Journal of Orthopaedic Surgery and Research

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ISSN / EISSN : 1749-799X / 1749-799X
Current Publisher: Springer Science and Business Media LLC (10.1186)
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, Arkaphat Kosiyatrakul
Journal of Orthopaedic Surgery and Research, Volume 16, pp 1-9; doi:10.1186/s13018-021-02494-3

Abstract:
Background Modified tension band fixation has become commonly used for transverse patella fractures. The conventional stainless steel wire provides sufficient stability but may be associated with complications. Objective The study aimed to evaluate the effectiveness of a new modified tension band fixation technique for transverse patella fractures using a nonabsorbable suture. Material and methods We present the result of a prospective series using a nonabsorbable suture (FiberWire) for transverse patella fractures. The mean follow-up period totaled 12 months. A total of 16 patients were evaluated by radiographic and clinical review. The postoperative clinical evaluation employed Lysholm and Böstman scores. Result All clinical results on follow-up were good to excellent. Minimal intra-articular joint stepping and further fracture displacement were recorded. No patient needed re-operation, and functional outcomes of the knee were satisfactory. No significant differences were found between the injured and contralateral knee range of motion. No symptomatic implants and skin complications were noted, and all fractures were completed heal within 15 weeks. Conclusion FiberWire provided sufficient stability and reduced postoperative complications. The results proved appropriate, and the technique has merit, as it obviates the need for re-operation.
Huaguo Zhao, Song Xu, Guanyi Liu, Jingyu Zhao, Shandong Wu,
Journal of Orthopaedic Surgery and Research, Volume 16, pp 1-15; doi:10.1186/s13018-021-02505-3

Abstract:
Background Closed reduction and pinning entry fixation have been proposed as treatment strategies for displaced supracondylar humeral fractures (SCHFs) in children. However, controversy exists regarding the selection of the appropriate procedure. Hence, this meta-analysis was conducted to compare the effect of lateral and crossed pin fixation for pediatric SCHFs, providing a reference for clinical treatment. Methods Online databases were systematically searched for randomized controlled trials (RCTs) comparing lateral pinning entry and crossed pinning entry for children with SCHFs. The primary endpoints were iatrogenic ulnar nerve injuries, complications, and radiographic and functional outcomes. Results Our results showed that iatrogenic ulnar nerve injuries occurred more commonly in the crossed pinning entry group than in the lateral pinning entry group (RR = 4.41, 95% CI 1.97–9.86, P < 0.05). However, its risk between the crossed pinning with mini-open incisions group and the lateral pinning entry group was not significantly different (RR = 1.58, 95% CI 0.008–29.57, P = 0.76). The loss of reduction risk was higher in the lateral pinning entry group than in the crossed pinning entry group (RR = 0.66; 95% CI 0.49–0.89, P < 0.05). There were no significant differences in the carry angle, Baumann angle, Flynn scores, infections, and other complications between these two groups. Conclusions The crossed pinning entry with mini-open incision technique reduced the loss of reduction risk, and the risk of iatrogenic ulnar nerve injury was lower than in the lateral pinning entry group. The crossed pinning entry with mini-open incision technique is an effective therapeutic strategy for managing displaced supracondylar humeral fractures in children.
Jonathan Häußer, , Philip Catalá-Lehnen
Journal of Orthopaedic Surgery and Research, Volume 16, pp 1-9; doi:10.1186/s13018-021-02484-5

Abstract:
Background Extracorporeal shock wave therapy (ESWT) has been used for various pathologies associated with bone marrow oedema (BME). However, it is still not clear whether ESWT may be favourable in the treatment of BME. Therefore, the aim of this systematic review was to assess the efficacy of ESWT for the treatment of BME. Methods MEDLINE was searched for relevant literature with no time constraints. Both randomized and non-randomized trials were included. Case reports and conference abstracts were excluded. Titles and abstracts were screened and full-text articles of included studies were retrieved. Data on the effect of ESWT on pain, function, and the BME area on magnet resonance imaging were extracted. Results Pain, function, and magnet resonance imaging results all improved across the studies — regardless of whether it was a randomized or non-randomized study. This effect was consistent across multiple pathologies such as osteonecrosis of the femoral head, BME associated with knee osteoarthritis, Kienböck’s disease, and osteitis pubis. The meta-analysis showed that pain (after 1 month: weighted mean difference (WMD) = − 2.23, 95% CI − 2.58 to − 1.88, P < 0.0001; after 3–6 month: WMD = − 1.72, 95% CI − 2.52 to − 0.92, P < 0.00001) and function (after 1 month: WMD = − 1.59, 95% CI − 2.04 to − 1.14, P < 0.0001; after 3–6 month: WMD = − 2.06, 95% CI − 3.16 to − 0.96, P = 0.0002; after ≥ 12 month: WMD = − 1.20, 95% CI − 1.83 to − 0.56, P = 0.0002) was reduced in terms of ESWT treatment compared to a control group. Conclusions Based on the available evidence, ESWT may be an adequate option for conservative therapy in pathologies involving BME. Trial registration PROSPERO, CRD42021201719. Registered 23 December 2020
Huaijian Hu, , Mingli Feng, Zhihua Gao, Jingwei Wu, Shibao Lu
Journal of Orthopaedic Surgery and Research, Volume 16, pp 1-8; doi:10.1186/s13018-021-02517-z

