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Intracapsular fractures of the proximal femur are one of the most common fractures of the lower limbs. Most cases require osteosynthesis with suitable implants, and intraoperative positioning of the patient on the fracture table is a prerequisite to facilitate fracture manipulation, traction, reduction and fluoroscopy assessment. However, positioning the limbs of bilateral above-knee amputees for internal fixation of related proximal femoral fractures is a difficult task, which require customized inventory for effective limb positioning and fracture manipulation. This study reported a rare case following a crush injury of bilateral lower limb in a road traffic accident, and described some technical tips of acute femoral neck fractures in bilateral above-knee amputation. The patient was managed with immediate guillotine amputation and later secondary wound closure followed by internal fixation of the right-sided femoral neck fracture with multiple cancellous cannulated screws.

Background: The sciatic nerve is a peripheral nerve and is more vulnerable to compression with subsequent short- or long-term neuronal dysfunction. The current study was designed to elucidate the possible ameliorative effect of L-carnitine and sildenafil (SIL) on sciatic nerve crush injury. We sought to determine the effects of L-carnitine, a neuroprotective and a neuro-modulatory agent, and sildenafil citrate, a selective peripheral phosphodiesterases inhibitor on modulating neuro-degenerative changes due to sciatic nerve compression. Materials and methods: The comparative effect of L-carnitine (at an oral dose of 20 mg/kg/day) or SIL citrate (20 mg/kg/day orally) administration for 21 days was studied in a rat model of sciatic nerve compression. Sciatic nerve sections were subjected to biochemical, histological, ultrastructure, and immunohistochemical studies to observe the effects of these treatments on neurofilament protein. Results: The sciatic nerve crush injury group (group II) showed a significant decrease in tissue catalase (CAT), superoxide dismutase (SOD) and increase in malondhyde (MDA) as compared to control group (P < 0.01). Histological changes in the form of degenerated and vacuolated axoplasm with areas of nerve fiber loss and pyknotic nuclei were reported. The blood vessels were dilated, congested with areas of hemorrhage and mononuclear cell infiltration. Histo-morphometrically, a statistically significant reduction in the nerve fibers number, mean axon cross-sectional area, myelin sheath thickness and a significant increase in collagen fibers percentage (P < 0.05) as compared to control group. Immunohistochemically, neurofilament protein was significantly downregulated as proved by a significant reduction in mean area % of neurofilament expression. L-carnitine ameliorated the studied parameters through it`s neuroprotective effect while Sildenafil (SIL) is a selective peripheral phosphodiesterases (PDE-5) inhibitor had improved crush injury parameters but with less extent than L-carnitine. Conclusions: These findings indicate the valuable effects of L-carnitine administration compared to that of SIL citrate in alleviating the serious debilitating effects of sciatic nerve crush injury. Our results provide a new insight into the scope of neuroprotective and, neuro-regenerative effects of L-carnitine in a sciatic nerve compression model.

Introduction The aim of this study is to present various hand reconstruction methods and provide technical notes regarding the treatment of mutilating hand injuries using free-tissue transfers from the foot and to investigate whether these transfers provide patients with a usable hand or not. Patients and Methods Ninety patients with mutilating hand injuries were included in the study. A total of 101 procedures were performed. Patients were contacted by phone to evaluate their working status and to record any complaints regarding their donor sites. The Quickdash questionnaire was conducted for the 53 patients who could be reached. Operative techniques, secondary procedures, finger survival, and physiotherapy data were noted retrospectively. Results In 36 patients, a trimmed great toe was transferred to the thumb. Second toe-to-thumb transfers were performed in 8 patients, and second toe-to-finger transfers were performed in 10 patients. In 13 patients, 2 toes from one side were transferred, and in 6 patients, 3 toes were transferred to the hand. Bilateral toe transfers were performed in 9 patients. Eight patients underwent joint transfers, of which 2 involved joint transfers from both feet. The overall finger survival rate for the transfer procedures was 95.04%. The average Quickdash score of the patients who could be reached (n = 53) was 27.49, with 62.3% of the patients being able to use their hands in their previous jobs, and 26.4% needing to change their jobs because of their hand injuries. 41.5% of the patients had no donor site complaints. 47.2% had mild complaints, and 11.3% had major donor site complaints. Conclusion Multiple-toe transfer techniques along with flap coverage options should be considered, and delicate planning is mandatory to achieve at least a basic or acceptable hand. Three toes, including the great toe, can be transferred in a single operation by dissecting both the dorsal and plantar arterial systems. Crush injuries of the dorsal side of the hand may be reconstructed using combined transfers of bones, joints, extensor tendons, and skin. In our series, 88.7% of patients with mutilating hand injuries were able to return to work after we performed tissue transfers from the foot.

Extensive bone loss associated with severe vascular injury remains a challenge for lower extremity reconstruction. The fibular free flap has been utilized for many decades to reconstruct long-segment tibial defects. We present an unusual scenario of unilateral weight-bearing, wherein we salvaged the sole lower extremity by transfer of the fractured ipsilateral fibula and a bipedicled skin flap. A 38-year-old man sustained a severe crush injury in the right leg with loss of circulation. His left lower leg had a soft tissue defect measuring 20×15 cm with an exposed comminuted fracture and a 17-cm tibial defect, along with a segmental fracture of the fibula. Subsequently, we reconstructed the tibial defect by transferring a 17-cm-long section of the ipsilateral fibula. We covered the soft tissue defect with a bipedicled skin flap. The patient eventually began to ambulate independently after surgery.

The aim of this study was to evaluate the characteristics of paediatric hand fractures (PHF) at a tertiary hospital in South China based on sex, age, mechanism of injury and anatomical region. A retrospective observational study was performed on children aged 15 years and younger who were referred for actual or suspected hand fractures between January 2016 and December 2020. Medical records and radiographs were reviewed for age at the time of injury, sex, site and fracture pattern and mechanism of injury. A total of 436 consecutive children with 478 hand fractures were reviewed. Hand fractures was more common in boys (281/436; 64.4%) than in girls (155/436; 35.6%), although most fractures occurred in children aged 0-3 years (198/436; 45.4%). Distal phalanges were the most commonly injured bones (184/478; 38.5%), and the base fractures were most common (151/476; 31.7%); the fifth digit was most commonly injured (150/478; 31.3%). Crush injuries were the leading cause of fracture in children younger than 6 years of age (207/325; 63.7%), whereas punch injuries were the major cause of injury in older age groups (55/153; 35.9%); 60.1% of the fractures were managed nonsurgically. This study showed patterns of PHF in a tertiary hospital in South China. It illustrates the local variability across sex, age group, injury type and injury mechanism. Such demographic data will be valuable for optimally resourcing healthcare systems locally and help guide prevention policies.

The objective of this work was to assess whether the injury mechanisms are responsible for histological arterial lesions. This prospective single-center study included adults with wrist or hand arterial injury. Arterial resection of at least 2 mm from the proximal and distal stumps was performed before the arterial anastomosis. Histological analysis of the arterial stumps was performed. An ultrasound was performed 1 month postoperatively to check arterial patency. A clinical and functional evaluation was done at 1 month postoperative, then every 3 months. From 2018 to 2020, 46 patients were included with a maximum follow-up of 13 months. There were 35 cuts, 2 crush injuries, 8 amputation and 1 blast injury. Macroscopically, 37% of the margins were considered damaged. Histological analysis showed significant damage in 59% of the sections (27 out of 46 patients) with 50% for crush injury, 55% for cuts by mechanical tool, 62% for cuts by power tool, 62% for amputations and 100% for blasts. The failure rate was 9%: 2 replantations and 2 asymptomatic thromboses diagnosed by ultrasound. Postoperative pain on VAS was 1.75/10, range of motion was 87%, Quick DASH was 8%, SF36 PCS was 69% and SF36 MCS was 70%. Factors influencing the success or failure of anastomosis were the mechanism of injury (p = 0.02), associated nerve damage (p = 0.014) and length of proximal arterial cut (p = 0.046). Histological arterial lesions seem to correlate with the injury mechanism. Cuts caused by glass or crush injuries do not seem to require arterial resections of more than 2 mm. A continuation of the study with a larger number of subjects may generate statistically significant results.

