Comparison of different treatment approaches for coronoid process fracture in terrible triad injury: a multicenter, randomized controlled study.

PURPOSE: The purpose of the study was to compare the functional results of different treatment approaches for the fracture of the coronoid process in terrible triad injury (TTI). METHODS: This prospective randomized controlled trial included participants from seven level-1 trauma centres in China. All patients were randomly assigned to three groups, wherein different approaches were applied to treat coronoid fracture: group A) internal fixation of the coronoid process without external fixation or splint (ORIF group), B) external fixation using a hinged fixator without internal fixation (Exfix group), and C) long-arm plaster for two to three weeks postoperatively without internal fixation of coronoid process (Plaster group). Early active motion exercises within the limits of pain were started immediately after surgery under the supervision of a physical therapist. Outcomes were evaluated at regular intervals over the subsequent 12 months. RESULTS: A total of 65 patients (22 patients in Group A, 21 in Group B, and 22 in Group C) were included in this trial from January 2016 to January 2019. The average arc of elbow motion was 114.1° ± 8.92°. The average flexion and flexion contracture were 126.4° ± 11.2° and 12.3° ± 7.7°, respectively. The arcs of forearm rotation of the elbow for each group were 145.41° ± 9.36°, 143.38° ± 9.79°, and 143.86° ± 10.95°, respectively. The MEPS for each group were 86.82 ± 9.7, 86.67 ± 9.92, and 85.23 ± 8.66, respectively. The DASH score for each group were 18.26 ± 19.31, 18.85 ± 15.02, and 20.19 ± 13.59, respectively. CONCLUSION: All three approaches in our trial showed similar functional results in the long-term survey. Patients treated with external fixation without internal fixation of the coronoid process showed less pain during early mobilization and acquired maximum flexion within a short duration after surgery.

[Application of Digital Therapy in Post-operative Rehabilitation of Knee Anterior Cruciate Ligament Reconstruction].

OBJECTIVE: Digital therapy is important in treating motor system disease. The outcome of digital therapy in post-operative rehabilitation of knee anterior cruciate ligament (ACL) reconstruction is assessed. METHODS: 142 patients are treated with digital rehabilitation therapy after ACL reconstruction. Patients' pain score, joint motion, lower limb function score, anxiety score are statistically analyzed. Patients' satisfaction, device usage and adverse events are documented. RESULTS: At post-operative 1st day, 8th weeks, 12th weeks, pain score are 4, 2, 1, knee joint range of motion are 55°, 110°, 143°, lower limb function score are 18, 56, 76, anxiety score are 32.5, 26, 23.5 respectively. Patients' satisfaction are 9.4. Mean duration of device usage is (177.6±38.0) minutes per week. Rehabilitation-related and device-related adverse event does not happen. CONCLUSIONS: Digital therapy promotes post-operative rehabilitation after ACL reconstruction.

Role of Arterial Perfusion in Early Survival of Arterialized Venous Flaps: A Mechanism Study and Clinical Application.

BACKGROUND: The arterialized venous flap (AVF) is appropriate as a flap for hand and foot resurfacing meet the aesthetic demands in the same time. However, the inconsistency of survival rate limited its popularization in clinical settings. The purpose of this study was to investigate the role played by the caliber and location of the artery. METHODS: Arterialized venous flaps were designed on the abdomen of New Zealand rabbits, and the animals were randomized into 3 groups and 2 groups in experiment 1 and 2, respectively. In experiment 1, the artery flow was restricted with vascular staplers of different calibers. In experiment 2, the artery was anastomosed with the afferent vein in the center or at the margin of the flap. Blood perfusion state, water content, epidermal metabolite levels, and flap survival status were observed in both experiments. Furthermore, outcomes of 12 patients received AVF to resurface soft tissue defects in the digits, hands, and feet between January 2016 and February 2018 were analyzed. RESULTS: In experiment 1, compared with the control group, groups with restricted artery showed poor results regarding blood perfusion state, water content, epidermal metabolite levels, and flap survival status. In experiment 2, group with the afferent vein in the center of the flap showed better results mentioned previously. All the flaps survived uneventfully in this study. Two flaps partially failed (20% of the flap area) because of insufficient perfusion. Generally, larger caliber and center-located vein helped the survival of AVF. CONCLUSIONS: Experimental findings suggested that increased arterial perfusion and center-located vein are beneficial for the survival of AVF. Clinical series proved the findings previously. The problem of inconsistency of AVF can be partially solved by increasing arterial perfusion and dissecting afferent vein into the center of flap, and still, further studies are needed to shed light on the mechanism behind.

