The impact of varus angulation on proximal fractures of the ulna.

BACKGROUND: We studied anteromedial varus angulation (VA) in the proximal third of the ulna. The importance of restoration of the anatomical orientation of the ulnar after a proximal fracture is unclear. The purpose of this study was to evaluate the impact of minimal proximal ulna malunion on elbow function after a proximal ulna fracture. METHODS: We reviewed the follow-up of 60 patients who had undergone open reduction with internal fixation (ORIF) of a proximal fracture of the ulna. Patients were divided into two groups, defined as either more or less than 5° of the difference between the VA of the fractured and contralateral ulna. The range of motion(ROM)of elbow flexion, extension and forearm rotation on both sides, Mayo Elbow Performance Score (MEPS) and Visual Analogue Scale (VAS) were measured. RESULTS: The average postoperative time was 3.1 years (1-5 years). Mean VA of the fractured arm was different from the normal side (7.8 ± 3.0 vs 12.7 ± 3.0). Compared to the unfractured arm there was a loss in mean elbow flexion (14.2 ± 4.9 vs 18.0 ± 5.9), extension ROM (7.1 ± 2.5 vs 9.3 ± 1.9, p < 0.05) and forearm rotation ROM (15.6 ± 8.6 vs 21.8 ± 9.5) that were statistically significant (p < 0.05). There were no statistically significant differences in the MEPS and VAS score results between the two groups (p > 0.05). CONCLUSIONS: The function of the elbow and forearm was restricted after VA malunion in the proximal ulna, but the quality of life of these patients had not been significantly affected. We suggest that orthopedic surgeons should assess whether the specialized structures of the proximal ulna are damaged or not before surgery. If the anatomy of the fractured bone cannot be restored through manipulation of the connected end directly, it is better to image the anatomical structure of the healthy side from using an elbow X-ray before surgery, and then reset using a pre-shaped plate to prevent malunion.

Comparison of traditional surgery and surgery assisted by three dimensional printing technology in the treatment of tibial plateau fractures.

PURPOSE: This study was conducted to compare traditional surgery and surgery assisted by 3D printing technology in the treatment of tibial plateau fractures. In addition, we also investigated the effect of 3D printing technology on the communication between doctors and patients. METHODS: Seventy two patients with tibial plateau fractures were enrolled in the study from April 2014 to October 2015. They were divided into two groups: 34 cases of 3D model group, 38 cases of traditional surgery group. The individual models were used to simulate the surgical procedures and carry out the surgery according to plan. Operation time, blood loss, and number of intra-operative fluoroscopy were recorded. Through the follow-up, the recovery of patients were observed. Besides, we designed questionnaires to verify the satisfaction for both surgeons and patients. RESULTS: The average operation time, average amount of blood loss, and number of intra-operative fluoroscopy for 3D model group was 85.2±0.9 minutes, 186.3± 5.5ml, 5.3± 0.2 times, and for traditional surgery group was 99.2±1.0 minutes, 216.2 ±6.9 ml,7.1 ± 0.2 times respectively. There was statistically significant difference between the traditional surgery group and 3D model group (P < 0.05). Via follow-up, we can see that the 3D printing group has a better clinical efficacy. The average score of the questionnaires to Patient and doctors were 7.3 ± 0.1 points and 8.5± 0.1 points respectively. CONCLUSION: This study suggested the clinical feasibility of 3D printing technology in treatment of tibial plateau fractures.

Intra-operative application of ultrasonography combined with limited radiography for the treatment of supracondylar humerus fractures in children: a randomized controlled trial.