Extensive necrosis of lower extremity muscles through the clinical practice of limb salvage after a case of high level crushing injury. A case of car accident injury complicated with necrotizing fasciitis, myositis, and septic shock was admitted to our hospital. The pathogenic factors, clinical characteristics, and surgical repair of this case were analyzed. Septic shock, pulmonary infection and atelectasis, and skin and soft tissue injury of lower limbs were all effectively treated, and limbs were saved successfully. After wound healing, the patient was discharged from hospital and entered the follow-up rehabilitation treatment. Although there is no direct trauma to the distal extremity below the cross-section of both lower extremities, there are still hypoxic ischemic changes, which can easily be ignored in the early stage. If not treated in time, myofascial and osteofascial compartment syndrome, necrotizing fasciitis, myositis, and sepsis are often secondary in the later stage, which should be warned against. During surgical debridement, attention should be paid to the protection of the source artery, and debridement and surgical exploration should be carried out according to the trend of blood vessels. The interecological muscle tissue between the intersections should be kept as far as possible, and the main nerves, blood vessels, and musculocutaneous perforators should be kept to ensure the blood supply of the skin flap.

The present study was performed to evaluate the effects of the medial and anterolateral approach combined with internal fixation by double head compression screws and countersunk K-wires for Hawkins Ⅲ talus neck and medial malleolus fracture. Eleven patients with articular surface crush injury resulting in Hawkins Ⅲ talus neck fractures accompanied by medial malleolus fractures were reviewed. All patients underwent emergency operations. The fractures were fixed using double head compression screws and countersunk K-wires through combined medial and anterolateral approaches. FAOS, AOFAS ankle-hindfoot scale, and VAS questionnaire scores were recorded. In addition, ROM of the ankle and postoperative complications were assessed. All patients were followed up for a median of 52.45 ± 5.15 months. The multiple scales data of FAOS on the affected side were: pain score 89.14 ± 7.08; activities of daily living score 89.57 ± 8.88; quality-of-life score 89.20 ± 7.44; sports score 75.00 ± 15.49; and other symptoms score 84.74 ± 7.51. The mean overall AOFAS ankle-hindfoot score was 88.36 ± 6.39. The VAS score was 0.72 ± 0.65. Ankle motion included dorsiflexion (13.18° ± 9.02°) and plantar flexion (32.27° ± 12.34°). Subtalar joint motion included eversion (10.91° ± 7.01°) and inversion (11.36° ± 7.45°). All scores of the healthy side were higher than those of the affected side (p .05). In addition to ROM of the ankle and subtalar joint and sports score, various indicators of recovery rate had scores 80%. One patient developed skin necrosis, which healed after debridement and wound dressing. Late complications included subtalar and/or ankle traumatic arthritis in six patients, four of whom showed no obvious clinical symptoms. In conclusion, the method of emergency surgery and medial and anterolateral approach combined with countersunk K-wires to fix small bone fragments to restore the integrity of the articular surface is acceptable for Hawkins Ⅲ talus neck with medial malleolus fracture.

OBJECTIVE Traditional animal models of nerve injury use controlled crush or transection injuries to investigate nerve regeneration; however, a more common and challenging clinical problem involves closed traction nerve injuries. The authors have produced a precise traction injury model and sought to examine how the pathophysiology of stretch injuries compares with that of crush and transection injuries. METHODS Ninety-five late-adolescent (8-week-old) male mice underwent 1 of 7 injury grades or a sham injury (n > 10 per group): elastic stretch, inelastic stretch, stretch rupture, crush, primary coaptation, secondary coaptation, and critical gap. Animals underwent serial neurological assessment with sciatic function index, tapered beam, and von Frey monofilament testing for 48 days after injury, followed by trichrome and immunofluorescent nerve histology and muscle weight evaluation. RESULTS The in-continuity injuries, crush and elastic stretch, demonstrated different recovery profiles, with more severe functional deficits after crush injury than after elastic stretch immediately following injury (p < 0.05). However, animals with either injury type returned to baseline performance in all neurological assessments, accompanied by minimal change in nerve histology. Inelastic stretch, a partial discontinuity injury, produced more severe neurological deficits, incomplete return of function, 47% ± 9.1% (mean ± SD) reduction of axon counts (p < 0.001), and partial neuroma formation within the nerve. Discontinuity injuries, including immediate and delayed nerve repair, stretch rupture, and critical gap, manifested severe, long-term neurological deficits and profound axonal loss, coupled with intraneural scar formation. Although repaired nerves demonstrated axon regeneration across the gap, rupture and critical gap injuries demonstrated negligible axon crossing, despite rupture injuries having healed into continuity. CONCLUSIONS Stretch-injured nerves present unique pathology and functional deficits compared with traditional nerve injury models. Because of the profound neuroma formation, stretch injuries represent an opportunity to study the pathophysiology associated with clinical injury mechanisms. Further validation for comparison with human injuries will require evaluation in a large-animal model.

Severe work accidents are one of the most frequent causes for physical disability in adults, alongside car accidents and war/gunshot injuries. In this article we present the case of a severe crush injury of the left foot that occurred in a 31 year-old patient who was involved in a work accident. After an unsuccessful tissue coverage using local flaps, the salvage solution was that of a composite free flap, aiming not only to cover, but also to restore stability to the foot. The treatment of choice was the serratus anterior muscle harvested together with osseous component (8th rib). The healing was difficult, due to wound dehiscence with bone exposure over a small area, but the problem was addressed using FGF (fibroblast growth factor) sponges, which enabled granulation and complete wound closure. The outcome of the case was favourable, gait being possible without any deficiency. For the cosmetic and functional reasons, the patient suffered one last surgical procedure to debulk the dorsal aspect of the foot. The final result was more than satisfactory, the patient being totally rehabilitated and socially and professionally reintegrated.

Irreversible loss of retinal ganglion cells (RGCs) is a common pathological feature of various optic nerve degenerative diseases such as glaucoma and ischemic optic neuropathy. Effective protection of RGCs is the key to successful treatment of these diseases. Total Panax notoginseng saponins (TPNS) are the main active component of Panax notoginseng, which has an inhibitory effect on the apoptosis pathway. This study is aimed at assessing the protective effect of TPNS on RGCs of the optic nerve crush (ONC) model of rats and exploring the underlying mechanisms. The intraperitoneal or intravitreal injection of TPNS was used based on the establishment of the rat ONC model. Fifteen days after the injury, the cell membrane fluorescent probe (Fluoro-Gold) was applied to retrograde RGCs through the superior colliculus and obtain the number of surviving RGCs. TUNEL assay was also used to detect the number and density of RGC apoptosis after the ONC model. The expression and distribution of Bcl-2/Bax, c-Jun/P-c-Jun, and P-JNK in the retina were demonstrated by Western blot analysis. After the intervention of TPNS, the rate of cell survival increased in different retinal regions ( p < 0.05 ) and the number of apoptosis cells decreased. Regarding the expression of Bcl-2/Bax, c-Jun/P-c-Jun, and P-JNK-related apoptotic proteins, TPNS can reduce the level of apoptosis and play a role in protecting RGCs ( p < 0.05 ). These findings indicate that topical administration of TPNS can inhibit cell apoptosis and promote RGC survival in the crushed optic nerve.

BACKGROUND Onychoheterotopia, or ectopic nail, is a rare nail condition in which nail growth occurs in areas other than the distal phalanges. The majority of cases in the literature are noted to be congenital; however, acquired cases have less commonly been described following either acute or chronic trauma. METHODS We present a case of acquired onychoheterotopia in a child, with a corresponding literature review of acquired pediatric onychoheterotopia cases for comparison. RESULTS There were a total of 10 cases of acquired onychoheterotopia in pediatric patients in the literature. Including our patient, 81.8% (9/11) developed an ectopic nail on the fingers. Crush injury preceded the ectopic nails in 45.5 % (5/11) of cases. Infection occurred in 27.3% (3/11). CONCLUSIONS Although the incidence and prevalence of acquired onychoheterotopia are unknown, it seems to be an uncommon phenomenon. From our case and others from the literature, there may be associations with crush injury specifically. Further research will be needed to fully elucidate the pathophysiology and risk factors for ectopic nail growth.

