Corynoline Suppresses Osteoclastogenesis and Attenuates ROS Activities by Regulating NF-κB/MAPKs and Nrf2 Signaling Pathways.

Declining estrogen production in postmenopausal females causes osteoporosis in which the resorption of bone exceeds the increase in bone formation. Although clinical drugs are currently available for the treatment of osteoporosis, sustained medication use is accompanied by serious side effects. Corydalis bungeana Herba, a famous traditional Chinese herb listed in the Chinese Pharmacopoeia Commission, constitutes various traditional Chinese Medicine prescriptions, which date back to thousands of years. One of the primary active components of C. bungeana Turcz. is Corynoline (Cor), a plant isoquinoline alkaloid derived from the Corydalis species, which possesses bone metabolism disease therapeutic potential. The study aimed at exploring the effects as well as mechanisms of Cor on osteoclast formation and bone resorption. TRAcP staining, F-actin belt formation, and pit formation were employed for assessing the osteoclast function. Western blot, qPCR, network pharmacology, and docking analyses were used for analyzing the expression of osteoclast-associated genes and related signaling pathways. The study focused on investigating how Cor affected OVX-induced trabecular bone loss by using a mouse model. Cor could weaken osteoclast formation and function by affecting the biological receptor activators of NF-κB and its ligand at various concentrations. Mechanistically, Cor inhibited the NF-κB activation, and the MAPKs pathway stimulated by RANKL. Besides, Cor enhanced the protein stability of the Nrf2, which effectively abolished the RANKL-stimulated ROS generation. According to an OVX mouse model, Cor functions in restoring bone mass, improving microarchitecture, and reducing the ROS levels in the distal femurs, which corroborated with its in vitro antiosteoclastogenic effect. The present study indicates that Cor may restrain osteoclast formation and bone loss by modulating NF-κB/MAPKs and Nrf2 signaling pathways. Cor was shown to be a potential drug candidate that can be utilized for the treatment of osteoporosis.

Position of Coracoid Button Predicts Loss of Reduction in Acromioclavicular Joint Dislocation Patients Treated With the Suture-Button.

BACKGROUND: Loss of reduction is the most common complication after acromioclavicular (AC) joint dislocation treated with the suture-button. Some predictors of it are known, but finding new predictors is an ongoing process. In this study, we evaluate the importance of the position of the coracoid button. MATERIALS AND METHODS: Between April 2010 and February 2017, 186 patients with AC joint dislocation were identified. All patients were managed with the same surgical technique and postoperative protocol. The position of the coracoid button was determined immediately after surgery by anterior-posterior views of the operated shoulder and was classified as medial (Group A, 42 cases), central (Group B, 85 cases) and lateral (Group C, 59 cases) positions. The main outcome measurement was loss of reduction. The main analysis was the association between the coracoid button position and loss of reduction. RESULTS: No significant difference was found in the baseline characteristics among 3 groups. During follow-up, there were 15 cases (35.7%) developing loss of reduction in Group A, 5 cases (5.9%) in Group B and 26 cases (44.1%) in Group C. The rate of loss of reduction in Groups A and C were higher than that in Group B (p < .05). Moreover, there was no significant difference in the rate of reduction loss between lateral and medial positions of the coracoid buttons (p > .05). CONCLUSION: Our results indicated that both lateral and medial positions of the coracoid buttons could predict loss of reduction in AC joint dislocation patients treated with the suture-button.

Detection of dorsal screw penetration during volar plating of the distal radius fractures: A comparison of different fluoroscopic views and screw sizes.

