Comparing outcomes in the treatment of pediatric and adolescent intraarticular radial head fractures.

Intraarticular radial head (IARH) fractures are uncommon pediatric injuries with unpredictable yet poor outcomes. The aim of this study was to evaluate clinical outcomes of IARH fractures in pediatric and adolescent patients, by testing our hypothesis that surgically managed fractures would have less risk for an unplanned second surgery and better elbow range of motion at the final follow-up. A retrospective review of 53 IARH fractures was performed. Demographic and clinical data were recorded. Concomitant and associated injuries were documented. Initial management and any attempted reduction in the emergency room were documented. The primary outcome was the need for an unplanned second procedure. Motion at final follow-up, presence of pain and need for physical therapy were reviewed. Radiographs were carefully reviewed and analyzed for physeal status, displacement, angulation and percent of radial head involved. We rejected our hypothesis, however, because it was displaced fractures that tended to require an unplanned change in treatment at a higher rate than nondisplaced fractures, regardless of index management with or without surgery. Fracture displacement on the lateral radiograph was a significant risk factor compared to the anterior-posterior images, and younger patients, particularly those with open physis, were at higher risk of an unplanned second procedure. Moreover, 80% of displaced fractures had asymmetric elbow motion after healing was achieved. It is important to counsel patients and families regarding the potential for suboptimal outcomes and elbow stiffness regardless of treatment choice, in the setting of an initially displaced IARH fracture. Level of evidence: Level III.

Functional Outcomes of Arthroscopic Os Trigonum Excision in Adolescents.

BACKGROUND: Outcomes of symptomatic os trigonum excision have been well described as a successful treatment in adults; however, the literature lacks information on standardized longer term functional outcomes in the pediatric population. This study intends to report functional outcomes of arthroscopic os trigonum excision in adolescents who failed conservative management, with the hypothesis that these younger patients would have similar, successful outcomes of adult patients. METHODS: A retrospective study was performed on adolescents who underwent arthroscopic os trigonum excision at a single institution between 2011 and 2017. Patient demographic, clinical history, radiographic, and operative data were documented. Outcome measures included the Foot and Ankle Ability Measure (FAAM) score comprised of the Activities of Daily Living (ADL) and Sports subscales, Single Assessment Numeric Evaluation (SANE) score, ability to return to the same level of sport, and any additional foot/ankle surgery. RESULTS: Ten patients (12 ankles) met criteria with a mean age at surgery of 15.4 years (range, 12 to 18 y) and a mean follow-up of 6.5 years (range, 2.8 to 9.1 y). Mean FAAM ADL subscale, Sports subscale, and SANE scores were 91.0±15.5, 76.3±29.1, and 88.6±15.1, respectively. A chronic duration of symptoms before surgery was associated with a lower FAAM Sports current level of function score (P=0.032). Four patients (40%) discontinued their sport due to continued ankle issues and reported significantly lower FAAM ADL subscale (P=0.01), Sports subscale (P<0.001), and SANE scores (P=0.002). CONCLUSIONS: Os trigonum syndrome in the adolescent population may not have the same rate of success as that seen in adult athletes over the long-term. However, if proven to be refractory to conservative measures and surgical intervention is indicated, patients and their families should be counseled about the risk for persistent ankle symptoms and the possibility that they may not be able to return to their previous level of sport. LEVEL OF EVIDENCE: Level IV-case series.

Greater trochanteric fractures with lntertrochanteric extension identified on MRI: What is the rate of displacement when treated nonoperatively?

