Porous Se@SiO2 nanospheres attenuate cisplatin-induced acute kidney injury via activation of Sirt1.

Cisplatin (CDDP) is the most commonly used chemotherapeutic drug and has an irreplaceable role in cancer treatment. However, CDDP-induced acute kidney injury (AKI) greatly limits its use. Abundant evidence has confirmed that apoptosis contributes to AKI caused by CDDP administration. The nanoparticle form of selenium, also known as Se@SiO2 nanocomposites (NPs), has been proven to be a potential agent to prevent apoptotic cell death. In this article, we established acute kidney injury models in vivo via a single injection of CDDP and used human kidney 2 (HK-2) cells for experiments in vitro. We demonstrated that NPs can improve CDDP-induced renal dysfunction. In addition, therapy with NPs attenuated apoptosis in cells and kidney tissues treated with CDDP. In terms of mechanism, we discovered that Sirt1, a deacetylase with an important role in CDDP-induced acute kidney injury, was remarkedly increased after NPs pretreatment, and the anti-apoptotic effect of the NPs was markedly abrogated after the inhibition of Sirt1. The results linked the protective effect of NPs on nephrotoxicity with Sirt1, suggesting the potential clinical importance of nanomaterials in alleviating the side effects of chemotherapy.

Nicotinamide mononucleotide alleviates Aluminum induced bone loss by inhibiting the TXNIP-NLRP3 inflammasome.

Aluminum (Al) recognized as a persistent environmental contaminant is associated with bone diseases. Nicotinamide mononucleotide (NMN) is an intermediate of nicotinamide adenine dinucleotide (NAD+) biosynthesis widely used to replenish NAD+. Increasing evidences demonstrated that replenishment of NAD+ can protect against bone loss. However, the potentially protective effects of NMN against Al-induced bone impairment and the underlying mechanisms remain unknown. In the present study, we sought to investigate the protective effects of NMN on Al-induced bone damages and elucidate the potential mechanisms. We orally exposed AlCl3 (10 mg/L) to Sprague-Dawley rats in drinking water for 12 weeks while NMN (20 mg/kg) were intraperitoneally injected in last 4 weeks. We found that Al could induce bone damages, bone loss and oxidative stress. In addition, we showed that Al triggered inflammatory responses, which is mediated by the NOD-like receptor pyrin domain containing 3 (NLRP3) inflammasome activation. However, NMN treatment significantly alleviated Al-induced bone injuries by decreasing bone loss, suppressing oxidative stress as well as inhibiting Thioredoxin-interacting protein (TXNIP)-NLRP3 inflammasome pathway and pro-inflammatory cytokine production in vivo and in vitro. Meanwhile, treatment with TXNIP siRNA performed the same protective effects as NMN in Al-treated MC3T3-E1 cells. Collectively, our results suggest that NMN may reduce Al-induced bone loss partly by suppression of the TXNIP-NLRP3 inflammasome pathway.

Inferior displacement of greater tuberosity fracture suggests an occult humeral neck fracture: a retrospective single-centre study.

PURPOSE: To radiographically characterize the relationship between inferior displacement of great tuberosity (GT) fracture and associated occult or minor displaced humeral neck fracture. METHODS: Thirty patients with inferior displacement of the GT on the initial anterior-posterior (AP) view X-ray were included in this study. Twenty-four patients received further computed tomography (CT) scans. One patient with negative CT scans underwent MRI. Radiographic indexes included the cervico-diaphyseal angle, the distance of the inferior displacement of the GT fracture, the apex-tuberosity distance, and the direction of the GT shift on the 3D-CT scan. The measurement reliability was analyzed by calculating intra-class correlation (ICC) coefficients. The relationships between the parameters were revealed using Pearson correlation analysis. RESULTS: In the 30 cases, humeral neck fractures were detected by AP view X-ray (6 cases), CT (23 cases), and MRI (1 case). The mean cervico-diaphyseal angle was 146.7° ± 8.9°. The mean inferior displacement of the GT fracture was 13.4 ± 5.9 mm. The mean apex-tuberosity distance was 11.8 ± 2.8 mm. Posterior/inferior displacement of the GT fractures was observed in 24 patients via CT scan. All the evaluated parameters presented correlations among methods, indicating intra-rater and inter-rater reliability. The Pearson correlation analysis revealed that inferior displacement of GT fracture was correlated with the cervico-diaphyseal angle (P < 0.05). CONCLUSION: The inferior displacement of GT fracture on AP view X-ray is a useful diagnostic clue for the early recognition of occult humeral neck fracture and may indicate the need for further CT/MRI examination.