AIMS: To introduce a new method of intra-operative application of ultrasonography (US) combined with limited radiography to treat supracondylar humerus fractures in children and evaluate its effect on radiation protection. MATERIAL AND METHODS:  Fifty patients were randomly divided into the radiography-only group (RO group, n = 22) and the US combined with the limited radiography group (UR group, n = 28). US was performed to evaluate fracture displacement and to guide reduction in the UR group. The primary outcome measures were the average number of radiography instances and the quantitative value of radiation emission. Secondary outcome measures were length of hospital stays, loss of range of motion, loss of carrying angle, loss of Baumann angle, fracture healing time, pin site infection, compartment syndrome, cubitus varus, cubitus valgus, and iatrogenic ulnar nerve injury. RESULTS: Average number of radiography instances and quantitative value of radiation emission in the UR group decreased compared with the RO group (p<0.05). There were no significant differences between the groups regarding mean time to surgery, the average length of hospital stays, average surgery time, radiological union time, Flynn grade, or loss of Baumann angle. Pin site infection was seen in one patient in the RO group and two patients in the UR group. No other complications occurred. CONCLUSION: Intra-operative application of US combined with limited radiography decreases radiation exposure during treatment of supracondylar humerus fractures in children without compromising the therapeutic effect.

The efficacy of Schroth exercises combined with the Chêneau brace for the treatment of adolescent idiopathic scoliosis: a retrospective controlled study.

PURPOSE: We aimed to determine the global effects of the Chêneau brace combined with Schroth exercises on adolescent idiopathic scoliosis (AIS). METHODS: We analyzed 192 patients with AIS who underwent the Chêneau brace treatment alone or combined with Schroth best practice (SBP) from June 2013 to October 2019. There were 138 patients in the Brace group and 54 patients in the Brace + SBP group. Radiographs were obtained at various treatment durations. Answers to the health-related quality of life (HRQoL) questionnaire were recorded before the intervention and at the time of treatment wean. RESULTS: The Cobb angle (-3.55°; p < 0.001) and C7-CSVL (-3.03 mm; p < 0.001) significantly decreased in the Brace + SBP group. Thoracic kyphosis (TK) decreased in both the Brace + SBP group (-1.85°; p = 0.0152) and the Brace group (-5.06; p < 0.001). Changes before and after treatment of TK were significantly different between groups (p < 0.001). The 22-item Scoliosis Research Society function score, self-image, mental health, and EuroQol 5-Dimension scores were significantly higher in the Brace + SBP group. The satisfaction score was higher in the Brace + SBP group (3.77 ± 0.63 vs. 3.13 ± 0.79; p < 0.001). CONCLUSIONS: Compared to bracing alone, the Schroth exercises plus bracing had a better effect on coronal balance. Schroth exercises improve flatback deformity caused by bracing and positively influence the HRQoL in AIS patients who received the Chêneau brace treatment.Implications for RehabilitationBracing and physiotherapy are common treatments for adolescent idiopathic scoliosis (AIS).The Chêneau brace treatment causes flatback deformity and muscle stiffness in AIS patients.The Schroth method helps patients increase muscle strength, halt curve progression, increase vital capacity, and maintain improved posture.The Schroth exercises could improve flatback deformity caused by bracing and positively influence the health-related quality of life in AIS patients who received the Chêneau brace treatment.

Decreased Radiation Exposure Using Ultrasound-Assisted Reduction and Fixation of Femoral Shaft Fractures in Children: A Pilot Study.

Elastic stable intra-medullary nail procedures have been used to treat femoral fractures in children for some time. Radiation exposure generated by intra-operative radioscopy may induce side effects in children and staff. This study introduces a method of ultrasound-assisted reduction and fixation of femoral fractures in children to decrease radiation exposure. We included 21 children and evaluated displacement of fractures using multi-section scanning. All fracture reductions were performed with ultrasonography. A hyperechoic point with a posterior acoustic shadow can be seen under the proximal and distal segments after the nail passes through the fracture site. Comparison with radioscopy suggests that this is a viable method of reduction and fixation of femoral shaft fractures in children, and can effectively decrease radiation exposure.

Nobiletin Inhibits IL-1ß-Induced Inflammation in Chondrocytes via Suppression of NF-κB Signaling and Attenuates Osteoarthritis in Mice.