Objective To analyze the learning curve experience of hip arthroscopy based on patient demographics, surgical time, portal setup time, and postoperative complications and to find the key point in the learning curve. Methods From May 2016 to February 2019, a prospective study on the learning curve experience of hip arthroscopy was performed in our hospital. We evaluated the first 50 consecutive hip arthroscopy procedures performed by a single surgeon. There were nine females and 41 males with a mean age of 30.8 years. We divide the patients into early group and late group according to the date of their operation, with each group including 25 patients. Data on patient demographics, types of procedure, surgical time, portal setup time, and postoperative complications were collected. Functional scores were assessed with the modified Harris Hip Score (mHHS). Results Patients were followed up for 16.4 months on average (range, 13–27 months). The early group of patients had a mean age of 35.2 years and the late group a mean age of 26.5 years. The most common procedures performed for the early group were debridement (17 patients, 68%), and in the late group, most patients underwent labral repair (18 patients, 72%). Mean total surgical time was 168 min for the early group and 143 min for the late group, and there was no statistically significant difference between two groups. The portal setup time in the early group and late group was 40.2 ± 12.4 min and 18.5 ± 6.2 min, respectively (P, This study analyzed the learning curve experience of hip arthroscopy based on the data of 50 patients, and found that the steep learning curve was mainly caused by the challenging of portal setup and portal‐related complications were more common in the early stage.

INTRODUCTION/AIMS Obesity is a factor contributing to suboptimal improvement of motor function in peripheral nerve disorders. In this study we aimed to evaluate the skeletal muscles during denervation and reinnervation after nerve crush injury in leptin-deficient (ob/ob) mice. METHODS Experiments were performed on the skeletal muscles of the hindlimbs in 20 male ob/ob mice and controls. Characteristics of the gastrocnemius muscles were evaluated by histological analysis, immunohistological analysis, and Sircol-collagen assay after measurement of body weight and wet weight of the skeletal muscles, and by walking track analysis. The sciatic nerve was denervated by crushing with smooth forceps and reinnervation was evaluated. RESULTS Gastrocnemius wet weight was significantly lower in the ob/ob mice than in the control mice. A smaller cross-sectional area of type II fibers and increase of type I fiber grouping of the skeletal muscles was demonstrated in the ob/ob mice. After nerve injury, motor function recovery was equal between the groups but the cross-sectional area of type II fibers was significantly smaller in the ob/ob mice than in control mice at 4 weeks. The denervated muscles showed an increase in collagen deposition in the interstitial space; predominant in the ob/ob mice after nerve injury. DISCUSSION The results of this study suggest that fibrosis in the skeletal muscle of obese patients after nerve injury is prominent, which may impair improvement of muscle function after treatment of peripheral nerve disorders.

Introduction - Post traumatic complex defects of the forearm require multiple operations and prolonged rehabilitation. Segmental bony defects of the radius and ulna are occasionally seen as part of these complex wounds. There are a few options in bridging the skeletal defect. These include corticocancellous bone grafting, creation of a one bone forearm and vascularised fibula. Vascularised bone grafting is superior in an ischemic and fibrosed area as it enhances local blood supply. The fibula is usually used to bridge the defect in one bone i.e. the radius. Case presentation – A young male presented with an open comminuted fracture of radius and ulna following a crush injury to the left upper limb. The reconstruction was done in two stages – first a pedicled thoracoumbilical flap for soft tissue and in later stage a double barrel free fibula flap for segmental bone loss. Conclusion – The above approach offered the best chance of skeletal healing in a complex defect. The patient was able to gain reasonably good upper extremity function with the described technique.

Objective: To develop a standardized model of stretch–crush sciatic nerve injury in mice, and to compare outcomes of crush and novel stretch–crush injuries using standard manual gait and sensory assays, and compare them to both semi-automated as well as deep-learning gait analysis methods. Methods: Initial studies in C57/Bl6 mice were used to develop crush and stretch–crush injury models followed by histologic analysis. In total, 12 eight-week-old 129S6/SvEvTac mice were used in a six-week behavioural study. Behavioral assessments using the von Frey monofilament test and gait analysis recorded on a DigiGait platform and analyzed through both Visual Gait Lab (VGL) deep learning and standardized sciatic functional index (SFI) measurements were evaluated weekly. At the termination of the study, neurophysiological nerve conduction velocities were recorded, calf muscle weight ratios measured and histological analyses performed. Results: Histological evidence confirmed more severe histomorphological injury in the stretch–crush injured group compared to the crush-only injured group at one week post-injury. Von Frey monofilament paw withdrawal was significant for both groups at week one compared to baseline (p < 0.05), but not between groups with return to baseline at week five. SFI showed hindered gait at week one and two for both groups, compared to baseline (p < 0.0001), with return to baseline at week five. Hind stance width (HSW) showed similar trends as von Frey monofilament test as well as SFI measurements, yet hind paw angle (HPA) peaked at week two. Nerve conduction velocity (NCV), measured six weeks post-injury, at the termination of the study, did not show any significant difference between the two groups; yet, calf muscle weight measurements were significantly different between the two, with the stretch–crush group demonstrating a lower (poorer) weight ratio relative to uninjured contralateral legs (p < 0.05). Conclusion: Stretch–crush injury achieved a more reproducible and constant injury compared to crush-only injuries, with at least a Sunderland grade 3 injury (perineurial interruption) in histological samples one week post-injury in the former. However, serial behavioral outcomes were comparable between the two crush groups, with similar kinetics of recovery by von Frey testing, SFI and certain VGL parameters, the latter reported for the first time in rodent peripheral nerve injury. Semi-automated and deep learning-based approaches for gait analysis are promising, but require further validation for evaluation in murine hind-limb nerve injuries.

Background and objectives Crush injuries and prolonged pressure on muscles lead to bruises and sprains and, in most of the cases, cause distraction of the muscle and release of particles into the blood stream, causing renal and systemic complications in severe cases. Laser photobiomodulation treatment (i.e., laser phototherapy) is a method suggested to decrease the pressure damage in the first 24-48 hours after muscle injury, allowing a faster and more complete physical rehabilitation. We studied the efficacy of non-invasive laser photobiomodulation treatment as an on-site treatment for crush-injured gastrocnemius muscles, developing a moderate muscle crush injury model and aiming at decreasing damage extent while regaining physical competence faster. Study design/materials and methods Muscle crush injury was performed on 30 female Wistar rats using direct pressure for 10 minutes on the gastrocnemius muscle in both left and right hindlimbs. Immediately after the injury, only the left hindlimb were irradiated for 16 minutes (with 780 nm laser with a power of 250 mW, the energy at the target was 240 J, and the fluence was 1019 J/cm2 ) for 1, 3, or 7 consecutive days, and sacrificed accordingly. During the follow-up period, 1, 3, or 7 days, both gastrocnemius muscles (of the treated and untreated hindlimbs) were evaluated for electrophysiology and functionality. Results The laser photobiomodulation treatment showed a significant electrophysiological and functional recovery of the gastrocnemius muscle during the first 3 days after injury, in comparison with the untreated hindlimb. Conclusions These preliminary results are promising, showing a significant effect of the laser photobiomodulation treatment during the first 3 days after the induction of the muscle crush injury, which is the most critical period in the clinical aspect. These findings suggest a therapeutic approach, which may help restore the muscle after crush injury.