OBJECTIVE: The objective of this study was to compare different screw lengths combined with different fluoroscopic views to detect intraoperative dorsal screw penetration in distal radius fractures treated with volar locked plating. MATERIAL AND METHODS: From April 2014 to October 2018, one hundred and eighty patients were included. We divided the patients into four groups. Intraoperative AP and lateral views were taken and sizes of the screws were chosen based on actual measurement (Group A, 45 patients). AP, lateral and tangential views were taken and sizes of the screws were also chosen based on actual measurement (Group B, 45 patients). Intraoperative AP and lateral views were taken and the selected screws were 2mm shorter than actual measurement (Group C, 45 patients). AP, lateral and tangential views were taken and the selected screws were 2mm shorter than actual measurement (Group D, 45 patients). Prominent screws were changed intraoperatively according to each view. A computed tomography (CT) was taken postoperatively to identify residual prominent screws. RESULTS: The number of dorsally prominent screws exceeding 1mm was 6 of 301 in Group A (2.0%), 15 of 290 (5.2%) in Group B, 2 of 289 in Group C (0.7%), and 2 of 282 (0.7%) in Group D. All these prominent screws (25 screws) were exchanged for shorter screws during surgery. Group A and Group B had significant difference in detecting intraoperative dorsal screw penetration (p<0.05). Group C and Group D had no significant difference in detecting intraoperative dorsal screw penetration (p>0.05). Postoperative CT identified 12 additional prominent screws with≥1mm dorsal penetration in Group A, 2 screws in Group B, 1 screw in Group C and 0 screw in Group B respectively. Significant difference was found between Group A and Group B of CT results (p<0.05) while no statistical difference was found between Group C and Group D of CT results (p>0.05). DISCUSSIONS: Tangential view helped identify screw penetration. If tangential view was not available intraoperatively, screw penetration could also be avoided by downsizing the distal locking screw by 2mm shorter than actual measurement.

Factors associated with the decision for operative versus conservative treatment of displaced distal radius fractures in the elderly.

BACKGROUND: The treatment of senile distal radius fractures had not been clearly defined. The objective of this study was to identify the factors associated with the decision for operative treatment of displaced distal radius fractures in patients aged over 55 years. METHODS: Data of 318 patients with displaced distal radius fractures were collected on patient-, fracture- and surgeon-related characteristics that were plausibly related to the decision for operation. Mean comparisons or chi-squared test were used for univariate analysis of the above-mentioned factors, and then multiple logistic regression was used to identify factors associated with the decision for operation. RESULTS: Univariate analysis showed that age, osteoporosis, Charlson score, associated orthopaedic injuries requiring surgery, Orthopaedic Trauma Association (AO) and Fernandez classification, radial height, volar tilt, volar/dorsal comminution, ulnar variance, intra-articular displacement/step-off, associated distal radioulnar joint instability or radiocarpal joint dislocation and subspecialty of treating surgeons had statistically significant association with operative intervention. In the multivariate analysis, the predictors of operative intervention were younger patient age (P = 0.028), associated orthopaedic injuries requiring surgery (P = 0.020), higher AO classification (P = 0.037), higher Fernandez classification (P = 0.041), radial shortening >5 mm (P = 0.020), volar tilt > -10° (P = 0.020), volar/dorsal comminution (P = 0.020), ulnar variance >5 mm (P = 0.023), intra-articular displacement/step-off >2 mm (P = 0.004), associated distal radioulnar joint instability or radiocarpal joint dislocation (P = 0.047) and treatment by an upper extremity specialist (P = 0.038). CONCLUSION: The decision for surgery was predominantly influenced by the characteristics and severity of the fracture. Patients' age and treatment by an upper extremity specialist were also significant factors associated with a higher likelihood of operative intervention.

Analysis of risk factors for loss of reduction after acromioclavicular joint dislocation treated with the suture-button.

