Endobutton technique for dynamic fixation of traumatic symphysis pubis disruption.

Plate fixation, the conventional treatment for traumatic symphysis pubis disruption, carries the risk of implant failure and demands extensive exposure. The goal of the present study was to evaluate the outcome of dynamic fixation with the Endobutton CL, which has a long successful record in anterior cruciate ligament reconstructions. Twenty-one APC-II injuries were treated from January 2006 to December 2009. The mean duration of follow-up was 23 months (18 to 26). All patients received Endobutton fixation. The incision length was 6.8 +/- 13 cm. The external blood loss was 106 +/- 15 mL. The average surgical time was 63 +/- 12 min. The symphysis distance after reduction was 4.1 +/- 1.2 mm. The symphysis distance at final visit was 4.2 +/- 1.2 mm. Loss of reduction was not significant during bone healing (p = 0.09). The Majeed scoring was excellent in 15 patients, good in 5 patients and fair in 1 patient. One malreduction was seen; there was no implant failure. Our results indicate that Endobutton fixation of the pubic symphysis might be used in the treatment of APC-II injuries.

[Methylation of P15INK4B gene in patients with myelodysplastic syndromes and demethylating effects of drugs].

OBJECTIVES: To detect the methylation of P15INK4B gene in patients with myelodysplastic syndromes (MDS) and to investigate the demethylating effects of decitabine and arsenic trioxide (As2O3). METHODS: The bone marron mononuclear cells from 14 MDS patients were collected. The methylation of P15INK4B gene was detected with restrictive endonucleases combined with PCR technique. The peripheral blood mononuclear cells from one of the patients who had progressed into acute leukemia were treated with decitabine and As2O3 in vitro to test the change of methylation. RESULTS: No methylation of P15INK4B gene was detected in MDS patients with low risk of leukemia. The methylation of P15K4B gene was found in 4 MDS patients with high-risk of leukemia and 4 patients who had progressed from MDS to acute leukemia. After exposed to decitabine or As2O3, the methylation went down by 50%. CONCLUSION: P15INK4B gene hypermethylation is closely associated with MDS pathogenesis. Decitabine and As2O3 have demethylating effect on the cells from the MDS patient.

Missed diagnosis of oesophageal perforation in ankylosing spondylitis cervical fracture: Two case reports and literature review.

Oesophageal perforation after blunt injury cervical fracture in patients with ankylosing spondylitis (AS) is rarely reported. The early diagnosis of oesophageal perforation is extremely important. We present two cases of patients with AS who sustained cervical fracture dislocation and spinal cord injury. The ossified sharp fragments caused oesophageal perforation, and the delayed diagnoses had serious consequences. Oesophageal perforation should be suspected in patients with AS and cervical fracture if bone fragments are pressing against the oesophagus and a gas shadow is visible around the fracture site on computed tomography imaging.

Platelet-rich plasma promotes healing of osteoporotic fractures.

With an aging population worldwide, the frequency of osteoporotic fractures is increasing. Therefore, biological methods to enhance the internal fixation of osteoporotic fractures becomes more important to reduce the societal burden of care. The purposes of this study were to evaluate the role of platelet-rich plasma (PRP) in the treatment of osteoporotic fractures and to clarify the best concentration of PRP. Bone marrow mesenchymal stem cells isolated from osteoporotic rats were cultured in high- (8.21±0.4×10(9)/mL), medium-(2.65±0.2×10(9)/mL), and low-concentration (0.85±0.16×10(9)/mL) PRP and in platelet-poor plasma (8±0.5×10(6) platelet/mL). The capacities of cell proliferation and osteogenic and adipogenic differentiation were compared. A transverse osteotomy was performed in the middle of the left femoral diaphysis followed by K-wire fixation, and various concentrations of PRP were transplanted into the fracture zone. Radiologic, mechanical, and histologic evaluations were performed at 2, 4, and 8 weeks, respectively. The results indicated that PRP could inhibit adipogenic differentiation and that medium-concentration PRP was effective in inducing the proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells derived from osteoporotic bone marrow and in promoting fracture healing, whereas high-concentration PRP inhibited osteogenic differentiation and callus remodeling. Certain concentrations of PRP can effectively enhance the healing of osteoporotic fractures. Medium-concentration PRP is a suitable concentration to use in practice.