The aim of this study was to determine that low-intensity pulsed ultrasound (LIPUS) at an intensity of 140 mW/cm² promotes functional and histologic improvements in sciatic nerve crush injury in a rat model and to investigate changes over time in relevant growth factors and receptors, exploring the mechanism of LIPUS in the recovery process after injury. Toe angle in the toe-off phase, regenerative axonal length, myelinated nerve fiber density, diameter of myelinated nerve fiber, axon diameter and myelin sheath thickness were significantly higher in the LIPUS group than in the sham group. Gene and protein expression of brain-derived neurotrophic factor (BDNF) was upregulated in the LIPUS group. In conclusion, LIPUS contributed to rapid functional and histologic improvement and upregulated BDNF expression after sciatic nerve crush injury in rats.

In adult mammals, axon regeneration is limited within the lesion site after injury to the optic nerve. Changes in the microenvironment of lesion sites play an important role in retinal ganglion cells (RGCs) axon regeneration along with other intrinsic factors. In this study, the effect of the lesion site on the microenvironment and axon growth was evaluated using a refined optic nerve crush (ONC) injury model, in which the injury range was extended compared to classical injury. The number of regenerated axons labeled anterogradely with cholera toxin B fragment (CTB) was significantly increased in the long-range crush injury (LI) group compared to the ONC group at distances of 500, 1000 and 1500 µm from the initial site of the injury. These data confirmed that RGC axons can regenerate inside the lesion site. Immunofluorescence and proteomic analysis showed that the microenvironment at the lesion site was highly heterogeneous. The levels of myelin-associated inhibitors, chondroitin-sulfate proteoglycans (CSPGs) and other axon growth inhibitors decreased inside the lesion site compared to the posterior segment of the optic nerve lesion site. The expression of multiple lysosome-related enzymes, metabolic inhibitors including cholesterol esterase, cathepsin B, D, Z and arylsulfatase B (ARSB) were significantly increased inside the lesion site for the LI group compared to the normal optic nerves. Our results suggest that the model of long range optic nerve injury is more useful towards understanding the lesion microenvironment and the endogenous regeneration of RGCs. Also, we showed that myelin and neurocan (a CSPG) are differently expressed in the optic nerve between the interior and posterior lesion sites and may explain why axons cannot reach the brain through the lesion site.

Objective The aim of the present study was to summarize the clinical efficacy of three‐dimensional (3D) printing technology combined with the Masquelet technique in the treatment of calcaneal defects. Methods From January 2018 to April 2019, 3D printing combined with induced masquelet technology was used to treat four patients with calcaneal defects, including two men and two women. The patients were aged 22–52 years old, with an average age of 36 years. There were two cases of traffic accident injuries, there was one case of a fall from height, and there was one case of crush injury. CT scans were used to reconstruct the bilateral calcaneus, mirror technology was used to construct the bone defect area, and Materialise 3‐matic software was used to design the calcaneus shaper mold and 3D print the mold. During the operation, the mold was used to shape the bone cement and fill the bone defect. In the second stage, the bone cement was removed and autologous bone was implanted to repair the bone defect. All patients were followed up to observe the effect. Results All four patients were followed up for 14 months (range, 10–18 months). There were three cases of infectious bone defects: two cases of Escherichia coli and one case of Pseudomonas aeruginosa. The 3D printed mold was used to shape the bone cement. During the operation, it was found to have a high degree of matching with the defect area of calcaneus. There is no need to adjust it again, and the wound healed well after the first stage. In the second stage of surgery, it was found that the induced membrane formed was complete and of appropriate size; the bone cement was easily removed during the operation. The fracture healing time was 3–6 months, with an average of 4 months. At the last follow up, there was no pain and the patients walked with full weight bearing. The Maryland score was 94 points (range, 88–98 points); three cases were excellent and one case was good. The AOFAS score ranged from 86 to 98, with an average of 92.8 points; three cases were excellent and one case was good. Conclusion Three‐dimensional printing technology combined with induced membrane technology is an effective approach for treating calcaneal bone defects., a. 3D printed model of the affected side and healthy side. b. Mold design of the shaper. c. Debride the wound to the osteotomy surface and see the seepage of fresh blood. d. The shaper mold will solidify the bone cement. e. The lateral skin flap of the leg repairs the skin defect of the foot. f. Appearance of the last follow‐up.

Closed degloving injuries are uncommon, high-energy injuries that separate the bony structures from the soft tissue and frequently result in amputation. Because the epidermis is often intact, it is difficult to visualize the extent of the soft tissue damage. Although there is no gold standard of treatment for closed degloving injuries at present, previous cases have reported that neurovascular presentation is a key predictor of amputation Herein, we report a closed degloving injury involving the second through fifth phalanges of the left foot following a crushing injury with a forklift. Despite adequate capillary refill upon initial presentation, the patient ultimately underwent transmetatarsal amputation.

Traumatic peripheral nerve injury (TPNI) represents a major medical problem that results in loss of motor and sensory function, and in severe cases, limb paralysis and amputation. To date, there are no effective treatments beyond surgery in selective cases. In repurposing studies, we found that daily systemic administration of the FDA-approved drug 4-aminopyridine (4-AP) enhanced functional recovery after acute peripheral nerve injury. This study was aimed at constructing a novel local delivery system of 4-AP using thermogelling polymers. We optimized a thermosensitive (4-AP)–poly(lactide-co-glycolide)–b-poly(ethylene glycol)–b-poly(lactide-co-glycolide) (PLGA–PEG–PLGA) block copolymer formulation. (4-AP)–PLGA–PEG exhibited controlled release of 4-AP both in vitro and in vivo for approximately 3 weeks, with clinically relevant safe serum levels in animals. Rheological investigation showed that (4-AP)–PLGA–PEG underwent a solution to gel transition at 32 °C, a physiologically relevant temperature, allowing us to administer it to an injured limb while subsequently forming an in situ gel. A single local administration of (4-AP)–PLGA–PEG remarkably enhanced motor and sensory functional recovery on post-sciatic nerve crush injury days 1, 3, 7, 14, and 21. Moreover, immunohistochemical studies of injured nerves treated with (4-AP)-PLGA-PEG demonstrated an increased expression of neurofilament heavy chain (NF-H) and myelin protein zero (MPZ) proteins, two major markers of nerve regeneration. These findings demonstrate that (4-AP)–PLGA–PEG may be a promising long-acting local therapeutic agent in TPNI, for which no pharmacologic treatment exists.

Introduction Limb injury is a major health concern that imposes a direct danger to both life and limb viability. At Kandou Hospital Manado, hyperbaric oxygen (HBO) therapy has been performed as an adjunctive treatment for crush injury although no study has yet directly compared outcomes of HBO versus conventional therapy. Documentation of the association between HBO therapy and the healing process of crush injury is necessary to reduce the gaps in the literature and to establish an evidence-based clinical use of HBO therapy. Methods In this study, we assessed the changes in the vascular endothelial growth factor (VEGF) serum levels and VEGF mRNA expression as biomarkers of wound healing using ELISA and qRT-PC at four different measurement times: at baseline, after receiving initial treatment (debridement and limb-salvage surgeries), 2 h after the first session HBOT, and after a full 10 HBOT sessions. A randomized controlled trial (RCT) was used to enroll patients subjected to crush injury who were admitted to the Surgical Emergency Department (ER) of Kandou Hospital Manado, Indonesia. Results VEGF serum levels increased significantly in patients suffering from crush injury who received HBO therapy versus the control group. The increased VEGF serum is expected to result in an acceleration time of wound healing and a reduction in amputation rate. Conclusion There was a significant difference between crush injury patients who received conservative therapy versus those receiving HBO therapies; thus, there was an increased likelihood of an accelerated wound healing and a reduction in the risk of amputation.