Abstract:
Background The clinical outcome of a new fixation device (femoral neck system, FNS) for femoral neck fractures remains unclear. The main purpose of this study was to evaluate two different internal fixation methods for the treatment of femoral neck fractures in patients aged under 60 years. Methods We retrospectively studied patients who underwent internal fixation surgery in our hospital for femoral neck fractures between January 2017 and January 2020. Cannulated compression screws (CCS) and FNS groups were divided according to different internal fixation methods. General data (such as sex, age, body mass index, type of fracture) of all patienFemoral neck shorteningts were collected, and joint function was evaluated using the Harris Hip Score (HHS) before and 1 year after surgery. We recorded related surgical complications, including femoral head necrosis, nonunion, and femoral neck shortening. Results There were no significant differences in age, sex, or body mass index between the two groups. There was no statistical difference in HHSs between the two groups before surgery. Patients who underwent FNS treatment had longer surgery time (79.75 ± 26.35 min vs. 64.58 ± 18.56 min, p = 0.031) and more blood loss (69.45 ± 50.47 mL vs. 23.71 ± 28.13 mL, p < 0.001). The degree of femoral neck shortening in the FNS group was significantly lower than that in the CCS group (10.0% vs 37.5%, p = 0.036). Regarding postoperative complications, there was no statistical difference in the incidence of femoral head necrosis and fracture nonunion between the two groups. Conclusion Patients younger than 60 with femoral neck fractures can obtain satisfactory clinical results with CCS or FNS treatment. FNS has excellent biomechanical properties and shows significantly higher overall construct stability.
Qi Sun, Xin-Yu Nan, Fa-Ming Tian, Fang Liu, Shao-Hua Ping, Zhuang Zhou,
Journal of Orthopaedic Surgery and Research, Volume 16, pp 1-10; doi:10.1186/s13018-021-02504-4

Abstract:
Background Adjacent segmental intervertebral disk degeneration (ASDD) is a major complication secondary to lumbar fusion. Although ASSD pathogenesis remains unclear, the primary cause of intervertebral disk degeneration (IVDD) development is apoptosis of nucleus pulposus (NP). Raloxifene (RAL) could delay ASDD by inhibiting NP apoptosis. Methods An ASDD rat model was established by ovariectomy (OVX) and posterolateral spinal fusion (PLF) on levels 4–5 of the lumbar vertebrae. Rats in the treatment groups were administered 1 mg/kg/d RAL by gavage for 12 weeks, following which, all animals were euthanized. Lumbar fusion, apoptosis, ASDD, and vertebrae micro-architecture were evaluated. Results RAL maintained intervertebral disk height (DHI), delayed vertebral osteoporosis, reduced histological score, and inhibited apoptosis. The OVX+PLF+RAL group revealed upregulated expression of aggrecan and B-cell lymphoma-2 (bcl2), as well as significantly downregulated expression of a disintegrin and metalloproteinase with thrombospondin motifs 4 (ADAMTS-4), metalloproteinase-13 (MMP-13), caspase-3, BCL2-associated X (bax), and transferase dUTP nick end labeling (TUNEL) staining. Micro-computed tomography (Micro-CT) analysis revealed higher bone volume fraction (BV/TV), bone mineral density (BMD), and trabecular number (Tb.N), and lower trabecular separation (Tb.Sp) in OVX+PLF+RAL group than in the OVX+PLF group. Conclusions RAL can postpone ASDD development in OVX rats through inhibiting extracellular matrix metabolic imbalance, NP cell apoptosis, and vertebral osteoporosis. These findings showed RAL as a potential therapeutic target for ASDD.
Chih-Hsun Chang, Hao-Chun Chuang, Wei-Ren Su, Fa-Chuan Kuan, Chih-Kai Hong,
Journal of Orthopaedic Surgery and Research, Volume 16, pp 1-8; doi:10.1186/s13018-021-02519-x