Beneficial effects of paeoniflorin on osteoporosis induced by high-carbohydrate, high-fat diet-associated hyperlipidemia in vivo.

Osteoporosis is linked to reduced bone mineral density (BMD) as a major risk factor for fragility fractures. Recent studies indicated an association between BMD and abnormally elevated lipid levels in blood as common indicators for hyperlipidemia. In this study, we assessed the protective effect of paeoniflorin, a phytochemical compound with multiple pharmacological activities, against hyperlipidemia-induced osteoporosis in rats fed a high-carbohydrate, high-fat diet (HCHF). The special diet-fed rats were subjected to an 8-week treatment with either paeoniflorin (20 mg/kg, daily) or vehicle. The control group received a normal diet during the entire study. At study conclusion, serum markers of lipid metabolism and bone turnover were measured. Bone strength was assessed by biomechanical testing, and femurs were scanned using micro-computed tomography to analyze trabecular and cortical bone structure. Interestingly, paeoniflorin controlled the serum lipid profile by significantly decreasing HCHF-induced high levels of total cholesterol, triglyceride, and low-density lipoprotein cholesterol. Paeoniflorin significantly improved trabecular and cortical parameters as well as femur length and width that were negatively affected by HCHF diet. Biomechanical strength testing showed that femurs of HCHF diet-fed rats endured significantly lower force but higher displacement and strain than those of control rats, whereas paeoniflorin reversed the negative effects. Moreover, paeoniflorin rescued osteoblast differentiation and cell spreading activities along with bone turnover markers. In conclusion, HCHF-induced hyperlipidemia caused adverse effects on the bone that were rescued by paeoniflorin treatment.

Medial Plantar Venous Flap: Classic Donor Site Modification for Hand Defects.

BACKGROUND: Destruction of digits from trauma results in a much more significant influence on patients' mental state and quality of life than do injuries to other parts. The purpose of this study was to describe a novel modification of medial plantar venous flap for soft tissue defects in the hands and digits. METHODS: Nine patients received medial plantar venous flap to resurface soft tissue defects in the hands or digits between January 2015 and February 2017. This flap can be used either in a free-island pattern or in a flow-through pattern through the medial branch of the great saphenous vein. All patient data including preoperative statues and follow-up examinations (flap survival rates, complication rates, total active motion, static 2-point discrimination, and Semme-Weinstein test score) were analyzed. RESULTS: We included 6 men and 3 women, with a mean age of 34.2 years. The medial plantar venous flaps were used for vascularization in 5 patients because of segmental defects of bilateral digit arteries. Eight flaps survived uneventfully in this study. One flap partially failed (20% of the flap area) because of venous congestion. The functional outcomes and sensory restoration were satisfied for all 9 flaps. CONCLUSIONS: Compared with the traditional medial plantar flap, the medial plantar venous flap involves a simpler surgical procedure and allows for revascularization of distal areas using the flow-through technique. Furthermore, the medial plantar area presents a sensitive, glabrous skin with proper bulkiness and allows for movement of the underlying structure.

Association of gout with osteoporotic fractures.

PURPOSE: Previous studies have shown that serum uric acid levels and inflammation are associated with bone mineral density. Gout, a disease characterized by hyperuricemia and inflammation, contributes to the risk of osteoporotic fractures. However, this association is controversial. Therefore, this study investigated whether gout in older people (age > 55 years) is associated with osteoporotic fracture risk. METHODS: This population-based, cross-sectional study included 2674 participants (147 cases of gout and 388 fractures). Standardized and self-administered questionnaires were employed and physical examinations, blood tests, and bone mineral density examinations were performed; multivariate-adjusted logistic regression models were used to evaluate associations between gout and osteoporotic fracture risk. RESULTS: The data were adjusted for age; smoking status; alcohol status; physical activity; body mass index; waist circumference; hypertension; cardiovascular events; diabetes mellitus; rheumatoid arthritis; serum levels of total cholesterol (TC), triglycerides, and high- and low-density lipids; and T-scores. We found a significant association between gout and osteoporotic fracture risk in women (odds ratio [OR], 2.00; 95% confidence interval [CI], 1.12-3.56; P = 0.019), but no such association in men (OR, 1.30; 95% CI, 0.58-2.88; P = 0.525). Further stratified analyses showed a significant association between gout and osteoporotic fracture risk in women without rheumatic arthritis and in those with high TC levels or with osteoporosis (all, P < 0.05). CONCLUSIONS: In older Chinese adults, gout is significantly associated with the risk of osteoporotic fractures in women, especially those without rheumatic arthritis and in those with high TC levels or with osteoporosis.