True compression of pelvic fractures under lateral impact.

PURPOSE: To promote the understanding of pelvic fracture mechanism and make more accurate evaluation of maximal deformity at the moment of fracture, kinematic response of pelvis to lateral impact and the difference between peak and final displacement were investigated. METHODS: A total of three human cadaver pelves were seated uprightly on a sled test table, explored to horizontal lateral impact by a 22.1-kg impactor at a speed of 5.2, 4.0, and 4.8 m/s. Kinematic data of pelvic osseous interesting points (POIP) were measured by the motion capture system. Trajectories of POIP, duration of impact, and deflection of pelvis were calculated as well as rotational movement of pelvis was evaluated. After impact, autopsy and CT scan were made to validate the motion capture data. RESULTS: The peak deflection of pelvis under lateral impact was 31.9, 30.1, and 18.5%, while final deflection was 19.6, 13.8, and 13.8%. The final deflection was only 61.5, 45.9, and 74.46% of the peak deflection. CONCLUSIONS: In clinical practice, pelvic fracture displacement tends to be underestimated. The peak compression can be 1.3-2.2 times of final compression appearing on images in hospital. Clinicians shall give adequate estimation of displacement and related injuries.

Surgical exposures of the distal humeral fractures: An anatomical study of the anterior, posterior, medial and lateral approaches.

PURPOSE: Exposure of the articular surface is the key to the successful treatment of intra-articular fractures of distal humerus. Anterior, posterior olecranon osteotomy as well as medial and lateral approaches are the four main approaches to the elbow. The aim of this study was to compare the exposure of distal articular surfaces of these surgical approaches. METHODS: Twelve cadavers were used in this study. Each approach was performed on six elbows according to previously published procedures. After completion of each approach, the exposed articular surfaces were marked by inserting 0.5 mm K-wires along the margins. The elbow was then disarticulated and the exposed articular surfaces were painted. The distal humeral articular surfaces were then closely wrapped using a piece of fibre-glass screen net with meshes. The exposed articular surfaces and the total articular surfaces were calculated by counting the number of meshes, respectively. RESULTS: The average percentages of the exposed articular surfaces for the anterior, posterior olecranon osteotomy, medial and lateral approaches were 45.7% ± 2.0%, 53.9% ± 7.1%, 20.6% ± 4.9% and 28.5% ± 6.3%, respectively. CONCLUSION: The anterior and posterior approaches provide greater exposures of distal humeral articular surface than the medial and lateral ones in the treatment of distal humeral fractures.

Evaluation of Transsyndesmotic Fixation and Primary Deltoid Ligament Repair in Ankle Fractures With Suspected Combined Deltoid Ligament Injury.

The present prospective study examined the utility of the intraoperative tap test/technique for distal tibiofibular syndesmosis in the diagnosis of deltoid ligament rupture and compared the outcomes of transsyndesmotic fixation to deltoid ligament repair with suture anchor. This diagnostic technique was performed in 59 ankle fractures with suspected deltoid ligament injury. The width of the medial clear space of 59 cases was evaluated to assess the sensitivity and specificity. Those with deltoid ligament rupture were randomly assigned to 2 groups and treated with deltoid ligament repair with a suture anchor or with syndesmosis screw fixation. All the patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, short-form 36-item questionnaire (SF-36), and visual analog scale (VAS). The tap test was positive in 53 cases. However, surgical exploration demonstrated that 51 cases (86.4%) had a combined deltoid ligament injury and fracture. The sensitivity and specificity of the tap test was 100.0% and 75.0%, respectively. Finally, 26 cases (96.3%) in the syndesmosis screw group and 22 (91.7%) in the deltoid repair group were followed up. No statistically significant differences were found in the AOFAS ankle-hindfoot scale score, SF-36 score, or VAS score between the 2 groups. The malreduction rate in the syndesmosis screw group was 34.6% and that in the deltoid repair group was 9.09%. The tap test is an intraoperative diagnostic method to use to evaluate for deltoid ligament injury. Deltoid ligament repair with a suture anchor had good functional and radiologic outcomes comparable to those with syndesmotic screw fixation but has a lower malreduction rate. We did not encounter the issue of internal fixation failure or implant removal.