BACKGROUND: The most commonly reported complication after acromioclavicular (AC) joint dislocation treated with the Suture-button is loss of reduction. Loss of reduction is a major factor influencing the patient's joint function and subjective satisfaction. The objective of this study is to analyze the risk factors causing loss of reduction after AC joint dislocation treated with the Suture-button. METHODS: One hundred and thirty patients with AC joint dislocation who were surgically treated the Suture-button in our hospital from February 2009 to February 2015, were recorded their age, sex, BMI, time from injury to surgery, Rockwood's classification, with or without osteoporosis, double or triple button technique, position of the clavicle tunnel, tunnel diameter, coracoid button position, alignment of the button, acromioclavicular ligament repair or not, different methods of postoperative limb immobilization, and so on. Mean comparisons or chi-square test was used for univariate analysis of the above factors, and then multivariate logistic regression analysis was performed to predict risk factors. RESULTS: Reduction was lost in 23.1% of the patients. Univariate analysis showed that button alignment, double or triple button technique, coracoid button position, position of the clavicle tunnel, acromioclavicular ligament repair or not and osteoporosis had statistically significant association with loss of reduction for AC joint (P = 0.031, 0.034, 0.000, 0.042, 0.047 and 0.000 respectively). Multivariate logistic regression analysis demonstrated that osteoporosis (P = 0.003), position of the clavicle tunnel (P = 0.032) and coracoid button position (P < 0.001) were the risk factors that significantly associated with the loss of reduction after AC joint dislocation treated with the Suture-button. CONCLUSIONS: Clavicle tunnel location using relative ratio method, accurate placement of button plate under coracoid process (inside or outside deviation <20°), various reinforcement operations for patients with osteoporosis are important factors in preventing loss of reduction.

A comparative study of two closed reduction methods for pediatric supracondylar humeral fractures.

BACKGROUND: No randomized controlled studies have confirmed the advantages of the joystick technique over the traditional manual traction. The objective of this study was to compare the results of the joystick technique and the traditional manual traction for facilitating closed reduction of pediatric supracondylar humeral fractures. METHODS: From February 2009 to December 2012, sixty eight children were included in this study. Group A included 34 fractures reduced by the joystick technique. Group B consisted of 34 fractures reduced by the traditional manual traction. Preoperative demographic data were comparable between the two groups. The operative time, fluoroscopy time, hospitalization time, time to bone union, complications were recorded in both groups. Radiologic and functional results were assessed using the Flynn scoring system. RESULTS: Closed reduction was successfully done in all the fractures of Group A while traditional closed manipulation was successfully done in 25 fractures of Group B and 9 fractures failed. There was a significant difference between the two groups in the rate of failed closed reduction (P = 0.004). The mean operative time was 30.5 ± 9.0 and 48.2 ± 16.4 min, and the mean fluoroscopy time was 25.4 ± 10.5 s and 55.0 ± 21.2 s in Group A and Group B, respectively. Both the operative time and fluoroscopy time were significantly longer in Group B (P < 0.001 and 0.001, respectively). However, there was no significant difference in terms of the mean hospitalization time, mean union time, total complications, the Flynn scores between the two groups (P > 0.05). CONCLUSIONS: The joystick technique should be chosen to facilitate closed reduction if traditional manual traction failed to yield an acceptable reduction.

The effects of combined human parathyroid hormone (1-34) and simvastatin treatment on the interface of hydroxyapatite-coated titanium rods implanted into osteopenic rats femurs.

The effect of human parathyroid hormone 1-34 (PTH) and simvastatin (SIM) alone could promote bone healing in osteoporotic implant fixation, but there are no reports about the combined use of PTH and SIM for promotion of bone healing around implant in osteoporotic settings. This study aims to investigate effects of PTH + SIM on implant stabilization in osteopenic rats. Fourteen weeks after chronically fed a low protein diet, osteopenic rats randomly received implants. Subsequently, the animals were randomly divided into four groups: Control, SIM, PTH and PTH + SIM. Then all rats from groups PTH, SIM and PTH + SIM received PTH (40 µg/kg, three times a week), SIM (25 mg/kg, daily), or both for 12 weeks. The results of our study indicated that all treatments promoted bone healing around implant compared to Control, but PTH + SIM treatment showed significantly stronger effects than PTH or SIM alone in histological, micro-CT, and biomechanical tests. The results indicated additive effects of PTH and SIM on implant fixation in osteoporotic rats.