Osteoarthritis (OA), a common degenerative joint disease, is principally characterized by inflammation and destruction of cartilage. Nobiletin, an extract of the peel of citrus fruits, is known to have anti-inflammatory properties. However, the mechanisms by which nobiletin plays a protective role in osteoarthritis (OA) are not completely understood. In the present study, we investigated the anti-inflammatory effects of nobiletin in the progression of OA in both in vitro and in vivo experiments. Mouse chondrocytes were pretreated with nobiletin (0, 10, 20, 40 µM) for 24 h and then incubated with IL-1ß (10 ng/ml, 24 h) in vitro. The generation of PGE2 and NO was evaluated by the Griess reaction and ELISAs. The protein expression of inducible nitric oxide synthase, matrix metalloproteinase-3, matrix metalloproteinase-13, A disintegrin and metalloproteinase with thrombospondin motifs-5 (ADAMTS5), cyclooxygenase-2, collagen II, and aggrecan was analyzed by Western blotting. Immunofluorescence and Western blot analysis were used to detect nuclear factor-κB (NF-κB) signaling molecules. Induction of proinflammatory and catabolic mediators by IL-1ß stimulation of mouse chondrocytes could be partially blocked by treatment with nobiletin or ammonium pyrrolidine dithiocarbamate (an NF-κB inhibitor). Furthermore, our results indicated that nobiletin exhibited a therapeutic effect through active inhibition of the NF-κB signaling pathway. In a mouse model of OA, injection of nobiletin (20 mg/kg) every 2 days for 8 weeks after surgery inhibited cartilage destruction and synovitis. Taken together, our findings suggest that nobiletin may be a potential therapeutic agent for the treatment of OA.

Correction to: Geniposide Suppresses Interleukin-1ß-Induced Inflammation and Apoptosis in Rat Chondrocytes via the PI3K/Akt/NF-κB Signaling Pathway.

The original version of this article contained mistakes, and the authors would like to correct them. The correct details are given below: • Fig.4 A. In the GPO group, the S-O and H-E staining pictures were used incorrectly. This is our mistake. Now correct the correct pictures.

Sauchinone inhibits IL-1ß induced catabolism and hypertrophy in mouse chondrocytes to attenuate osteoarthritis via Nrf2/HO-1 and NF-κB pathways.

BACKGROUND: Osteoarthritis (OA) is a common degenerative joint disease for which currently no anti-inflammatory therapy is available. Sauchinone (SAU), a key bioactive compound derived from Saururus chinensis, which has shown remarkable anti-inflammatory effects. METHODS: To evaluate the effect of SAU on OA progression, mouse chondrocytes were pretreated with SAU and subsequently stimulated with interleukin (IL)-1ß. We found that SAU reduced the production of pro-inflammatory cytokines, such as nitric oxide (NO), prostaglandin E2 (PGE2), tumor necrosis factor alpha (TNF-α), and IL-6. SAU also inhibited the expression of cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS) at both the gene and protein level. Moreover, SAU promoted the expression of aggrecan, while inhibiting the expression of catabolic factors, such as matrix metalloproteinases (MMPs) and thrombospondin motifs 5 (ADAMTS-5) in mouse chondrocytes. Col X, vascular endothelial growth factor-A (VEGF)-A, and Runx2, major markers of hypertrophic chondrocytes, were markedly elevated following IL-1ß stimulation, and were reduced by SAU treatment while having the opposite effect on Col II. Mechanistically, we found that SAU inhibited nuclear factor kappa B (NF-κB) and activated the Nrf2/HO-1 pathway. The beneficial effects of SAU were also observed in vivo using a mouse OA model. CONCLUSIONS: Our findings indicate that SAU may be a potential novel therapeutic for the treatment of OA.

Geniposide Suppresses Interleukin-1ß-Induced Inflammation and Apoptosis in Rat Chondrocytes via the PI3K/Akt/NF-κB Signaling Pathway.