The safe screw path along inferior border of the arcuate line at acetabular area: an anatomical study based on CT scans.

BACKGROUND: Misplaced screw during the internal fixation of acetabular fractures may penetrate the hip joint which might cause chondrolysis and traumatic osteoarthritis in the future. This study aims to acquire the safe path for screw insertion along inferior border of the arcuate line fixation route at acetabular area. METHODS: Computed tomography (CT) scans of 98 patients without pelvic trauma were rebuilt for three-dimensional models of pelvis. After depicting the fixation route curve, five cross-sections perpendicularly to the curve were established from the anterior of pelvis to the posterior along inferior border of the arcuate line. The safe screw lengths for section 1 and 5 were measured from the computer models. In section 2, 3 and 4, a line from the screw entry point tangent to the inferior edge of the acetabulum was depicted and the measurements of minimum safe direction of screw insertion were performed then marked with angle θ. RESULTS: The safe screw lengths for section 1 and 5 were 22.29 ± 4.41 mm and 32.64 ± 4.70 mm (n = 98). The minimum safe angles of screw insertion for the middle three sections 2, 3, and 4 were 65.38 ± 10.23°, 74.20 ± 10.20°, and 57.88 ± 11.11°(n = 98), respectively. The results for the male group (n = 98) indicated smaller minimum safe angles in these three sections compared with the female (n = 98). CONCLUSIONS: Compared to male, the minimum safe angles of screw placement at acetabular area for female should be more away from inferior edge of acetabulum and tilt to the bottom of pelvis along inferior border fixation route in surgical management of acetabular fractures.

Treatment of type B pelvic fracture using anterior subcutaneous internal fixator with triple pedicle screws: a new surgical technique.

INTRODUCTION: To evaluate the clinical outcomes of anterior subcutaneous internal fixator using triple pedicle screws (ASIF/TPS) in the treatment of unstable type B pelvic fracture compared with open reduction internal fixation (ORIF). MATERIALS AND METHODS: This was a retrospective cohort study of 26 patients with type B unstable fractures that underwent ASIF/TPS and 26 similar patients that underwent ORIF using plates and screws. Intraoperative blood loss, operating time, and post operation hospitalization duration were compared. Anteroposterior, inlet, and outlet X-rays and 3D computed tomography were obtained. Pain, numbness, sexual dysfunction, and activity were evaluated at every follow-up visit until the implants were removed. The Majeed score was used to assess the clinical and radiological outcomes. RESULTS: Blood loss, operating time, and hospitalization duration were less (all P < 0.001) in the ASIF/TPS group compared with the ORIF group. The clinical and radiological outcomes of the ASIF/TPS group after a mean follow-up of 6 months were excellent and good in 80.8%, and moderate in 19.2%. In comparison, the results of the ORIF group were excellent and good in 65.4%, moderate in 29.0%, and poor in 5.6%. No patient experienced nonunion, delayed union, superficial infection, or deep surgical wound infection. No urethral injury or dysuria occurred in the ASIF/TPS group. Two patients had temporary lateral femoral cutaneous nerve numbness after operation. There were two superficial wound infections in the ORIF group. CONCLUSIONS: The use of ASIF/TPS with triple pedicle screws could be a reasonable option for the treatment of type B unstable pelvic fractures.