Geraniin inhibits migration and invasion of human osteosarcoma cancer cells through regulation of PI3K/Akt and ERK1/2 signaling pathways.

Geraniin, an active compound isolated from Geranium sibiricum, was found to inhibit proliferation and induce apoptosis of tumor cells. However, the antimetastatic effects of geraniin remain elusive. Our study found the potential antitumor mechanisms of geraniin through inhibiting the migration and invasion of human osteosarcoma U2OS cells. The western blot, gelatin zymography, and reversed transcription-PCR analysis showed that geraniin suppressed matrix metalloproteinase-9 (MMP-9) expression in a concentration-dependent manner. Geraniin potently suppressed the phosphorylation of extracellular signal regulating kinase (ERK)1/2, phosphatidylinositide-3-kinase (PI3K), and Akt, but did not affect phosphorylation of p38 mitogen-activated protein kinase and c-Jun N-terminal kinase. Furthermore, when transforming growth factor-ß1 (TGF-ß1) was used as an agonist, geraniin inhibited TGF-ß1-mediated cell invasion and upregulation of MMP-9. These results suggested that geraniin inhibited U2OS cell migration and invasion by reducing the expression of MMP-9 through the PI3K/Akt and ERK1/2 signaling pathways.

Baicalin inhibits human osteosarcoma cells invasion, metastasis, and anoikis resistance by suppressing the transforming growth factor-ß1-induced epithelial-to-mesenchymal transition.

The epithelial-mesenchymal transition (EMT) plays an important role in inducing cancer metastasis. Baicalin, a flavone derivative isolated from Scutellaria spp., shows a series of pharmacological and physiological activities. However, the possible role of baicalin in the EMT is unclear. In this study, we attempted to investigate the potential use of baicalin as an inhibitor of transforming growth factor-ß1 (TGF-ß1)-induced EMT in U2OS cells. We found that TGF-ß1 induced the EMT to promote U2OS cells migration, invasion, and anoikis resistance. Western blotting showed that baicalin inhibited U2OS cells' invasion and migration, increased the expression of the epithelial phenotype marker E-cadherin, repressed the expression of the mesenchymal phenotype marker vimentin, as well as decreased the level of EMT-inducing transcription factors Snail1 and Slug during the initiation of TGF-ß1-induced EMT. Baicalin also inhibited the TGF-ß1-induced increase in cell migration, invasion, and anoikis resistance in TGF-ß1-induced U2OS cells. In addition, the TGF-ß1-mediated phosphorylated levels of Smad2/3 were inhibited by baicalin pretreatment. Above all, we conclude that baicalin suppresses human osteosarcoma cells' migration, invasion, and anoikis resistance in vitro through suppression of TGF-ß1-induced EMT.

Amputation Stump Revision Using a Free Sural Neurocutaneous Perforator Flap.

BACKGROUND: The development of microsurgery and the concept of the surgical flap have enabled orthopedic surgeons to deal with various soft tissue defects and compositions during limb salvage procedures. However, severely damaged bony structures with accompanying soft tissue deficiencies often result in amputation. When performing amputations, surgeons must preserve the stump length to maximize functional ambulation, even during the posttraumatic phase and chronic period when a fillet flap is not an option. PATIENTS AND METHODS: Eleven patients with previous below-knee amputation were enrolled in our study from January 2006 to December 2011. Each patient underwent stump revision using a free sural neurocutaneous perforator flap. Preoperative and postoperative data were reviewed to evaluate the functional and aesthetic results. RESULTS: The 11 patients comprised 7 men and 4 women with an average age of 35.6 years (range, 26.0-49.0 years). The mean follow-up period was 15.3 months (range, 10.0 months-2.0 years). All free flap reconstructions of the amputation stump ultimately survived. All patients achieved both superficial and deep sensory recovery and are comfortable with their prostheses, and none have required further surgical intervention. CONCLUSIONS: The sural neurocutaneous perforator flap provided stable coverage and improved patients' quality of life by aiding in early rehabilitation and prosthetic fitting, function, and comfort.