Abstract:
Background The optimal surgical technique for the fixation of inferior pole patellar fracture remains controversial. The aims of this study were (1) to compare clinical and radiological outcomes following fixation of inferior pole patellar fracture by using tension band wire (TBW) and transosseous reattachment (TOR) without excision of the bony fragment and (2) to determine the risk factors for postoperative radiological loss of reduction. Methods For this retrospective cohort study, consecutive patients with inferior pole patellar fracture between January 2010 and December 2017 were recruited. The patients were grouped according to their fixation method (TBW or TOR), and demographic data, clinical outcomes, and postoperative Insall–Salvati (IS) ratio were analyzed. Then, the patients were grouped according to radiological loss of reduction, the possible risk factors for loss of reduction were identified, and odds ratios were calculated. Result This study included 55 patients with inferior pole patellar fracture; 30 patients were treated using TBW and 25 were treated using TOR. Clinical failure occurred in two patients in the TBW group (7%) and three in the TOR group (12%). The rate of radiological loss of reduction was significant higher in the TOR group, whereas removal of implants was significantly more common in the TBW group. Patella baja was noted immediately after surgery in the TOR group, but the IS ratios of the two groups were similar after 3 months. Fracture displacement of more than 30 mm was the only independent risk factor for postoperative radiological loss of reduction. Conclusion For treating inferior pole patellar fracture, both TWB and TOR were effective and had a low clinical failure rate. In 60% of patients undergoing TBW fixation, however, additional surgery was required to remove the implants. Patella baja occurred immediately following TOR, but the patellar height was similar to that in the TBW group after 3 months. Surgeons should be aware of the high risk of postoperative radiological loss of reduction, especially when the fracture displacement is more than 30 mm.
, , Ashraf El Naga, Anthony Ding, Saam Morshed
Journal of Orthopaedic Surgery and Research, Volume 16, pp 1-5; doi:10.1186/s13018-021-02478-3

Abstract:
Introduction Academic trauma institutions rely on fracture databases as research and quality control tools. Frequently, these databases are populated by trainees, but the completeness and accuracy of such databases has not yet been evaluated. The purpose of this study is to determine the capture rate of a resident-populated database in collecting extremity fractures and to determine the accuracy of assigned Orthopaedic Trauma Association (OTA) classifications. Materials and methods A retrospective study was performed at a level 1 trauma center of all adult patients who underwent treatment for extremity fractures after an emergency department or inpatient consultation. A 20% random sample was taken from these entries and compared to a resident-populated fracture database designed to capture the same patients. For all matching records containing a resident-assigned OTA classification, relevant imaging was blindly reviewed by a trauma fellowship-trained orthopedic attending surgeon for fracture pattern classification. Resident OTA classifications were compared to this gold standard to determine overall accuracy rate. Results Three hundred eighteen (80%) out of 400 entries were captured by the resident-populated database. Two hundred thirty-one of these 318 entries contained an OTA classification. One hundred fifty-three (66%) of these 231 entries demonstrated concordance between resident and attending assigned OTA classifications. On subgroup analysis, 133 (70%) of the 190 lower extremity classifications were accurately identified as compared to just 20 (49%) of the 41 upper extremity classifications (p = 0.009). Seventy-nine (65%) of the 121 end segment fractures showed agreement versus 42 (67%) of the 63 diaphyseal injury patterns (p = 0.85). Accuracy of classification did not significantly vary by resident year of training (p = 0.142). Conclusion Trainee generated databases at academic institutions may be subject to incomplete data entry and inaccurate fracture classifications. Quality control measures should be instituted to ensure accuracy in such databases if efforts are invested with the expectation of useful information.
Nima Anaraki, Amir Hossein Beyraghi, , , Ghasem Farjanikish, Amin Bigham Sadegh
Journal of Orthopaedic Surgery and Research, Volume 16, pp 1-11; doi:10.1186/s13018-021-02498-z

