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PFNA2 versus 95 Degree Condylar Blade Plate in the Management of Unstable Trochanteric Fractures

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Open Journal of Orthopedics 2024年第2期14卷 93-104页

作者： Piyush Gadegone Wasudeo Gadegone Vijayanand Lokhande Virender Kadian department of orthopaedic Trauma and Orthopaedic Hospital Chandrapur India

Purpose: The proximal femoral nail anti-rotation (PFNA) is known to have advantages in enhancing the anchorage ability of internal fixation in elderly unstable osteoporotic intertrochanteric fracture patients. However whether it is superior to condylar blade fixation is not clear. This study aimed to determine which treatment has better clinical outcomes in older patients. Materials and Methods: A total of 86 patients over the age of 60 with unstable trochanteric fractures within the past 3 weeks, were included in this prospective study conducted from June 1, 2018, to May 31, 2021. All the intertrochanteric fractures were classified according to AO/OTA classification. Among them, 44 cases were treated with the Proximal Femoral Nail (PFNA2) with or without an augmentation screw, and 42 cases were treated with the Condylar Blade Plate. In addition, the operative time, intraoperative blood loss, intraoperative and postoperative blood transfusion, postoperative weight-bearing time, hospitalization time, Harris score of hip function, Kyle’s criteria and postoperative complications were compared between the two groups. Results: The mean duration of surgery for the PFN group was 66.8 minutes (on average), whereas for the condylar blade plate group, it was 99.30 minutes (on average). The PFNA2 group experienced less blood loss (average of 80 mL) compared to the condylar blade plate group (average of 120 mL). Union and partial weight-bearing occurred earlier in the PFNA2 group (14.1 weeks and 10.6 weeks, respectively) compared to the Condylar blade plate group (18.7 weeks and 15.8 weeks). In two patients from the PFNA2 group, screw backing out and varus collapse complications were encountered;however, these patients remained asymptomatic and did not require revision surgery. In two other patients, screw cut out and breakage of the nail at the helical screw hole leading to non-union of the proximal femur were observed during the nine-month follow-up, necessitating revision su

关键词： Proximal Femoral Nail Anti-Rotation Condylar Blade Plate Internal Fixation Unstable Intertrochanteric Fracture Osteoporotic

Surgical management of the diabetic foot:The current evidence

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World Journal of Orthopedics 2024年第5期15卷 404-417页

作者： Richard Henry Randall Roberts Gareth Rhys Davies-Jones James Brock Vaishnav Satheesh Greg AJ Robertson department of trauma and orthopaedics Wrexham Maelor HospitalWrexham LL137TDUnited Kingdom department of trauma and orthopaedics The Robert Jones and Agnes Hunt Orthopaedic HospitalOswestry SY107AGUnited Kingdom

The prevalence of diabetes mellitus and its associated complications,particularly diabetic foot pathologies,poses significant healthcare challenges and economic burdens *** review synthesises current evidence on the surgical management of the diabetic foot,focusing on the interplay between neuropathy,ischemia,and infection that commonly culminates in ulcers,infections,and,in severe cases,*** escalating incidence of diabetes mellitus underscores the urgency for effective management strategies,as diabetic foot complications are a leading cause of hospital admissions among diabetic patients,significantly impacting morbidity and mortality *** review explores the pathophysiological mechanisms underlying diabetic foot complications and further examines diabetic foot ulcers,infections,and skeletal pathologies such as Charcot arthropathy,emphasising the critical role of early diagnosis,comprehensive management strategies,and interdisciplinary care in mitigating adverse *** addressing surgical interventions,this review evaluates conservative surgeries,amputations,and reconstructive procedures,highlighting the importance of tailored approaches based on individual patient profiles and the specific characteristics of foot *** integration of advanced diagnostic tools,novel surgical techniques,and postoperative care,including offloading and infection control,are discussed in the context of optimising healing and preserving limb function.