Osteoarthritis (OA) is a chronic degenerative joint disease that is principally characterized by progressive joint dysfunction and cartilage degradation. Inflammation and apoptosis play critical roles in the progression of OA. Geniposide (GPO), one of the principal components of the fruit of Gardenia jasminoides Ellis, has been reported to have anti-inflammatory and other pharmacological effects. In this study, we performed in vitro experiments on rat chondrocytes to examine the therapeutic effects of GPO on OA and investigated its effects in vivo in a rat model of OA induced by medial meniscal tear (MMT). The results suggest that GPO can inhibit the expression of INOS, COX-2, and MMP-13 in vitro, and promote the expression of collagen II in rat chondrocytes stimulated with interleukin-1ß (IL-1ß). In addition, we also found that GPO can inhibit the expression of pro-apoptotic proteins such as Bax, Cyto-c, and C-caspase3 and increase the expression of the anti-apoptotic protein Bcl-2. These changes may be related to GPO-induced inhibition of the IL-1ß-induced activation of the PI3K/Akt/NF-κB signaling pathway. In vivo, we also found that GPO can limit the development of OA in a rat model. Taken together, the above results indicate that GPO has potential therapeutic value for treating OA.

Comparison of three different fixation constructs for radial neck fractures: a biomechanical study.

BACKGROUND: Fixation of radial neck fractures can be achieved with a plate and screw construct or with two screws. This study evaluated the biomechanical properties of three different fixation methods following radial neck fractures. METHODS: Twenty-four fourth-generation composite radii were sawed to simulate an unstable radial neck fracture. They were then instrumented with a plate and screw construct or two different orientations (crossed and parallel) of screw fixation. Implants were tested under bending and torsional loads via a tension torsion composite test system. Bending and torsional failure loads were added to the remaining implant-radius constructs if they did not fail during the previous tests. RESULTS: During the bending loading test, the crossed-screw group showed the greatest stiffness, followed by the parallel-screw group, the plate group demonstrating the weakest stiffness. There was no significant difference between the crossed- and the parallel-screw groups. However, there was a significant difference between the two screw groups and the plate group. During the bending failure test, the largest stiffness was found for the crossed-screw group, while the plate group exhibited the smallest stiffness. There was a significant difference between the three groups. During the torsion loading test, the highest stiffness was observed for the crossed-screw group, while the plate group showed the lowest stiffness. In the torsion failure test, the failure torques were 11.97 ± 2.659, 8.531 ± 1.768, and 7.079 ± 1.666 N m respectively for the crossed-screw, parallel-screw, and plate groups. There was a significant difference between the crossed-screw group and the two other groups. CONCLUSIONS: Crossed screws and plate fixation are commonly used in clinical practice to treat simple radial neck fractures. While the present study shows that the parallel-screw method results in similar biomechanical strength as the two other techniques, it has the advantages of reaching limited wound exposure and having the implant buried. Therefore, it may be widely used in clinical practice.

Alpha-Mangostin protects rat articular chondrocytes against IL-1ß-induced inflammation and slows the progression of osteoarthritis in a rat model.