INTRODUCTION: . Despite the ability of MRI to identify intertrochanteric (IT) fracture extension for greater trochanteric (GT) fractures, there is no consensus about which fractures require operative intervention. Previous studies have suggested GT fractures with >50% extension into the IT region might benefit from fixation. We sought to evaluate the rate at which GT fractures with IT extension displaced, requiring operative fixation. PATIENTS AND METHODS: . This is a Retrospective Chart Review performed at a Level 1 Trauma Center. Patients included all nonoperatively treated GT fractures (OTA/AO 31A1.1) with IT extension identified on MRI between 2010 and 2017 at our institution. Patients lost to follow up prior to radiographic evidence of healing or fracture displacement were excluded. Patient charts and imaging were reviewed for demographic data, treatment plan, percent extension into the IT region (as determined from coronal MRI images), and clinical and radiographic evidence of fracture healing. Percent extension into the IT region was measured using coronal T1-weighted MRI images. The primary outcome measures were fracture displacement requiring operation and nonunion. RESULTS: . Seventeen patients met initial inclusion criteria, with two subsequently excluded due to no radiographic follow-up. Of the 15 patients, zero had displacement of their IT fracture. None required operative intervention. All 15 patients healed their fractures. Fourteen of 15 (93%) had IT extension of 50% or less across the IT region. One patient had initial IT extension of 60%, this patient also healed without displacement. DISCUSSION: . Incomplete intertrochanteric femur fractures are a relatively newer diagnosis that have become more prevalent with the increased usage and availability of MRI. Currently, there is no consensus on the ideal treatment of these injuries. To our knowledge, this is the largest series of its kind to help guide treatment of these GT fractures with IT extension. CONCLUSIONS: . Fractures with less than 50% extension into the IT region have a low likelihood of future displacement and high union rates when treated nonoperatively. LEVEL OF EVIDENCE: . IV.

Systemic administration of ß-glucan of 200 kDa modulates melanoma microenvironment and suppresses metastatic cancer.

Converting an immunosuppressive melanoma microenvironment into one that favors the induction of antitumor immunity is indispensable for effective cancer immunotherapy. In the current study we demonstrate that oat-derived ß-(1-3)-(1-4)-glucan of 200 kDa molecular size (BG34-200) previously shown to mediate direct interaction with macrophages could alter the immune signature within melanoma microenvironment. Systemic administration of BG34-200 resulted in reversion of tolerant melanoma microenvironment to an immunogenic one that allows M1-type activation of macrophages, the induction of pro-inflammatory cytokines/chemokines including IFN-γ, TNF-α, CXCL9, and CXCL10, and enhanced IRF1 and PD-L1 expression. In turn, BG34-200 induced a superior antitumor response against primary and lung metastatic B16F10 melanoma compared to untreated controls. The enhanced tumor destruction was accompanied with significantly increased tumor infiltration of CD4+ and CD8+ T cells as well as elevated IFN-γ in the tumor sites. Systemic administration of BG34-200 also provoked systemic activation of tumor draining lymph node T cells that recognize antigens naturally expressing in melanoma (gp100/PMEL). Mechanistic studies using CD11b-knockout (KO), CD11 c-DTR transgenic mice and nude mice revealed that macrophages, DCs, T cells and NK cells were all required for the BG34-200-induced therapeutic benefit. Studies using IFN-γ-KO transgenic mice showed that IFN-γ was essential for the BG34-200-elicited antitumor response. Beyond melanoma, the therapeutic efficacy of BG34-200 and its immune stimulating activity were demonstrated in a mouse model of osteosarcoma. Together, BG34-200 is highly effective in modulating antitumor immunity. Our data support the potential therapeutic use of this novel immune modulator in the treatment of metastatic melanoma.

Antitumor activity of miR-1280 in melanoma by regulation of Src.

MicroRNAs (miRNAs) play a key role in cancer progression by coordinately repressing target genes involved in cell proliferation, migration, and invasion. miRNAs regulate gene expression by repressing translation or directing sequence-specific degradation of complementary mRNA. Here, we report that expression of miR-1280 is significantly suppressed in human melanoma specimens when compared with nevi, and in human melanoma cell lines when compared with cultured normal human melanocytes. The proto-oncogene Src was identified as a target of miR-1280 action. Levels of Src expression were significantly higher in melanoma samples and cell lines than in nevi and normal melanocytes. miR-1280 overexpression significantly suppressed the luciferase activity of reporter plasmids containing the full-length 3' untranslated region of Src. miR-1280-mediated suppression of Src led to substantial decreases in melanoma cell proliferation, cell cycle progression, invasion, as well as induced melanoma cell apoptosis. The effects of miR-1280 overexpression on melanoma cell proliferation and growth were reversed by Src overexpression. Intratumoral delivery of miR-1280 significantly suppressed melanoma cell growth in vivo. Our results demonstrate a novel role for miR-1280 as a tumor suppressor in melanoma, identify the Src signaling pathway as a target of miR-1280 action, and suggest a potential therapeutic role for miR-1280 in melanoma.