关键词： Diabetes Diabetic foot Charcot Osteomyelitis Amputation Diabetic foot attack Conservative surgery

Paeoniflorin,the Main Monomer Component of Paeonia lactiflora,Exhibits Anti-inflammatory Properties in Osteoarthritis Synovial Inflammation

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Chinese Journal of Integrative Medicine 2024年第5期30卷 433-442页

作者： CHEN Pu ZHOU Jun RUAN An-min MA Yu-feng WANG Qing-fu department of orthopaedic Surgery Beijing University of Chinese Medicine Third Affiliated HospitalBeijing 100029China department of orthopaedic Surgery Guangdong Provincial Hospital of Chinese MedicineGuangzhou 510120China department of orthopaedic Surgery Beijing Longfu HospitalBeijing 100010China

Objective:To explore the mechanism of paeoniflorin(PF)on osteoarthritis(OA)synovial inflammation from network pharmacology to experimental ***:Targets of OA were constructed by detecting the database of network database platforms(Therapeutic Target database,Drug Bank and Gene Cards),and the targets of PF were constructed by Pub Chem and Herbal Ingredients'Targets *** Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)analysis of these co-targeted genes were conducted via Database for Annotation,Visualization,and Integrated Discovery(DAVID)database,and protein-protein interaction(PPI)networks were conducted via the search tool for the retrieval of interacting genes(STRING)*** counting kit-8(CCK-8)assay was performed to assess the potential toxicity of PF on human OA fibroblast-like synoviocytes(FLS),quantitative real-time polymerase chain reaction(q PCR),enzyme-linked immunosorbent assay(ELISA)and Western blot were used to verify the potential mechanism of PF in synovial ***:Twenty-six co-targeted genes were *** enrichment results showed that these co-targeted genes were most likely localized in the cytoplasm,and the biological processes mainly involved'cellular response to hypoxia''lipopolysaccharide(LPS)-mediated signaling pathway'and'positive regulation of gene expression'.KEGG pathway analysis indicated that these co-targeted genes may function through pathways associated with'hypoxia-inducible factor-1(HIF-1)signaling pathway'and'tumornecrosis factor(TNF)signaling pathway'.The PPI network showed that the top 3 hub genes were TP53,TNF,and *** docking results showed that PF was well docking with ***-8 showed no potential toxicity of 10,20 and 50μmol/L PF on human OA *** PF significantly decreased the expression levels of interleukin-1β,interleukin-6,TNF-αmatrix metalloproteinase 13(MMP13),and a disintegrin and metalloproteinase with thrombospondin motifs 5(ADAMTS5)and TNF

关键词： paeoniflorin osteoarthritis synovial inflammation tumor necrosis factor-α network pharmacology Paeonia lactiflora

A"messenger zone hypothesis"based on the visual three-dimensional spatial distribution of motoneurons innervating deep limb muscles

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Neural Regeneration Research 2024年第7期19卷 1559-1567页

作者： Chen Huang Shen Wang Jin Deng Xinyi Gu Shuhang Guo Xiaofeng Yin MoE Key Laboratory for trauma Treatment and Nerve Regeneration Peking UniversityBeijingChina department of Orthopedics and trauma Peking University People’s HospitalBeijingChina

Coordinated contraction of skeletal muscles relies on selective connections between the muscles and multiple classes of the spinal motoneuro *** r,current research on the spatial location of the spinal motoneurons innervating differe nt muscles is *** this study,we investigated the spatial distribution and relative position of different motoneurons that control the deep muscles of the mouse hindlimbs,which were innervated by the obturator nerve,femoral nerve,inferior gluteal nerve,deep pe roneal nerve,and tibial *** were visualized by combining a multiplex retrograde tracking technique compatible with three-dimensional imaging of solvent-cleared o rgans(3DISCO)and 3-D imaging technology based on lightsheet fluorescence microscopy(LSFM).Additionally,we propose the hypothesis that"messenger zones"exist as interlaced areas between the motoneuron pools that dominate the synergistic or antagonist muscle *** hypothesize that these interlaced neurons may participate in muscle coordination as messenger *** revealed the precise mutual positional relationships among the many motoneurons that innervate different deep muscles of the *** only do these findings update and supplement our knowledge regarding the overall spatial layout of spinal motoneurons that control mouse limb muscles,but they also provide insights into the mechanisms through which muscle activity is coordinated and the architecture of motor circuits.