Osteoarthritis (OA) is a joint disease characterized by inflammation and cartilage degradation. α-Mangostin (α-MG), which can be isolated from the fruit of the tropical evergreen tree Garcinia mangostana-L, is known to have anti-inflammatory properties. The aim of the study was to investigate the use of α-MG in the treatment of OA, using both rat chondrocytes and an OA rat model induced by destabilization of the medial meniscus (DMM). Rat chondrocytes were pretreated with α-MG (0, 1.25, 2.5, and 5.0µg/ml for 24h) prior to stimulation with interleukin-1ß (IL-1ß) (10ng/ml for 24h). Nitric oxide (NO) production was determined using the Griess method and prostaglandin E2 (PGE2) was assessed using an enzyme-linked immunosorbent assay (ELISA). The expression of inducible nitric oxide synthase (INOS), cyclooxygenase-2 (COX-2), matrix metalloproteinase-3, -9, and -13 (MMP-3, MMP-9, and MMP-13), Collagen II, and Aggrecan were detected by both quantitative real-time PCR (qRT-PCR) and a western blot analysis. Nuclear factor-κB (NF-κB) signaling molecules were detected by western blot analysis. Detection of p65 nuclear translocation of NF-κB was examined using immunofluorescence staining. The OA rats received intraperitoneal injections of α-MG (10mg/kg) or saline every other day. Hematoxylin and eosin and Safranin-O-Fast green staining were used to evaluate the severity of cartilage lesions up to 8weeks following surgery. α-MG inhibited the production of NO and PGE2. The elevated expression of INOS, COX-2, MMP-3, MMP-9, and MMP-13, and the degradation of Collagen II and Aggrecan, were reversed by α-MG in IL-1ß-stimulated chondrocytes. In addition, IL-1ß induced considerable phosphorylation of the NF-kB signaling pathway, which was inhibited by α-MG. Furthermore, the immunofluorescence staining demonstrated that α-MG could suppress IL-1ß-induced p65 nuclear translocation. In vivo, cartilage treated with α-MG showed attenuated degeneration and had low Osteoarthritis Research Society International (OARSI) scores compared with the control group. Taken together, these results show that α-MG has potential therapeutic value in the treatment of OA.

Effect of different orientations of screw fixation for radial head fractures: a biomechanical comparison.

BACKGROUND: Screw fixation is a common method used for the treatment of Mason type II radial head fractures. The purpose of our study was to evaluate the mechanical properties of three different screw orientations used for fixation of Mason type II radial head fractures. METHODS: We sawed 24 medium-frequency fourth-generation Synbone radial bones to simulate unstable radial head fractures, which we then fixed with three different screw orientations. Implants were tested under axial load by the tension-torsion composite test system. If the implant-radial constructs did not fail after the axial load test, an axial failure load was added to the remaining constructs. RESULTS: The stiffness of the divergent group was the highest of the three orientations, and this group had statistically significant difference from the other two groups (p < 0.05). However, there was no statistically significant difference between the convergence group and the parallel group (p > 0.05). When the displacement reached 2 mm, the load of the divergent screw was still larger than the other two groups (p < 0.05). CONCLUSIONS: The divergent screw orientation was the most stable and had the greatest control of Mason type II fractures of these three groups. Therefore, it can be better applied in clinical settings.

Alpha-Mangostin suppresses interleukin-1ß-induced apoptosis in rat chondrocytes by inhibiting the NF-κB signaling pathway and delays the progression of osteoarthritis in a rat model.

Osteoarthritis (OA) is a chronic degenerative joint disease that is characterized by progressive joint dysfunction and pain. Apoptosis and catabolism in chondrocytes play critical roles in the development of OA. Alpha-Mangostin (α-MG), one of the main components of the mangosteen, has been reported to have anti-apoptotic, anti-inflammatory and antioxidant effects. We investigated the therapeutic effects of α-MG on OA through experiments on rat chondrocytes in vitro and in a rat model of OA induced by destabilization of the medial meniscus (DMM). In vitro, we provided experimental evidence that α-MG inhibits the expression of MMP-13 and ADAMTs-5, and promotes the expression of SOX-9 in rat chondrocytes stimulated with interleukin-1ß (IL-1ß). In addition, we also found that α-MG can inhibit the expression of pro-apoptotic proteins such as Bax, Cyto-c, and C-caspase3, and increase the expression of the anti-apoptotic protein Bcl-2. These changes may be related to an α-MG induced inhibition of the IL-1ß-induced activation of the NF-kB signaling pathway. In vivo, we also found that α-MG can limit the development of OA in rat models. The above results show that α-MG has a potential therapeutic effect on OA, and that this effect may be achieved by inhibiting the mitochondrial apoptosis of chondrocytes induced by an activation of the NF-kB pathway.