hip joint pain in PFNA. CONCLUSION: Both of PCCP and PFNA in treating patients with intertrochanteric fracture with risk external wall can receive good clinical effects, while the effects and therapy strategy for displacement of bone on the top of lateral wall should further study.

[Repair of large tibial bone and soft tissue defects by shortening-lengthening method].

OBJECTIVE: To investigate the effectiveness of shortening-lengthening method using Ilizarov technique for repairing large tibial bone and soft tissue defects. METHODS: Between January 2006 and December 2011, 12 patients with large tibial bone and soft tissue defects were treated by shortening-lengthening method using Ilizarov technique. There were 8 males and 4 females with an average age of 39.3 years (range, 18-65 years). The causes were injury in 8 cases and chronic infection in 4 cases. The area of soft tissue defect was 5 cm x 4 cm to 20 cm x 16 cm, and the length of tibial bone defect was 4.5-8.0 cm with an average of 6.2 cm. RESULTS: Incision in the lengthening area healed by first intention; healing of wounds by first intention was achieved in 6 cases, delayed healing in 2 cases, and secondary healing in 4 cases, with no common peroneal nerve injury. All patients were followed up 18-54 months with an average of 29 months. In the lengthening area, the bone healing time was 180-365 days (mean, 267 days), and the healing index was 3.8-4.3 days/mm (mean, 4.1 days/mm). In the shortening area, the bone healing time was 195-380 days (mean, 297 days) in the others except 1 case who was repaired with bone grafting. Mild pin-related infection and loosening were observed in all cases, but no infection occurred in the lengthening or shortening area. At last follow-up, weight bearing of the leg was fully recovered in 12 cases. According to Mazur's criteria, the function of ankle was excellent in 2 cases, good in 6 cases, and fair in 4 cases. Nine patients had equal limb length, and 3 patients had shortened length less than 2 cm. CONCLUSION: Shortening-lengthening method using Ilizarov technique has the advantages of simple surgery, less complications, easy to close the wound, and good effectiveness in repairing of large tibial bone and soft tissue defects.

[Treatment of refractory sinus in the lower leg with modified VSD technique].

OBJECTIVE: To investigate the effects of modified vacuum sealing drainage (VSD) technique in treating refractory sinus in the lower leg. METHODS: From January 2010 to December 2011, 11 patients with refractory sinus in the lower leg, including 7 males and 4 females, with an average age of 34.5 years (ranged,23 to 56). These patients were treated with modified VSD technique after thorough cleaning sinus and continuous washing. After 14 to 21 days of treatment, removed VSD and re-debrided the sinus and sutured wound. RESULTS: Infections got control after operation, sinus in the lower leg healed. All patients were followed up from 6 to 14 months with an average of 10 months, no recidivations were found. CONCLUSION: Modified VSD technique is an effective method in the treatment of stubborn sinus in the lower leg.