Distally Based Saphenous Neurocutaneous Perforator Flap: A Versatile Donor Site for Reconstruction of Soft Tissue Defects of the Medial Malleolar Region.

Repair of both simple and complex defects in the medial malleolar region continues to be a challenging task for surgeons because of the local paucity of soft tissue available for transfer. The popular neurocutaneous flap has provided a reliable and less technically demanding method for resurfacing defects of the lower extremities. We present our experience with the versatile design of the distally based saphenous neurocutaneous perforator flap to provide coverage of complex post-traumatic medial malleolar defects by harvesting multiple tissue components in various combinations. Our series included 11 patients (8 males [72.7%] and 3 females [27.3%]); mean age 39.2 (range 22 to 58) years, who were followed for a mean duration of 13.3 (range 9 to 18) months. Three flaps (27.3%) were harvested with massive subcutaneous tissue to obliterate dead space. The procedure was uneventful in 10 patients (90.9%). Venous congestion was noted in 1 patient (9.1%), in whom secondary healing was achieved with conservative treatment.

Versatility of the reversed superficial peroneal neurocutaneous island flap in the coverage of ankle and foot.

BACKGROUND: In the last decades, the skin island flap supplied by the vascular axis of sensitive superficial nerves, like the sural and saphenous nerves, has emerged as one of the most ideal reconstructive options for soft tissue coverage of lower limbs. The nutrient vessels of reversed superficial peroneal neurocutaneous island flap have been well described; however, it is still not commonly clinically applied. The aim of this study was to evaluate the efficacy of reversed superficial peroneal neurocutaneous island flap for coverage of ankle and foot. STUDY DESIGN: This is a retrospective and descriptive study of reversed superficial peroneal neurocutaneous island flap which was carried out for reconstruction of ankle and foot. PLACE AND DURATION OF STUDY: This study was conducted at the Department of Repair and Reconstructive Surgery, the 6th People's Hospital affiliated to Shanghai Jiaotong University, during a period of 51 months from July 2008 to October 2012. PATIENTS AND METHODS: A total of 12 patients with soft tissue defect of ankle and foot were included in the series; reversed superficial peroneal neurocutaneous island flap was performed on each case if relevant indications permitted. Preoperative and postoperative data of each patient, including etiology, size of defect, dimension of flap, complications, and functional and aesthetic results were noted. RESULTS: Among the 12 patients, there were 8 men and 4 women with an average age of 40.7 years (22-65 years) and with a mean follow-up time of 17.3 months (10-23 months). Most patients (11 patients) were posttraumatic. The size of the flap ranged from 48 to 108 cm2. Postoperatively, 11 flaps survived uneventfully, whereas marginal venous congestion was seen in the remaining patient, and secondary healing was achieved by conservative treatment. CONCLUSIONS: The reversed superficial peroneal neurocutaneous island flap could be an excellent alternative to other neurocutaneous perforator flap in the soft tissue reconstruction of foot and ankle.

One-stage reconstruction of complex lower extremity deformity combining Ilizarov external fixation and sural neurocutaneous flap.

BACKGROUND: Complex lower extremity deformities include multidirectional foot and ankle deformities, which are complicated therapeutic and surgical challenges. Correction often requires several stages, which is time consuming and costly. The need to restore the physical, mechanical, and cosmetic aspects of the lower extremity results in a difficult balancing act between these concerns and the deformity correction and soft tissue reconstruction. METHODS: Between January 2009 and September 2011, we treated 5 patients with multidirectional foot and ankle deformities. Significant mobility limitation was caused by abnormal scarring, which led to abnormal gait and weight-bearing regions. We used a sural neurocutaneous flap to repair the soft tissue defects after scar-tissue removal in all patients and placed a circular hinged Ilizarov external fixator for gradual correction. RESULTS: All the flaps survived and resulted in good texture match and contour. The follow-up period was 19 to 26 months. The correction lasted 3 to 5 months, and all of the patients were able to walk with satisfactory gaits and without assistance. We encountered no complications, such as pin-track infection or drop foot in our series. CONCLUSION: Our approach, combining a sural neurocutaneous flap and Ilizarov external fixation, was a reliable and effective tool for one-stage reconstruction of complex lower extremity deformities.