Treatment of Unstable Posterior Pelvic Ring Fracture with Pedicle Screw-Rod Fixator Versus Locking Compression Plate: A Comparative Study.

BACKGROUND The aim of this study was to assess the clinical results of treatment for unstable posterior pelvic fractures using a pedicle screw-rod fixator compared to use of a locking compression plate. MATERIAL AND METHODS A retrospective study was performed between June 2010 and May 2014 and the data were collected from 46 patients with unstable posterior pelvic ring fractures. All patients were treated using either a pedicle screw-rod fixator (study group, 24 patients) or locking compression plate (control group, 22 patients). In these patients, causes of injury included traffic accidents (n=27), fall from height (n=12), and crushing accidents (n=7). The quality of reduction and radiological grading were assessed. Clinical assessments included the operation time, times of X-ray exposures, bleeding volume during operation, incision length, and Majeed postoperative functional evaluation. RESULTS No iatrogenic neurovascular injuries occurred during the operations in these 2 groups. The average follow-up time was 24.5 months. All fractures were healed. The significant differences (P<0.05) between the 2 groups were operation duration, size of incision, and intraoperative bleeding volume. Statistically significant differences in the Majeed postoperative functional evaluation and times of X-ray exposures were not found between the 2 groups. CONCLUSIONS Similar clinical effects were achieved in treating the posterior pelvic ring fractures using the pedicle screw-rod fixator and the locking compression plate. However, the pedicle screw-rod fixator has the advantages of smaller incision, shorter duration of the operation, and less bleeding volume compared to using the locking compression plate.

Digital anatomical measurements and crucial bending areas of the fixation route along the inferior border of the arcuate line for pelvic and acetabular fractures.

BACKGROUND: Better understanding of three-dimensional (3D) morphology of the pelvis at the area of inferior border of the arcuate line is very important, which could guide the surgeons to treat pelvic and acetabular fractures more efficiently. The objective of this study is to provide references for screw placement and design of anatomical internal fixators for the fixation route along the pelvic inferior border of the arcuate line. METHODS: Seventy five cases of computed tomography (CT) scan data were collected using Medical Image Database in Shanghai General Hospital between December 2009 and November 2010. 44 males and 31 females, aging from 21 to 91 years (average: 57.8 years) were enrolled. Using MIMICS 13.0, these data were used for three dimensional (3D) reconstructions of pelvic model. A curve from the pubic tubercle, along the inferior border of the arcuate line, to the sacroiliac joint was depicted and then divided into 11 equal parts. The measurements of whole length of the curve, the radius of the curvature and the thickness of bone at each decile point were performed, respectively. RESULTS: The thinnest bone thickness at acetabular area was 17.24 ± 2.90 mm and 9.94 ± 2.69 mm for male and female, respectively. The radius of curvature at the decile points 1, 8 and 10 were smaller compared with the surrounding points. CONCLUSIONS: Using a screw shorter than 10 mm perpendicular to the bone surface along the inferior border of the arcuate line can avoid intra-articular screw penetration. There should be more recontouring of the plate at the areas of pubic tubercle and posterior edge of the acetabulum when placing a fixator along this fixation route. This study provides solid guidance for pelvic and acetabular surgeries as well as designing of anatomical fixators along inferior border fixation route at this area.

Precision insertion of percutaneous sacroiliac screws using a novel augmented reality-based navigation system: a pilot study.