After complete spinal cord injuries (SCI), spinal segments below the lesion maintain inter-segmental communication via the intraspinal propriospinal network. However, it is unknown whether selective manipulation of these circuits can restore locomotor function in the absence of brain-derived inputs. By taking advantage of the compromised blood-spinal cord barrier following SCI, we optimized a set of procedures in which AAV9 vectors administered via the tail vein efficiently transduce neurons in lesion-adjacent spinal segments after a thoracic crush injury in adult mice. With this method, we used chemogenetic actuators to alter the excitability of propriospinal neurons in the thoracic cord of the adult mice with a complete thoracic crush injury. We showed that activating these thoracic neurons enables consistent and significant hindlimb stepping improvement, whereas direct manipulations of the neurons in the lumbar spinal cord led to muscle spasms without meaningful locomotion. Strikingly, manipulating either excitatory or inhibitory propriospinal neurons in the thoracic levels leads to distinct behavioural outcomes, with preferential effects on standing or stepping, two key elements of the locomotor function. These results demonstrate a strategy of engaging thoracic propriospinal neurons to improve hindlimb function and provide insights into optimizing neuromodulation-based strategies for treating SCI., After complete spinal cord injury, spinal segments below the lesion maintain inter-segmental communication via the intraspinal propriospinal network. Here, the authors show that neurons in these circuits can be chemogenetically modulated to improve locomotor function in mice after spinal cord injury.

Objective The ability to salvage the mangled lower extremity is both technically challenging and time consuming. It requires the collaborative efforts amongst multiple surgical specialties in addition to comprehensive post-traumatic wound follow-up. Our institution has integrated a dynamic effort amongst these specialists in the planning and facilitating a successful limb salvage program with creation of a mangled extremity algorithm. An integral part in this process is the vascular inflow to prepare coverage for large tissue defects lacking adequate recipient targets. Utilization of long saphenous arterial-venous loop has been cited with minimal data available using larger inflow vessels in the acute trauma setting. We performed a retrospective review and describe our early experience using our protocol with arteriovenous (AV) loop creation with free flap reconstruction to salvage traumatic leg injuries. Using the data, we sought to develop a mangled extremity protocol for trauma centers to follow to guide mangled limb salvage. Methods Since June 2016, 398 patients were admitted to our level II trauma facility with isolated traumatic wounds to the lower extremities. Thirty-one limbs were deemed mangled in which twenty-one received primary amputations due to multiple factors. Ten patients admitted from the trauma service with isolated mangled lower extremities injuries were identified for review. All ten patients sustained severe crush injuries with large soft tissue defects and decreased perfusion for healing but deemed salvageable by multispecialty assessment. Mangled extremity severity scores (MESS) were tabulated. Patients age ranged from 21-44 with 8 males and 2 females. Repeated debridements until successful sterilization of the wounds was accomplished. Ten long saphenous vein arteriovenous loops were anastomosed to the at or above knee popliteal vessels for free flap reconstruction. All patients were followed post AV loop creation for vascular complications and wound assessments. Results All ten patients had sterilization of the wounds with repair of the fracture site prior to vascular reconstruction. Mean debridement to surgical site sterilization was 4.3 washouts (Range 2-7). Successful AV loop creation with long saphenous vein was completed in 100% of patients without vascular complications nor steal events. Free flap tissue transfers directly connected to the loop were completed using 6 rectus abdominis, 3 latissimus dorsi and 1 anterior thigh graft within 10 days of its creation. Patency rates of the AV loop was 100% with 10 successful flap transfers and 90% amputation free survival. One flap did not survive due to recurrent bacterial infection of the hardware. The nine patients with successful procedures reached pre-operative ambulatory status within 3 months after their final surgery. At 24 months follow-up, 90% amputation free survival is still maintained. Conclusion Although a small patient cohort, utilization of long saphenous vein arterio-venous loop is successful as a bridge to free flap transfer for isolated mangled lower extremities. Development and incorporation of our mangled extremity protocol to guide limb salvage has proven successful in our early experience. Long term data needs to be complied to assess patency of the free flap transfer and quality of life outcomes.

Introduction: Morel–Lavallée (MLL) is an uncommon entity that is missed by many physicians, it is the result of a shearing force that leads to degloving of the subcutaneous fat from the underlying deep fascia. Case Report: We present a case of a 15-year-old male patient who presented 3 months after the initial crush injury with a large MLL lesion at the lateral aspect of the right proximal thigh. He was treated with incision and drainage with compressive dressing and a negative pressure drain. Conclusion: Diagnosis of MLL is usually clinical and can be aided with radiological tools like MRI that is the gold standard of imaging in this lesion. Several treatment options are available, ranging from conservative treatment with compressive bandages to percutaneous drainage, injection of sclerotic agents, and surgical treatment with incision, drainage, and debridement. Diagnosis and treatment should be familiar to all caregivers to prevent further complications that could be life or organ-threatening. Keywords: Morel–Lavallée, thigh trauma, chronic Morel–Lavallée, thigh mass.

Introduction: Peripheral nerve crush injury (PNCI) models are commonly used to study nerve damage and the potential beneficial effects of novel therapeutic strategies. Current models of PNCI rely on inter-device and operator precision to limit the variation with applied pressure. Although the inability to accurately quantify the PNCI pressure may result in reduced reproducibility between animals and studies, there is very limited information on the standardization and quantification of applied pressure with PNCI. To address this deficit, we constructed a novel device comprised of an Arduino UNO microcontroller board and Force Sensitive Resistor capable of reporting the real-time pressure applied to a nerve. Methods: Two forceps and two needle drivers were used to perform 30-second PNCIs to the sciatic nerves of mice (n = 5/group). Needle drivers were set to the first notch, and a jig was used to hold the forceps pinch at a reproducible pressure. The Force Sensitive Resistor was interposed in-series between the nerve and instrument during PNCI. Results: Data collected from these procedures displayed average needle driver pressures an order of multitude greater than forceps pressures. Additionally, needle driver inter- and intra-procedure pressure remained more consistent than forceps pressure, with needle driver coefficient of variation equal to 14.5% vs. a forceps coefficient of variation equal to 45.4%. Conclusions: This is the first demonstration of real-time pressure measurements in PNCI models and it reveals that the applied pressures are dependent on the types of device used. The large disparity in pressure represents an inability to apply graded accurate and consistent intermediate pressure gradients in PNCI. These findings indicate a need for documentation of pressure severity as a screening for PNCI in animals, and the real-time pressure sensor could be a useful tool in monitoring and applying consistent pressure, reducing the outcome variability within the same experimental model of PNCI.

Objective: This study aimed to investigate the potential neuroprotective action of brimonidine against facial nerve crush injury in rats and the possible underlying mechanisms. Methods: Sixty Wistar adult rats were randomly and equally divided into 3 groups: 40 rats underwent unilateral facial nerve crush injury and were administered with either saline (intraperitoneal, n = 20) or brimonidine 1 mg/kg/day (intraperitoneal, n = 20) for 5 consecutive days. Functional and electromyographic recovery was recorded postoperatively. The facial nucleus of 5 mice in each group was analyzed for mRNA expression levels of GFAP, PAF, NT-4, P75NTR, NF-κB, TNF-α, IL-6, and α2-ARs by qRT-PCR. Results: Brimonidine promoted the recovery of vibrissae movement, eyelid closure, and electrophysiological function in a rat model of nerve crush injury. Hematoxylin and eosin staining and electron microscopy showed significant recovery of Schwann cells and axons in the brimonidine group. Brimonidine attenuated the crush-induced upregulation in GFAP and PAF mRNA (p < 0.05), as well as enhanced the mRNA levels of NT-4 and P75NTR (p < 0.05), while decreased the expression of NF-κB, TNF-α and IL-6 (p < 0.05). Conclusions: Brimonidine could promote the recovery of facial nerve crush injury in rats via suppressing of GFAP/PAF activation and neuroinflammation and increasing neurotrophic factors. Brimonidine may be apromising candidate agent for the treatment of facial nerve injury.