The effect of autologous endothelial progenitor cell transplantation combined with extracorporeal shock-wave therapy on ischemic skin flaps in rats.

BACKGROUND: Endothelial progenitor cells (EPCs) have been used to revascularize ischemic tissues, but only limited effect can be achieved. Extracorporeal shock-wave therapy (ESWT) is a promising angiogenic strategy. We hypothesized that EPC transplantation combined with ESWT would greatly benefit the survival of ischemic skin flaps. METHODS: Sixty-four male Sprague-Dawley rats were divided into 4 groups (n = 16 in each group): group 1 (serving as sham control), group 2 (treated with subcutaneous EPC implantation, 1.0 × 10(6) cells), group 3 (treated with ESWT, 300 impulses at 0.10 mJ/mm(2)) and group 4 (treated with EPCs implantation combined with ESWT). Ischemic skin flaps were made on the backs of rats and treated accordingly. Blood flow of skin flaps was measured periodically after operation, and flap survival rates were compared. Tissue samples were harvested at 2 weeks postoperatively from each group. RESULTS: The survival rate of skin flaps in group 4 was 87.5 ± 10.23%, which was statistically significantly higher than other groups. Histologic examination showed that the capillary density was higher in the dual-treatment group than in the two single-treatment groups. Compared with groups 2 and 3, blood perfusion increased significantly in group 4. A drastic increase of vWF+ cells was observed in the ischemic skin flaps on immunofluorescence staining in group 4. The expressions of chemotactic factors and angiogenic factors were higher in group 4. CONCLUSIONS: Combined treatment with EPCs and ESWT is superior to either EPCs or ESWT alone in improving the survival of ischemic skin flaps in rats.

Complex heel reconstruction with a sural fasciomyocutaneous perforator flap.

Reconstruction of weight-bearing surfaces at the foot and ankle is controversial. Free tissue transfer and local fasciocutaneous perforator flaps are preferred for plantar reconstruction, but high rates of flap breakdown and ulceration have caused unsatisfactory functional outcomes. We present a modified "sural fasciomyocutaneous perforator flap" and its functional outcome. Between January 2007 and September 2010, 19 patients were treated for soft-tissue defects in the weight-bearing area with sural fasciomyocutaneous perforator flaps. The gastrocnemius, preserved in the base of the flap, was applied as padding under the calcaneus. In follow-up from 9 to 25 months (mean 13.8 months), each patient's pain score, defect size, ulcer formation, protective sensation recovery, and normal footwear were analyzed. The majority of the flaps survived with satisfactory aesthetic and functional results. One case of partial flap loss and one case of delayed ulceration were noted. With partial weight bearing at 4 weeks, satisfactory gait recovery was obtained at 5 to 8 months (in conjunction with protective sensation recovery). Sural fasciomyocutaneous perforator flap is a reliable modality in heel construction, showing advantages of low ulceration rate, durability, and good protective sensation recovery compared with conventional free tissue transfer and local fasciocutaneous perforator flap.

Versatility of the greater saphenous fasciocutaneous perforator flap in coverage of the lower leg.