PURPOSE: Augmented reality (AR) enables superimposition of virtual images onto the real world. The aim of this study is to present a novel AR-based navigation system for sacroiliac screw insertion and to evaluate its feasibility and accuracy in cadaveric experiments. METHODS: Six cadavers with intact pelvises were employed in our study. They were CT scanned and the pelvis and vessels were segmented into 3D models. The ideal trajectory of the sacroiliac screw was planned and represented visually as a cylinder. For the intervention, the head mounted display created a real-time AR environment by superimposing the virtual 3D models onto the surgeon's field of view. The screws were drilled into the pelvis as guided by the trajectory represented by the cylinder. Following the intervention, a repeat CT scan was performed to evaluate the accuracy of the system, by assessing the screw positions and the deviations between the planned trajectories and inserted screws. RESULTS: Post-operative CT images showed that all 12 screws were correctly placed with no perforation. The mean deviation between the planned trajectories and the inserted screws was 2.7 ± 1.2 mm at the bony entry point, 3.7 ± 1.1 mm at the screw tip, and the mean angular deviation between the two trajectories was 2.9° ± 1.1°. The mean deviation at the nerve root tunnels region on the sagittal plane was 3.6 ± 1.0 mm. CONCLUSIONS: This study suggests an intuitive approach for guiding screw placement by way of AR-based navigation. This approach was feasible and accurate. It may serve as a valuable tool for assisting percutaneous sacroiliac screw insertion in live surgery.

The Use of Superselective Arteriography in the Evaluation of the Influence of Intracapsular Hip Joint Pressure on the Blood Flow of the Femoral Head.

OBJECTIVE: We aimed to analyze the intracapsular pressure of the hip joint following femoral neck fracture and its relationship to the position of the hip or to traction and (using superselective arteriography) to evaluate the blood supply to the femoral head and the influence of traction and hip position on the blood supply. SUBJECTS AND METHODS: Twenty-six cases of fresh Garden type I-III femoral neck fractures were enrolled. After being placed in the neutral position, in internal rotation or with traction of 3 and 5 kg, respectively, intracapsular manometric changes were measured. Eight cases underwent superselective arteriography of the medial circumflex femoral artery and its branches under the manometric changes of the hip joint capsule. RESULTS: Twenty-four to 48 h after the injury, the intracapsular pressure was significantly higher on the fractured side than on the normal side. The mean pressure was 28.41 ± 9.339 mm Hg in fully extended hips in the neutral position, 79.92 ± 12.80 mm Hg in internally rotated hips, 51.39 ± 15.41 mm Hg in hips with 3 kg of traction and 64.81 ± 13.56 mm Hg in hips with 5 kg of traction. The arteriographic findings revealed that traction and internal rotation reduced the perfusion of the femoral head at the medial circumflex femoral artery and its branches, and also negatively influenced venous reflux. CONCLUSION: Traction and internal rotation both caused the intracapsular pressure of the hip joint to rise considerably, which reduced the femoral head perfusion and impeded venous reflux. This could lead to avascular necrosis of the femoral head.

Talar Neck Fractures Treated Using a Highly Selective Incision: A Case-Control Study and Review of the Literature.

We describe a highly selective incision combined with percutaneous manipulation for reduction and internal fixation of talar neck fractures. We retrospectively investigated the clinical data from 29 cases of talar neck fractures treated from January 2009 to June 2013. Fifteen patients (study group) were treated using a 1- to 2-cm limited incision placed on the anteromedial or anterolateral side of the talus, followed by percutaneous reduction and fixation. Another 14 patients (control group) underwent open reduction and internal fixation through a conventional anteromedial or anterolateral approach. All cases were fixed with Herbert screws or cannulated titanium screws. All the patients were followed up for a minimum of 18 (median 24) months. All the fractures displayed bony union at or before the final follow-up visit. The mean American Orthopaedic Foot and Ankle Society ankle scale score in the study group was 75.3 ± 17.7, 9 patients (60%) had good or excellent results, and 3 (20%) developed talar avascular necrosis. The mean ankle scale score in the control group was 78.9 ± 15.2, 9 patients (64.3%) had good to excellent results, and 6 (42.9%) developed avascular necrosis. No statistically significant differences were found in the American Orthopaedic Foot and Ankle Society score, the number of good to excellent outcomes, or the incidence of complications between the incision groups. A highly selective incision combined with percutaneous reduction and internal fixation can be used to treat fractures of the neck of the talus satisfactorily.

Development of a surgical navigation system based on augmented reality using an optical see-through head-mounted display.