Compartment syndrome is a serious condition that results from increased pressure in a closed muscle compartment segment, which affects tissue perfusion and leads to necrosis. It can be acute because of fracture and crush injury or chronic due to recurrent transient increases in the intra-compartmental pressure that occurs during exertional activities. Rhabdomyolysis is a rare cause of compartment syndrome; clinicians should be aware of different atypical presentations of compartment syndrome and should have a low threshold for such a case. Early diagnosis and intervention may lead to better clinical outcome and may prevent any possible complication or future morbidity and disabilities. We are presenting a rare case of spontaneous atraumatic four-limb compartment syndrome in a patient post-minimal exertion, which was managed by urgent surgical fasciotomy and compartment decompression. 29 months follow-up; patient regained full function of both upper extremity without residual motor or sensory deficit, while he had bilateral foot drop without sensory deficit, and he was walking using bilateral ankle foot orthotic (AFO). We hypothesize that his compartment syndrome developed due to rhabdomyolysis, which was extenuated by dehydration.

4-Aminopyridine (4-AP) is a potassium channel blocker that enhances nerve excitability. In this study, rat models that have facial nerve crush injury (FNCI) were grouped and treated with methylprednisolone (MP), 4-AP, and a combination of these two drugs. Electrophysiologic and histopathologic outcomes of these groups will be compared with a control group. Thirty healthy male Wistar rats (mean weight of 265 g) were used in this study. The rats were randomly divided into five groups with six subjects in each: Group 1 (sham group), Group 2 (control group), Group 3 (MP group), Group 4 (4-aminopyridine group), and Group 5 (4-AP + MP group). All groups except the sham group underwent crush injury to the right facial nerve. Electrophysiologic and histologic recovery was recorded three weeks postoperatively. The 4-AP group and the combined group had a more significant recovery at Nerve Excitability Thresholds (NET) at the end of three weeks. The methylprednisolone group and the control group had a minimal recovery of NET. Histologically, when compared with the control group, the combined group was the only group that had significant recovery at all three of axonal degeneration, axon diameter, and myelin thickness. In this experimental study, we demonstrated that a combination treatment of 4-AP and MP is more effective in the recovery of peripheric FNCI than in the no-treatment control group and in the 4-AP- or MP-alone groups. Moreover, our results suggested that 4-AP can be a potent alternative to MP in the treatment of the FNCI. N/A.

Background Cavernosal fibrosis, which is induced by cavernosal nerve (CN) injury and progresses with time, is the main cause of cavernosal veno-occlusive dysfunction (CVOD) after radical prostatectomy. Objectives To determine whether daily oral administration of suberoylanilide hydroxamic acid (SAHA; vorinostat) for 5-weeks from the immediate post-injury period after CN injury would rectify CVOD by suppressing cavernosal fibrosis and normalizing HDAC pathway in a rat model of CN crush injury (CNCI) and to compare the results with those obtained using chronic administration of PDE5-inhibitors (a positive control). Methods Fifty-six 12-week-old rats were randomized into the four groups: sham surgery (S), CNCI (I), and CNCI treated with daily administration of 25.0 mg/kg SAHA (V) or 20.0 mg/kg udenafil (P). Group-V and Group-P received the respective treatment for 5-weeks from the following day after CNCI. At 5 weeks after surgery, dynamic infusion cavernosometry (DIC), histological staining, and Western blot analysis were performed. Results Group-I had a significantly decreased papaverine response, higher maintenance rate or drop rate, lower smooth muscle (SM)/collagen ratio, decreased SM content, and increased protein expression of HDAC2, HDAC3, TGF-β1, and collagen-1, compared with Group-S. The three DIC parameters in Group-V and Group-P significantly improved compared to those in Group-I. Except for the maintenance rate, the improvement in papaverine response and drop rate in Group-V was not significantly different from that in Group-P. Group-V and Group-P showed the rectification of SM/collagen ratio and protein expression of TGF-β1 or collagen-1. SM content was improved in Group-P, but not in Group-V. Group-V showed the normalization of protein expression of both HDAC2 and HDAC3, whereas protein expression of only HDAC2 was partially restored in Group-P. Discussion Treatment strategies targeting the HDAC pathway might be helpful to alleviate CVOD induced by CN injury. Conclusions According to our data, chronic administration of SAHA improves post-injury CVOD by suppressing cavernosal fibrosis via rectifying the HDAC/TGF-β1 pathway in nerve-injured rats, comparable to that with PDE5 inhibitors.

Peripheral nerve injury often leads to neuropathic pain. In the present study, we assessed the role of liver x receptor alpha (LXRα), an oxysterol regulated nuclear transcription factor that promotes reverse cholesterol transport and alternative (M2) macrophage activation, in the development of neuropathic pain. We found that compared to WT mice, in LXRα knockout mice the development of mechanical allodynia following sciatic nerve crush was accelerated and the duration was prolonged. Furthermore, the expression of M1-like macrophage marker iNOS and M1-like macrophages inducer hydrogen peroxide (H2O2) was increased, whereas expression of M2 macrophage marker arginase-1 (Arg-1) and interleukin-10 (IL-10) was reduced in the sciatic nerve of LXRα knockout mice. Moreover, peri-sciatic administration of LXRs agonist GW3965, immediately after the nerve crush, into wild type mice, suppressed the mechanical allodynia induced by crush injury. GW3965 also suppressed the expression of iNOS and production of H2O2 in the injured nerve and enhanced the expression of IL-10 and Arg-1. Importantly, peri-sciatic administration of IL-10 neutralization antibody prevented the alleviating effect of GW3965 on mechanical allodynia. Altogether, these results indicates that the lack of LXRα in the sciatic nerve results in an augmented inflammatory profile of macrophages, which ultimately speed up the development of neuropathic pain and dampen its recovery following nerve injury. Activation of LXRα by its agonist might rebalance the neuroprotective and neurotoxic macrophage phenotypes, and thus alleviate the neuropathic pain behavior.

Background Intestinal transplantation (ITx) is performed as an isolated ITx or as a part of multivisceral transplantation for intestinal failure secondary to short gut syndrome, inflammatory bowel disease, trauma, and sequelae of chronic parenteral nutrition dependence. Wound complications after ITx are very common, and abdominal wound closure cannot be immediately achieved in half of cases. Case presentation A 25-year-old man sustained an abdominal crush injury causing complete loss of his small intestine, requiring an isolated ITx in March 2016. He lost his graft because of early exfoliative rejection in November 2016. Five months after enterectomy and the immunosuppression-free period, he underwent multivisceral retransplantation in April 2017. His post-transplant course was complicated by wound healing problems that improved with treatment of his malnutrition, quantified by increasing albumin, total protein, prealbumin, weight, body mass index, and total psoas muscle area over a period of 19 months after retransplant. Conclusion To our knowledge, this is the first case described of long-term wound follow-up after a multivisceral (re)transplantation, with corresponding nutrition information and images of the wound.

Ultrasound-guided platelet-rich plasma (PRP) injection is able to make up for the limitations of applying a single growth factor. The goal of this study was to investigate the effects of serial ultrasound-guided PRP injections of the appropriate concentration on the treatment of sciatic nerve crush injury, and explore the value of multimodality ultrasound techniques in evaluating the prognosis of crushed peripheral nerve. In vitro, optimal concentration of PRP (from 150%, 250%, 450%, and 650%) was screened due for its maximal effect on proliferation and neurotrophic function of Schwann cells (SCs). In vivo, ninety rabbits were equally and randomly divided into normal control, model, PRP-2.5×, PRP-4.5×, and PRP-6.5× groups. The neurological function and electrophysiological recovery evaluation, and the comparison of the multimodality ultrasound evaluation with the histological results of sciatic nerve crush injury were performed to investigate the regenerative effects of PRP at different concentrations on the sciatic nerve crush injury. Our results showed that the PRP with a 4.5-fold concentration of whole blood platelets could significantly stimulate the proliferation and secretion of SCs and nerve repair. The changes in stiffness and blood perfusion were positively correlated with the collagen area percentage and VEGF expression in the injured nerve, respectively. Thus, serial ultrasound-guided PRP injections at an appropriate concentration accelerates the recovery of axonal function. Multimodality ultrasound techniques provide a clinical reference for prognosis by allowing the stiffness and microcirculation perfusion of crush-injured peripheral nerves to be quantitatively evaluated.