Paucity of soft tissue locally available for reconstruction of defects in the leg and foot remains a challenge. Greater saphenous fasciocutaneous perforator flap in reconstruction of the lower leg has been used effectively to cover these defects. In many situations, it is a viable alternative to free flaps and cross-leg flap reconstruction. The objective of this retrospective study was to evaluate the efficacy of the greater saphenous fasciocutaneous perforator flap for reconstruction of the medial and anterior lower leg, medial malleolus, and hind foot. A total of 26 patients with soft tissue defects of the medial and anterior lower leg, medial malleolus, and hind foot were evaluated. Preoperative data, age, sex, defect etiology, defect size, flap dimension, postoperative results, and complications were recorded. All patients were followed up postoperatively. The procedure was uneventful in 25 of 26 patients. The one unsuccessful flap developed partial necrosis of the distal edge due to venous congestion, and secondary healing was achieved by conservative treatment. No patient showed signs of infection. The defect etiology in all patients was trauma of the lower extremity or its complications, most frequently open fracture (19 patients), followed by osteomyelitis of the tibia (2 patients). The greater saphenous fasciocutaneous perforator flap is versatile, reliable, and useful in coverage of medial and anterior lower leg, malleolus, and hind foot defects. This surgical technique is a safe, short-duration alternative to microsurgical reconstruction.

Bacterial Contamination of Open Fractures: Pathogens and Antibiotic Resistance Patterns in East China.

Bacterial contamination of soft tissue in open fractures leads to high infection rates. Pathogens and their resistance against therapeutic agents change with time and vary in different regions. The purpose of this study was to characterize the bacterial spectrum present in open fractures and analyze the bacterial resistance to antibiotic agents based on five trauma centers in East China. A retrospective multicenter cohort study was conducted in six major trauma centers in East China from January 2015 to December 2017. Patients who sustained open fractures of the lower extremities were included. The data collected included the mechanism of injury, the Gustilo-Anderson classification, the isolated pathogens and their resistance against therapeutic agents, as well as the prophylactic antibiotics administered. In total, 1348 patients were included in our study, all of whom received antibiotic prophylaxis (cefotiam or cefuroxime) during the first debridement at the emergency room. Wound cultures were taken in 1187 patients (85.8%); the results showed that the positive rate of open fracture was 54.8% (651/1187), and 59% of the bacterial detections occurred in grade III fractures. Most pathogens (72.7%) were sensitive to prophylactic antibiotics, according to the EAST guideline. Quinolones and cotrimoxazole showed the lowest rates of resistance. The updated EAST guidelines for antibiotic prophylaxis in open fracture (2011) have been proven to be adequate for a large portion of patients, and we would like to suggest additional Gram-negative coverage for patients with grade II open fractures based on the results obtained in this setting in East China.

Effectiveness of blood flow restriction versus traditional weight-bearing training in rehabilitation of knee osteoarthritis patients with MASLD: a multicenter randomized controlled trial.

To compare the reliability and effectiveness of blood blow restriction resistance training (BFR) versus traditional weight-bearing training (WB) in knee osteoarthritis (KOA) patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Methods: This multicenter randomized controlled trial was conducted from January 2021 to June 2022 at Shanghai Jiao Tong University affiliated Sixth People's Hospital and The People's Hospital of Mengla County. A total of 120 outpatients were recruited and randomized to perform WB (n=60) or BFR (n=60) resistance training protocols in accordance with standard recommended protocols for 12 weeks. Demographic data and Kellgren and Lawrence grading system scores were collected. Pain, range of motion (ROM), scaled maximal isotonic strength (10RM), self-reported function (KOOS), and 30-s chair sit-to-stand test results were assessed at weeks 1, 4, and 12. Results: 112 patients (57 in the WB group, 55 in the BFR group) completed the training programs and assessments. No significant intergroup demographic differences were noted. ROM and scaled 10RM significantly increased at the 4- and 12-week assessments and differed significantly between groups. The pain, ability of daily living and quality of life subscale in KOOS increased significantly at the 12-week assessment and differed significantly between groups, adjusted for baseline value. Significant and comparable increases in 30-s chair sit-to-stand test results were observed within and between study groups. Conclusion: BFR training enhanced muscle strength, reduced pain, and improved daily living and sports activities in patients with KOA, compared to WB training alone. BFR should be recommended for rehabilitation in KOA individuals with MASLD. Clinical trial registration number: ChiCTR2100042872.

Elbow Kinematics and Function Following Treatment with Open Arthrolysis and Hinged External Fixator.