关键词： 3-D imaging motoneurons multiple retrograde tracing muscle coordination skeletal muscle spatial distribution optical tissue clearing

Long noncoding RNA protein-disulfide isomerase-associated 3 regulated high glucose-induced podocyte apoptosis in diabetic nephropathy through targeting miR-139-3p

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World Journal of Diabetes 2024年第2期15卷 260-274页

作者： Yin-Xi He Ting Wang Wen-Xian Li Yan-Xia Chen department of orthopaedic trauma The Third Hospital of ShijiazhuangShijiazhuang 050000Hebei ProvinceChina department of Endocrinology The Second Hospital of Hebei Medical UniversityShijiazhuang 050000Hebei ProvinceChina department of Endocrinology The First Hospital of ZhangjiakouZhangjiakou 075000Hebei ProvinceChina

BACKGROUND Podocyte apoptosis plays a vital role in proteinuria pathogenesis in diabetic nephropathy(DN).The regulatory relationship between long noncoding RNAs(lncRNAs)and podocyte apoptosis has recently become another research hot spot in the DN *** To investigate whether lncRNA protein-disulfide isomerase-associated 3(Pdia3)could regulate podocyte apoptosis through miR-139-3p and revealed the underlying *** Using normal glucose or high glucose(HG)-cultured podocytes,the cellular functions and exact mechanisms underlying the regulatory effects of lncRNA Pdia3 on podocyte apoptosis and endoplasmic reticulum stress(ERS)were *** Pdia3 and miR-139-3p expression were measured through quantitative real-time polymerase chain *** cell viability was detected through the cell counting kit-8 colorimetric *** podocyte apoptosis rate in each group was measured through flow *** interaction between lncRNA Pdia3 and miR-139-3p was examined through the dual luciferase reporter ***,western blotting was performed to detect the effect of lncRNA Pdia3 on podocyte apoptosis and ERS via *** The expression of lncRNA Pdia3 was significantly downregulated in HG-cultured ***,lncRNA Pdia3 was involved in HG-induced podocyte ***,the dual luciferase reporter assay confirmed the direct interaction between lncRNA Pdia3 and *** Pdia3 overexpression attenuated podocyte apoptosis and ERS through miR-139-3p in HG-cultured *** Taken together,this study demonstrated that lncRNA Pdia3 overexpression could attenuate HG-induced podocyte apoptosis and ERS by acting as a competing endogenous RNA of miR-139-3p,which might provide a potential therapeutic target for DN.

关键词： Long noncoding RNAs Diabetic nephropathy Podocyte apoptosis Endoplasmic reticulum stress Competing endogenous RNA

The efficacy of vitamin E in preventing arthrofibrosis after joint replacement

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Animal Models and Experimental Medicine 2024年第2期7卷 145-155页

作者： Yingfang Fan Jean Yuh Sashank Lekkala Mehmet D.Asik Andrew Thomson Madeline McCanne Mark A.Randolph Antonia F.Chen Ebru Oral Harris orthopaedic Laboratory Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA department of orthopaedic Surgery Harvard Medical SchoolBostonMassachusettsUSA department of Surgery Harvard Medical SchoolBostonMassachusettsUSA department of orthopaedic Surgery Brigham and Women's HospitalBostonMassachusettsUSA

Background:Arthrofibrosis is a joint disorder characterized by excessive scar formation in the joint *** E is an antioxidant with potential anti-fibroblastic *** aim of this study was to establish an arthrofibrosis rat model after joint replacement and assess the effects of vitamin E supplementation on joint ***:We simulated knee replacement in 16 male Sprague–Dawley *** immobilized the surgical leg with a suture in full *** control groups were killed at 2 and 12 weeks(n=5 per group),and the test group was supplemented daily with vitamin E(0.2 mg/mL)in their drinking water for 12 weeks(n=6).We performed histological staining to investigate the presence and severity of *** staining andα2-macroglobulin(α2M)enzyme-linked immunosorbent assay(ELISA)were used to assess local and systemic *** weight bearing(total internal reflection)and range of motion(ROM)were collected for functional ***:The ROM and weight-bearing symmetry decreased after the procedure and recovered slowly with still significant deficit at the end of the study for both *** analysis confirmed fibrosis in both lateral and posterior periarticular *** E supplementation showed a moderate anti-inflammatory effect on the local and systemic *** vitamin E group exhibited significant improvement in ROM and weight-bearing symmetry at day 84 compared to the control ***:This model is viable for simulating arthrofibrosis after joint *** E may benefit postsurgical arthrofibrosis,and further studies are needed for dosing requirements.