The surgical navigation system has experienced tremendous development over the past decades for minimizing the risks and improving the precision of the surgery. Nowadays, Augmented Reality (AR)-based surgical navigation is a promising technology for clinical applications. In the AR system, virtual and actual reality are mixed, offering real-time, high-quality visualization of an extensive variety of information to the users (Moussa et al., 2012) [1]. For example, virtual anatomical structures such as soft tissues, blood vessels and nerves can be integrated with the real-world scenario in real time. In this study, an AR-based surgical navigation system (AR-SNS) is developed using an optical see-through HMD (head-mounted display), aiming at improving the safety and reliability of the surgery. With the use of this system, including the calibration of instruments, registration, and the calibration of HMD, the 3D virtual critical anatomical structures in the head-mounted display are aligned with the actual structures of patient in real-world scenario during the intra-operative motion tracking process. The accuracy verification experiment demonstrated that the mean distance and angular errors were respectively 0.809±0.05mm and 1.038°±0.05°, which was sufficient to meet the clinical requirements.

Digital anatomical measurements of safe screw placement at superior border of the arcuate line for acetabular fractures.

BACKGROUND: Screw penetration into hip joint is a severe complication during acetabular fracture surgery, which might result in osteoarthritis and chondrolysis. The purpose of this study was to obtain the safe and effective screw angles and lengths at acetabular area of the fixation route along the superior border of the arcuate line. METHODS: A total of 98 uninjured pelvises of Chinese adults were examined. Each person's computed tomography (CT) scans were reconstructed to create a three-dimensional pelvic model. A curve of the fixation route was delineated and five cross-sections from the pubic tubercle to the sacroiliac joint direction were constructed perpendicularly to the curve. The minimum safe direction, which was tangent to the acetabulum, was measured in the middle three sections and then recorded as the angle α. The maximum effective direction, which was determined by a 14 mm arc and the quadrilateral surface, was also measured in the above sections and then recorded as the angle ß. The maximum screw lengths for the five sections were measured. RESULTS: The ranges of safe and effective screw insertion angles for the 2nd, 3rd, 4th cross-sections were 21.09±13.57°~40.45±13.60°, 30.43±14.05°~47.54±12.67°, 23.84±11.60°~37.13±8.45°, respectively. The maximum screw lengths for the five sections were 15.89±3.80 mm, 58.83±27.66 mm, 42.94±22.41 mm, 72.43±6.73 mm, 40.99±6.33 mm. The male group showed significantly greater minimum safe angle compared to the female group in the 2nd, 3rd, and 4th sections (p<0.05). CONCLUSIONS: The screw insertion at the acetabular area for the female requires greater minimum safe angle towards the quadrilateral surface than the male.

Arthroscopic versus mini-open rotator cuff repair: an up-to-date meta-analysis of randomized controlled trials.

PURPOSE: The aim of this meta-analysis was to compare the clinical outcomes of arthroscopic and mini-open rotator cuff repairs based on recently published Level I randomized controlled trials (RCTs). METHODS: We systematically searched electronic databases to identify RCTs that compared arthroscopic and mini-open rotator cuff repairs from 1980 to October 2013. The clinical outcome scores, including the University of California, Los Angeles score and the Constant-Murley score, were converted to a common 100-point outcome score for further analysis. The results of the pooled studies were analyzed in terms of surgery time, weighted 100-point score, pain on a visual analog scale (VAS), and range of motion. Study quality was assessed and relevant data were extracted independently by 2 reviewers. RESULTS: Five RCTs, including 166 patients in the arthroscopic repair group and 163 patients in the mini-open repair group, were included in this meta-analysis. The results of the meta-analysis showed that there were no significant differences in surgery time (P = .11), weighted 100-point score (P = .65), VAS pain score (P = .87), or range of motion (P = .29 for forward flexion and P = .82 for external rotation). CONCLUSIONS: On the basis of current literature, no differences in surgery time, functional outcome score, VAS pain score, and range of motion were found at the end of follow-up between the arthroscopic and mini-open rotator cuff repair techniques. In addition, there was no significant difference in VAS pain score in the early phase between the 2 repairs. LEVEL OF EVIDENCE: Level I, meta-analysis of Level I studies.