OBJECTIVE: Open arthrolysis (OA) combined with hinged external fixator (HEF) is a promising surgical option for patients with elbow stiffness. This study aimed to investigate elbow kinematics and function following a combined treatment with OA and HEF in elbow stiffness cases. METHODS: Patients treated with OA with or without HEF due to elbow stiffness were recruited between August 2017 and July 2019. Elbow flexion-extension motion and function (Mayo elbow performance scores, MEPS) were recorded and compared between patients with and without HEF during a 1-year follow-up period. Additionally, those with HEF were assessed by dual fluoroscopy at week 6 postoperatively. Flexion-extension and varus-valgus motions, as well as ligament insertion distances of the anterior medial collateral ligament (AMCL) and lateral ulnar collateral ligament (LUCL), were compared between the surgical and intact sides. RESULTS: This study included 42 patients, of which 12 with HEF demonstrated a similar flexion-extension angle and range of motion (ROM) and MEPS as the other patients. In patients with HEF, the surgical elbows showed limitations in flexion-extension (maximal flexion, 120.5° ± 5.3° vs 140.4° ± 6.8°; maximal extension, 13.1° ± 6.0° vs 6.4° ± 3.0°; ROM, 107.4° ± 9.9° vs 134.0° ± 6.8°; all Ps < 0.01) compared with the contralateral sides. During elbow flexion, a gradual valgus-to-varus transition of the ulna, increase in the AMCL insertion distance, and steady change in the LUCL insertion distance were observed, with no significant differences between the bilateral sides. CONCLUSIONS: Patients treated with OA and HEF demonstrated similar elbow flexion-extension motion and function to those treated with OA alone. Although the use of HEF could not restore an intact flexion-extension ROM and might result in some minor but not significant changes in kinematics, it contributed to clinical outcomes comparable to that of the treatment with OA alone.

Simultaneous reconstruction of septic composite defects in lower extremities: Combination of fasciocutaneous perforator flap and Masquelet technique.

Background: Management of composite defects with deep infection is a challenge to reconstructive surgeons. This study aimed to demonstrate the versatility, safety, and complications of simultaneous reconstruction of infectious composite defects with fasciocutaneous perforator flap combined with the Masquelet technique. Methods: This study presents 10 patients in whom a fasciocutaneous perforator flap combined with the Masquelet technique was used to restore soft tissue and bone defects of the lower extremity, and were admitted in two level 1 trauma centers in Shanghai. The first stage included debridement of necrotic bone and infected tissues, implantation of a polymethylmethacrylate cement spacer to cover the void; bridging fixation of the osseous defect using external or internal fixators, and soft-tissue reconstruction with a fasciocutaneous perforator flap. The second stage included cement spacer removal with membrane preservation, refreshing bone edges, and grafting the cavity with bone morphogenetic proteins and autologous iliac bone graft. Results: The mean follow-up duration after autologous bone graft was 17.5 months. The average bony defects and average flap dimensions were 7.1 cm and 44.9 cm2, respectively. All flaps survived uneventfully. No recurrence of infection was detected in either the second stage of surgery or follow-up period. The mean duration of bone consolidation was 31.9 weeks. One patient had a 2 cm leg length discrepancy, and one patient had mild foot drop. No residual deformity requiring a secondary procedure occurred. Conclusion: Fasciocutaneous perforator flap combined with Masquelet technique provides a reliable and versatile alternative for patients with composite defects resulting from lower extremity infection.

miR-199a-5p Plays a Pivotal Role on Wound Healing via Suppressing VEGFA and ROCK1 in Diabetic Ulcer Foot.

Diabetes mellitus (DM) is a growing health problem. As a common complication of DM, diabetic foot ulcer (DFU) results in delayed wound healing and is a leading cause of nontraumatic amputation. miR-199a-5p, a short noncoding RNA, had abnormal expression in DFU wound tissues. The expression of miR-199a-5p was significantly increased in DFU wound tissues, skin tissues of diabetic rats, and high glucose-induced cells. Vascular endothelial growth factor A (VEGFA) and Rho-associated kinase 1 (ROCK1) are directly targets of miR-199a-5p. Inhibiting the expression of miR-199a-5p alleviated the inhibition of VEGFA and ROCK1, thereby rescued impaired proliferation and migration of HG-induced cells, and restored the normal function of the cells to some extent. In diabetic rats, inhibition of miR-199a-5p significantly increased the expression of VEGFA and ROCK1, significantly promoted wound healing, and rescued impaired wound healing. miR-199a-5p and its targets showed therapeutic effect on diabetic wounds.