A randomised prospective study of two different combined internal and external fixation techniques for distal tibia shaft fractures.

BACKGROUND: External fixation combined with limited open reduction and internal fixation (EF + LORIF) is a well-accepted and effective method for distal tibia shaft fractures, but it was also related to complications. The objective of this study was to compare external fixation combined with closed reduction and internal fixation (EF + CRIF) with EF + LORIF in the treatment of distal tibia shaft fractures, and explore the benefits and defects of these two techniques. METHODS: Fifty-six patients were randomised to operative stabilisation either by an external fixator combined with two closed titanium elastic nails or by external fixation combined with limited open reduction and internal fixation. Pre-operative variables included the patients' age, sex, the affected side, cause of injury, Tscherne classification of soft tissue injury, fracture pattern, and time from injury to surgery. Peri-operative variables were the operating time and the radiation time. Postoperative variables were wound problems and other complications, union time, time of recovery to work, the functional American Orthopaedic Foot and Ankle surgery (AOFAS) score. RESULTS: There was no significant difference in the mean operating time (72.6 ± 11.5 vs. 78.5 ± 16.4 min, P = 0.125), the time to union (21.2 ± 11.0 vs. 22.5 ± 12.3 weeks, P = 0.678), the time of recovery to work (25.0 ± 14.5 vs. 26.4 ± 13.6 weeks, P = 0.711), pin track infection (3/28 vs. 4/28, P = 1.000), delayed union (2/28 vs. 3/28, P = 1.000), pain (38.3 ± 1.6 vs. 38.7 ± 1.5, P = 0.339), function (44.4 ± 6.0 vs. 45.0 ± 5.5, P = 0.698), and total AOFAS scores (91.5 ± 7.4 vs. 93.4 ± 6.8, P = 0.322) between the two groups. However, the mean radiation time was longer in the EF + CRIF group than in the EF + LORIF group (2.0 ± 1.2 vs. 0.3 ± 0.1 min, P < 0.01). The EF + CRIF group had no wound complications while the EF + LORIF group had five wound complications, though the difference was not statistically significant (P = 0.052). Acceptable alignment was obtained in 50 patients (22 in EF + CRIF vs. 28 in EF + LORIF, P = 0.023). Two cases with EF + CRIF had a 6 degrees of recurvatum deformity and four had 6­9 degrees of valgus deformity. CONCLUSION: Our results indicated that both EF + CRIF and EF + LORIF were reliable methods in treatment of distal tibia shaft fractures. EF + CRIF had fewer wound complications and broader indications while EF + LORIF had lower radiation exposure and better alignment.

Pediatric femoral shaft fractures treated with titanium elastic nailing.

The objective of this study was to prospectively compare intraoperative fluoroscopy time and clinical and radiological results in pediatric femoral shaft fractures treated with titanium elastic nailing (TEN) using a small-incision, blind-hand reduction vs closed reduction. From February 2008 to December 2009, sixty-eight children were enrolled in the study. Patients were divided into 2 groups: group A comprised 34 patients treated with a small-incision, blind-hand reduction technique and group B comprised 34 patients treated with a closed reduction technique. Operative time, intraoperative fluoroscopy time, fracture union time, and complications were recorded in both groups. Clinical and radiological results were assessed using the TEN scoring system. Mean operative time was 30.5±8.5 in group A and 53.0±15.0 minutes in group B, and mean fluoroscopy time was 28.4±18.5 seconds in group A and 65.0±28.5 seconds in group B. Operative time and fluoroscopy time were significantly longer in group B (P<.001). According to the TEN scoring system, the results were excellent in 31 patients and good in 3 patients in group A and excellent in 29 patients and good in 5 patients in group B. There was no significant difference between the 2 groups in terms of clinical and radiological results. There was also no significant difference in terms of fracture healing time, weight-bearing time, and complications. The small-incision, blind-hand reduction technique provided similar clinical results as closed reduction. This technique could be an alternative to closed reduction because it significantly reduced intraoperative radiation exposure and operative time.