BACKGROUND: Distal phalanx fractures are frequently encountered in our daily practice. They are often caused by crush injuries and are the most frequent work-related hand fractures. Different types of fixation have been proposed for displaced fractures. METHODS: A retrospective study was performed on two fixation types. Twenty-four distal phalanx fractures were treated with k-wire fixation with fluoroscopic control in a main operating room setting. Twenty-five distal phalanx fractures were treated with hypodermic needle fixation without fluoroscopic control in an emergency treatment room setting. Clinical and radiological data were collected on fracture type, fracture healing and complications. The cost of both types of surgery was assessed. RESULTS: No significant difference in healing time, union, delayed union and non-union was found between the two groups. Loosening was significantly more frequent in the hypodermic needle group, without affecting clinical or radiographic outcome. No infections were encountered in both groups. Surgery performed in the emergency treatment room reduced the cost with 9000 dollars when compared to surgery performed the main operating room. CONCLUSION: Treatment of displaced distal phalanx fractures with hypodermic needle fixation yields good results. Performing this procedure in a treatment room is safe and might reduce operative time, institutional costs and radiation exposure for both surgeon and patients.

Spinal cord injury in mammals is thought to trigger scar formation with little regeneration of axons1–4. Here we show that a crush injury to the spinal cord in neonatal mice leads to scar-free healing that permits the growth of long projecting axons through the lesion. Depletion of microglia in neonatal mice disrupts this healing process and stalls the regrowth of axons, suggesting that microglia are critical for orchestrating the injury response. Using single-cell RNA sequencing and functional analyses, we find that neonatal microglia are transiently activated and have at least two key roles in scar-free healing. First, they transiently secrete fibronectin and its binding proteins to form bridges of extracellular matrix that ligate the severed ends of the spinal cord. Second, neonatal—but not adult—microglia express several extracellular and intracellular peptidase inhibitors, as well as other molecules that are involved in resolving inflammation. We transplanted either neonatal microglia or adult microglia treated with peptidase inhibitors into spinal cord lesions of adult mice, and found that both types of microglia significantly improved healing and axon regrowth. Together, our results reveal the cellular and molecular basis of the nearly complete recovery of neonatal mice after spinal cord injury, and suggest strategies that could be used to facilitate scar-free healing in the adult mammalian nervous system. In neonatal mice, scar-free healing after spinal cord injury is organized by microglia, and transplantation of neonatal microglia or peptidase-inhibitor-treated adult microglia into adult mice after injury improves healing and axon regrowth.

BACKGROUND Nerve diseases and injuries, which are usually accompanied by motor or sensory dysfunction and disorder, impose a heavy burden upon patients and greatly reduce their quality of life. Dental pulp stem cells (DPSCs), derived from the neural crest, have many characteristics that are similar to those of neural cells, indicating that they can be an ideal source for neural repair. AIM To explore the potential roles and molecular mechanisms of DPSCs in crushed nerve recovery. METHODS DPSCs were isolated, cultured, and identified by multilineage differentiation and flow cytometry. Western blot and immunofluorescent staining were applied to analyze the expression levels of neurotrophic proteins in DPSCs after neural induction. Then, we collected the secretions of DPSCs. We analyzed their effects on RSC96 cell proliferation and migration by CCK8 and transwell assays. Finally, we generated a sciatic nerve crush injury model in vivo and used the sciatic function index, walking track analysis, muscle weight, and hematoxylin & eosin (H&E) staining to further evaluate the nerve repair ability of DPSCs. RESULTS DPSCs highly expressed several specific neural markers, including GFAP, S100, Nestin, P75, and NF200, and were inclined toward neural differentiation. Furthermore, neural-induced DPSCs (N-DPSCs) could express neurotrophic factors, including NGF, BDNF, and GDNF. The secretions of N-DPSCs could enhance the proliferation and migration of Schwann cells. In vivo, both DPSC and N-DPSC implants alleviated gastrocnemius muscle atrophy. However, in terms of anatomy and motor function, as shown by H&E staining, immunofluorescent staining, and walking track analyses, the repair effects of N-DPSCs were more sustained, potent, and effective than those of DPSCs and the controls. CONCLUSION In summary, this study demonstrated that DPSCs are inclined to differentiate into neural cells. N-DPSCs express neurotrophic proteins that could enhance the proliferation and migration of SCs. Furthermore, our results suggested that N-DPSCs could help crushed nerves with functional recovery and anatomical repair in vivo. Thus, DPSCs or N-DPSCs could be a promising therapeutic cell source for peripheral nerve repair and regeneration.

Background: Facial nerve (FN) injury is an important health issue worldwide and the most essential principle for all surgeonsis proper diagnosis and early treatment.Aim of the study: Evaluation of the effect of Cerebrolysin (CBL) versus N-acetyl-cysteine (NAC) on FN regeneration.Materials and Methods: Normal 24 Sprague Dawely adult male rats were selected with a weight range 250 - 300 gm. CrushtypeFN injury was performed on the right side of all rats then, they were randomly divided into three equal groups of eightrats each. In group I, the rats were left without any treatment and considered as a control. Rats of group II received 50 mg/kg/day NAC intraperitoneally for a period of 28 days while rats of group III received 2.5 ml/kg/day CBL intraperitoneallyfor the same period. Postoperatively, eye-blink reflex was used to evaluate the functional recovery after the 2nd and the 4thweeks. All animals were euthanized by overdose of diethyl ether after 28 days and nerve regeneration was evaluated based onhistopathological and immunohistochemical (IHC) examinations. All data collected were analyzed using SPSS version 20.0software. Statistical significance was inferred at a P value ≤ 0.05.Results: Nerve regeneration was obvious in group III with significant improvement of the eye-blink reflex at 2weeks period thatbecame non-significant at 4 weeks. Histological and IHC evaluation revealed high regeneration and minimum inflammation ingroup III when compared with groups I and II.Conclusion: CBL enhances nerve regeneration and rehabilitation better than NAC after facial nerve crush injury in rats.

The main goals of treating severe crush injuries are debriding away devitalized tissue and filling any resultant dead space with vascularized tissue. In the authors' experience, the most ideal methods for soft tissue coverage in treating crush injuries are the iliac flap, the adipofascial lateral arm flap, and the gracilis flap. Accompanying bone defects respond very well to free corticoperiosteal flaps. Digital defects often require the use of complete or subtotal toe transfer to avoid amputation and restore function to the hand.

Introduction. Midfoot dislocations are rare traumatic injuries. The best known patterns involve the Lisfranc and Chopart joints, although some other types have been described. Dislocations that occur at the level of the naviculocuneiform and calcaneocuboid joints simultaneously represent a very rare configuration of dislocation. Case Presentation. A 34-year-old man sustained a crush injury to his left foot causing a complete dislocation through the naviculocuneiform and calcaneocuboid joints. Immediate closed reduction and percutaneous pinning were performed, followed by open reduction and stabilization of both joints two weeks later. Anatomical reduction was obtained, and the clinical outcome remained satisfactory 10 months after surgery. Discussion. Anatomical reduction is essential to obtain favorable outcomes in traumatic midfoot injuries. An unusual pattern of midfoot dislocation can be treated according to the same principles as those for classical Lisfranc or Chopart injuries.