MicroRNA-100 inhibits osteosarcoma cell proliferation by targeting Cyr61.

Increasing evidence indicates that microRNAs (miRNAs) participate in almost every step of cellular processes and are often aberrantly expressed in human cancer. Therefore, the discovery of miRNAs may provide a new and powerful tool for understanding the mechanism and treatment of carcinogenesis. The aim of this study was to investigate the functional significance of miR-100 and to identify its possible target genes in osteosarcoma (OS) cells. Here, we found that expression level of miR-100 was significantly decreased in osteosarcoma tissues in comparison with the adjacent normal tissues. The enforced expression of miR-100 was able to inhibit cell proliferation in Saos-2 and MG63 cells, while its antisense oligonucleotides (antisense miR-100) promoted cell proliferation. Moreover, our results further revealed that expression of Cyr61, an extracellular matrix-associated growth factor, was negatively regulated by miR-100. Therefore, we consider that miR-100 acts as a tumor suppressor for osteosarcoma. It may provide novel diagnostic and therapeutic options for human osteosarcoma in the future.

Regression analysis of controllable factors of surgical incision complications in closed calcaneal fractures.

BACKGROUND: In surgeries of closed calcaneal fractures, the lateral L-shaped incision is usually adopted. Undesirable post-operative healing of the incision is a common complication. In this retrospective study, controllable risk factors of incision complications after closed calcaneal fracture surgery through a lateral L-shaped incision are discussed and the effectiveness of clinical intervention is assessed. MATERIALS AND METHODS: A review of medical records was conducted of 209 patients (239 calcaneal fractures) surgically treated from June 2005 to October 2012. Univariate analyses were performed of seven controllable factors that might influence complications associated with the surgical incision. Binomial multiple logistic regression analysis was performed to determine factors of statistical significance. RESULTS: Twenty-one fractures (8.79%) involved surgical incision complications, including 8 (3.35%) cases of wound dehiscence, 7 (2.93%) of flap margin necrosis, 5 (2.09%) of hematoma, and 1 (0.42%) of osteomyelitis. Five factors were statistically significant : The time from injury to surgery, operative duration, post-operative drainage, retraction of skin flap, bone grafting, and patients' smoking habits. The results of multivariate analyses showed that surgeries performed within 7 days after fracture, operative time > 1.5 h, no drainage after surgery, static skin distraction, and patient smoking were risk factors for calcaneal incision complications. The post-operative duration of antibiotics and bone grafting made no significant difference. CONCLUSION: Complications after calcaneal surgeries may be reduced by postponing the surgery at least 7 days after fracture, shortening the time in surgery, implementing post-operative drainage, retracting skin flaps gently and for as short a time as possible, and prohibiting smoking.

Retrograde nailing versus locked plating of extra-articular distal femoral fractures: comparison of 36 cases.

OBJECTIVE: The purpose of this study was to retrospectively evaluate the use of locked plating (LP) and retrograde nailing (RN) for treating extra-articular distal femoral fractures. MATERIALS AND METHODS: From January 2004 to March 2009, 36 patients with extra-articular distal femoral fractures were surgically treated at our Trauma Center. The patients were divided into two groups according to the treatment method, with 19 patients being treated by LP (LP group) and 17 patients via RN (RN group). RESULTS: The demographics of age (p = 0.460) and gender (p = 0.481) in both LP and RN groups were similar. No differences were found with respect to postoperative malreduction, deep infection, hardware failure, operating time, knee pain, HSS score and range of knee movement. The mean intraoperative blood loss was significantly higher in the RN group (298 ± 65.2 ml, range 200-410) than in the LP group (200 ± 48.9 ml, range 130-300) (p < 0.01). However, a higher rate of union disturbance was observed in the LP group (36.8%) compared to the RN group (5.9%) (p = 0.044). CONCLUSIONS: The overall union disturbance rate in the LP group was higher than in the RN group. However, further analysis revealed that clinical outcome may largely depend on surgical technique rather than on the choice of implant. Therefore, correct rules (the same for every procedure) should be strictly adhered to, especially in the application of LP.