关键词： arthrofibrosis range of motion total knee arthroplasty vitamin E

High dose of tranexamic acid infusion in primary total knee arthroplasty:A randomized multicenter clinical trail

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Chinese Medical Journal 2024年第3期137卷 359-361页

作者： Jinwei Xie Qiang Huang Zeyu Huang Fei Wang Jun Liu Hua Tian Wei Huang Fuxing Pei department of orthopaedic Surgery West China HospitalSichuan UniversityChengduSichuan 610041China department of orthopaedic Surgery The Third Hospital of Hebei Medical UniversityShijiazhuangHebei 050051China department of orthopaedic Surgery Tianjin HospitalTianjin 300211China department of orthopaedic Surgery Peking University Third HospitalHaidian DistrictBeijing 100191China department of orthopaedic Surgery The First Affiliated Hospital of Chongqing Medical UniversityYuzhong DistrictChongqing 400016China

To the Editor:Significant hyperfibrinolysis is always accompanied by surgical trauma and tourniquet use in total knee arthroplasty(TKA),leading to considerable hidden blood loss,inflammation,and pain,thereby impeding the recovery *** recovery after surgery(ERAS)has promoted the development of patient blood management in recent *** numerous methods of blood conservation,including tranexamic acid(TXA),a lysine analog competitive inhibitor of plasmin and plasminogen,have been studied.^([1–3])However,some issues remain controversial,such as the optimal TXA regimen in *** the other hand,the use of TXA in arthroplasty is considered off-label,although the current guideline or consensus suggests its routine use in arthroplasty.

关键词： arthroplasty infusion routine

The emerging role of tranexamic acid and its principal target,plasminogen,in skeletal health

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Acta Pharmaceutica Sinica B 2024年第7期14卷 2869-2884页

作者： Weixin Xie Antonia Donat Shan Jiang Anke Baranowsky Johannes Keller department of trauma and Orthopedic Surgery University Medical Center Hamburg-EppendorfHamburg 20246Germany

The worldwide burden of skeletal diseases such as osteoporosis,degenerative joint disease and impaired fracture healing is steadily *** acid(TXA),a plasminogen inhibitor and anti-fibrinolytic agent,is used to reduce bleeding with high effectiveness and safety in major surgical *** its widespread clinical application,the effects of TXA beyond anti-fibrinolysis have been noticed and prompted renewed interest in its *** clinical trials have characterized the effects of TXA on reducing postoperative infection rates and regulating immune responses in patients undergoing ***,several animal studies suggest potential therapeutic effects of TXA on skeletal diseases such as osteoporosis and fracture *** a direct effect of TXA on the differentiation and function of bone cells in vitro was shown,few mechanisms of action have been ***,we summarize recent findings of the effects of TXA on skeletal diseases and discuss the underlying plasminogen-dependent and-independent mechanisms related to bone metabolism and the immune *** furthermore discuss potential novel indications for TXA application as a treatment strategy for skeletal diseases.

关键词： Tranexamic acid Osteoporosis Osteoarthritis Fracture healing Bone metabolism Inflammation Plasminogen Fibrinolysis

Review and update on the management of triangular fibrocartilage complex injuries in professional athletes

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World Journal of Orthopedics 2024年第2期15卷 110-117页

作者： Valerio Pace Francesco Bronzini Giovanni Novello Giuseppe Mosillo Luca Braghiroli department of trauma and orthopaedics AOSP TerniTerni 05100Italy department of trauma and orthopaedics University of PerugiaPerugia 06100Italy department of trauma and orthopaedics Hand UnitAOSP TerniTerni 05100Italy

Triangular fibrocartilage complex injuries are common in amateur and professional *** injuries are mainly caused by acute or chronic repetitive axial loads on the wrist,particularly on the ulnar side and in association with rotations or radial/ulnar *** order to treat professional athletes,a detailed specific knowledge of the pathology is ***,the clinician should fully understand the specific and unique environment and needs of the athletes,their priorities and goals,the type of sport,the time of the season,and the position *** early diagnosis and appropriate management with the quickest possible recovery time are the uppermost goals for both the athlete and the surgeon.A compromise between conservative vs surgical indications,athletes’needs and expectations,and financial implications should be *** procedures should be timely planned when indicated as they could allow early diagnosis and treatment at the same *** measures are often used as first line treatment when *** lesions are treated by arthroscopic repair,whilst central lesions are treated by arthroscopic *** procedures(such as the Wafer procedure,ulnar osteotomies,etc.)have specific indications and great implications with regard to rehabilitation.

关键词： Triangular fibrocartilage complex injuries Professional athletes Ulnar sided wrist pain Wrist arthroscopy Wrist debridement