Abstract:
Background Bone fractures are medical emergencies that require prompt intervention to help return bone to its normal function. Various methods and treatments have been utilized to increase the speed and efficiency of bone repair. This study aimed to investigate the treatment effects of Prunus dulcis aqueous extract on tibial bone healing in rabbits. Methods All animals were distributed in five groups with six rats in each group, including the sham group, the control group in which tibial lesion was made and received distilled water, treatment groups with 150 mg kg−1, 300 mg kg−1 doses of Prunus dulcis extract, and osteocare treated group. Biochemical blood factors including calcium, phosphorus, and alkaline phosphatase (on days 0, 10, 30, and 50), biomarkers of oxidative stress such as GPx, CAT, and MDA (on days 10 and 30), radiological evaluation, histopathological parameters, and osteocalcin immunohistochemical expression were assessed. Results The data showed calcium levels in the treatment groups increased significantly from day 10 to day 50, respectively, and blood phosphorus levels decreased from day 10 to day 50 in the treatment groups. Alkaline phosphatase initially increased and then decreased in treatment groups. In the treatment groups, GPx and CAT levels significantly increased, and the serum amount of MDA reduced. The best antioxidant results were related to the extract-treated group with a higher dose. Radiographic score was significantly higher in the treatment groups than the control group on day 30. Based on the pathological findings, the healing occurred faster in the extract-treated group with a higher dose. Osteocalcin expression was significantly higher in the control group than that in the treatment groups. Conclusions Treatment with Prunus dulcis extract with a dosage of 300 mg/kg accelerated tibial bone healing in rabbits. Graphical abstract
Tong Zhao, Ying Meng, Yongping Wang,
Journal of Orthopaedic Surgery and Research, Volume 16, pp 1-8; doi:10.1186/s13018-021-02503-5

Abstract:
Background Cancer stem cells (CSCs) are mainly contributed to malignancy metastatic potential and resistant therapy of osteosarcoma (OS). The mitochondria-related apoptosis was generally accepted as the target of tumor therapy. However, the effect of N-myc downstream-regulated gene 1 (NDRG1) on CSCs and mitochondrial health in OS is still unknown. Methods In OS cells, MG63 and U2OS, the siRNA of NDRG1 were conducted. Transwell, western blot, RT-qPCR, and mitochondria isolation were used to identify the effect of NDRG on OS cells and mitochondria. Moreover, the differentiation-related factors of CSCs were determined. Results After downregulation of NDRG1, the cell viability, invasion ability decreased whereas cell apoptosis increased. The expressions profiles of fibronectin, vimentin, vascular endothelial growth factor (VEGF), matrix metalloproteinase (MMP) 2, MMP9, and MMP13 were downregulated, but E-cadherin expression level was upregulated by NDRG1 siRNA. At the same time, cytochrome (Cyt) C levels were increased in cytosol with the decreasing in mitochondria after siRNA treatment. The mitochondrial membrane potential (MMPs) was declined, and the function of mitochondria was impeded. The expressions of uncoupling proteins (UCP) 2, voltage dependent anion channel (VDAC), peroxisome proliferator-activated receptor gamma coactivator (PGC)-1α, and cyclooxygenase (COX) 2 were downregulated by NDRG1 silencing. Moreover, NDRG performed its function primarily through the Wnt pathway and could regulate the differentiation of osteosarcoma stem cells. Conclusion Silencing of NDRG1 could damage the function of mitochondria, promote the CSCs differentiation, alleviating OS progression.
Giuseppe Restuccia, Fabio Cosseddu, Andrea del Chiaro, Matteo Ceccoli, Alessandro Lippi,
Journal of Orthopaedic Surgery and Research, Volume 16, pp 1-5; doi:10.1186/s13018-021-02453-y

Abstract:
Background First metatarsophalangeal joint (MTPJ) fusion is the most effective technique for the treatment of MTPJ primary arthritis, severe hallux valgus and failure of primary corrective surgery of these conditions. It can be achieved through different techniques. We evaluated the outcomes in a cohort of patients treated with dorsal plate arthrodesis. Materials and methods We treated 30 feet for 28 patients; the mean follow-up was 35 months. For each foot, we collected radiological and clinical assessment, with the visual analogue scale (VAS) for pain and the Manchester and Oxford Foot questionnaire (MOFQ). The technique consisted in a cup and cone arthrodesis with the application of a low profile dorsal plate. Patients were allowed for immediate weight bearing. Results Consolidation was achieved in all cases; in 29 cases, radiographic union was recorded within 6 months from surgery, in one case after 9 months. Comparison between the preoperative and postoperative of VAS and MOXFQ values showed a statistically significant difference (p < 0.05). Only one case developed wound dehiscence as complication. Conclusions Even if there is still a debate regarding the best system for MTPJ fusion, we believe cup and cone fusion with dorsal plating is an effective method. Moreover, the stability of the osteosynthesis obtained allows for immediate post-operative weight bearing, making patients able to return soon to their normal life. Trial registration We present a retrospective study; all patients enrolled were retrospectively registered.
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