Trauma-mediated peripheral nerve axon injury invariably involves structural alteration of the axonal plasmalemma cell membrane. Increased axonal membrane permeability to electrolytes results in metabolic stress and axonal degeneration if the axon does not seal. Poloxamer 188 (P188) is a linear multiblock copolymer composed of a hydrophobic polyoxypropylene (POP) block in the middle with polyethylene glycol (PEG) blocks on both ends. The central POP block concentrates at sites of cell membrane disruption and catalyzes sealing of disrupted cellular membranes. We tested the hypothesis that intravenously administered P188 (9800 Da, 0.2 mM) can accelerate distal axon recovery after sciatic nerve crush injury using an established axonotemetic model. A crush injury was performed on the sciatic nerve of thirty female Sprague-Dawley rats. Rats were randomized to receive either 0.2 mM P188 or Dextran, administered 1 h after crush injury. Compound nerve action potentials (CNAP) and density of neurofilament distal to the point of injury were analyzed on post-crush day (PCD) 4, 14, and 21. A significant improvement in axonal conduction for animals treated with P188 was observed for PCD 4 and PCD 14 (p

The damage or loss of retinal ganglion cells (RGCs) and their axons accounts for the visual functional defects observed after traumatic injury, in degenerative diseases such as glaucoma, or in compressive optic neuropathies such as from optic glioma. By using optic nerve crush injury models, recent studies have revealed the cellular and molecular logic behind the regenerative failure of injured RGC axons in adult mammals and suggested several strategies with translational potential. This review summarizes these findings and discusses challenges for developing clinically applicable neural repair strategies.

The primary aim of this study was to assess the epidemiological evaluation of acute pediatric hand injuries frequently encountered in emergency department units. Its secondary aim was to identify the risk factors associated with such injuries. Out of the 1547 acute hand and forearm injury cases admitted to emergency trauma department between March 2017 and March 2018, the 129 injuries pertaining to children were included in the study. Mechanism, time, etiology, injured structures, anatomical regions, cut structures, and occupational accident status were determined in addition to demographic information. The injuries were evaluated according to circadian rhythm in order to ascertain the hours of intensification. The Modified Hand Injury Severity Score (MHISS) was used to assess injury severity. The mean age of 129 patients was 10.1 years. The most injuries were observed in the groups of patients over 12 years of age (57, 44%), and 0-6 years of age (42, 32%), respectively. Nineteen students participating in vocational internships were injured (14%). Twenty-six cases (20%) in the 12-year-old group involved punching glass, and 34 (26%) cases in the 0-6 age groups involved fingertip crush injuries. Temporal injury intensity was seen to have increased between 12.00 and 19.00 hours. The mean MHISS was 41 (8-120). Injury prevention measures need to be increased, particularly for fingertip injuries. A specific injury severity assessment system is also required for pediatric hand injuries, which are often simpler and easier to treat than adult hand injuries. Additionally, training and increasing awareness are believed to be important steps in preventing pediatric hand injuries.

BACKGROUND Postinjury hypercoagulability occurs in >25% of injured patients, increasing risk of thromboembolic complications despite chemoprophylaxis. However, few clinically relevant animal models of posttraumatic hypercoagulability exist. We aimed to evaluate a rodent model of bilateral hindlimb injury as a preclinical model of postinjury hypercoagulability. METHODS Forty Wistar rats were anesthetized with isoflurane: 20 underwent bilateral hindlimb fibula fracture, soft tissue and muscular crush injury, and bone homogenate injection intended to mimic the physiological severity of bilateral femur fracture. Twenty sham rats underwent anesthesia only. Terminal citrated blood samples were drawn at 0, 6, 12, and 24 hours (n = 5 per timed group) for analysis by native thromboelastography in the presence and absence of taurocholic acid to augment fibrinolysis. Plasminogen activator inhibitor 1 and α-2 antiplasmin levels in plasma were assessed via enzyme-linked immunosorbent assay. RESULTS Injured rats became hypercoagulable relative to baseline by 6 hours based on thromboelastography maximal amplitude (MA) and G (p < 0.005); sham rats became hypercoagulable to a lesser degree by 24 hours (p < 0.005). Compared with sham animals, injured rats were hypercoagulable by MA and G within 6 hours of injury, remained hypercoagulable by MA and G through at least 24 hours (all p < 0.01), and showed impaired fibrinolysis by taurocholic acid LY30 at 12 hours (p = 0.019) and native LY30 at 24 hours (p = 0.045). In terms of antifibrinolytic mediators, α-2 antiplasmin was elevated in trauma animals at 24 hours (p = 0.009), and plasminogen activator inhibitor 1 was elevated in trauma animals at 6 hours (p = 0.004) and 12 hours (p < 0.001) when compared with sham. CONCLUSIONS Orthopedic injury in rodents induced platelet and overall hypercoagulability within 6 hours and fibrinolytic impairment by 12 to 24 hours, mimicking postinjury hypercoagulability in injured patients. This rodent model of orthopedic injury may serve as a preclinical testing ground for potential therapies to mitigate hypercoagulability, maintain normal fibrinolysis, and prevent thromboembolic complications.

Accurate diagnosis and management of a femoral vascular injury is important as it is a life-threatening injury with high morbidity and mortality. This is the case of a 75-year-old man admitted to the emergency room with trauma to the right groin due to a horse fall. Computed tomography showed active bleeding of the femoral artery without pelvic or femoral fracture. We inserted a stent-graft, but hypotension persisted. Exploration of the groin was completed, and the bleeding from the external iliac vein was identified and repaired. In conclusion, vascular injury is rare in groin trauma without associated fracture, however, arterial and venous injury should not be completely ruled out. Endovascular therapy is worth recommending as a quicker and safer management than surgery in patients with active bleeding in the femoral artery. However, the possibility of combined injury of the femoral vein should be suspected in case of ongoing hemodynamic instability.

The discipline of reconstructive surgery has been slow to accept the role of hyperbaric oxygen therapy (HBOT) as an adjunct to surgery, despite clinical and experimental data showing potential benefits. Obstacles prevent this acceptance; one of the most potent is surgeon bias. This article attempts to lessen this bias by reviewing the benefits of HBOT in conditions where there is uniform acceptance of its role, such as carbon monoxide poisoning and decompression illness. It demonstrates that these conditions have similar pathophysiologic derangements to conditions commonly encountered by the reconstructive/wound care surgeon, including crush injuries, compartment syndrome, compromised flaps, and thermal burns.

Background Conservative treatment, such as electrical stimulation and steroid injection, have been employed in an attempt to improve symptoms after peripheral nerve injury, without significant success. Although non-invasive and safe extracorporeal shockwave therapy (ESWT) can be a practical alternative, the therapeutic effects of ESWT on peripheral nerve remyelination has not been established. Objectives To investigate the effects of ESWT on peripheral nerve remyelination and gait function for 5 weeks in a sciatic nerve crush model. Material and methods In total, we divided 97 rats into 5 groups: group 1 - a healthy negative control group; group 2 - 3 weeks after sciatic nerve crush and 3 sessions of ESWT; group 3 - 5 weeks after crush injury with 3 sessions of ESWT; group 4 - 3 weeks after crush injury with no ESWT; and group 5 - 5 weeks after crush injury with no ESWT. The focused ESWT was applied to the unilateral sciatic nerve injury site. One session consisted of 1,500 stimuli, and the session were performed at intervals of 1 week. Results The degree of myelination and expression of myelin basic protein at the distal part of the injured sciatic nerve tended to increase in the ESWT groups compared with the no-ESWT groups 3 and 5 weeks after crush injury. Regarding the functional gait recovery, the print width and area of the injured leg in the ESWT groups was significantly larger than that in the no-ESWT groups 3 and 5 weeks after crush injury. Conclusions The ESWT may enhance peripheral nerve remyelination and gait function in a nerve crush model. Long-term follow-up after ESWT and investigation of molecular mechanisms will be needed to confirm these therapeutic effects.

INTRODUCTION: Soft tissue defects due to trauma with crush injuries and post-tumor excision are large in size. Free anterolateral flap provides a stable and durable coverage of soft tissue defects and leads to good functional outcomes. MATERIALS AND METHODS: Between January 2017 and January 2019, eight males and six female patients with soft tissue defects were operated upon using a free anterolateral thigh flaps. The defects in ten patients were due to post-tumor extirpation and in four patients due to wound breakdown following post-tumor extirpation. RESULTS: The average flap dimension was 14 cm × 12 cm. The mean follow-up was 11 months (4–28 months). All the flaps survived well except in one patient who with an upper limb defect, had flap necrosis owing to which patient needed to undergo abdominal flap coverage. Two patients with sarcoma developed local recurrence and had to undergo above‑knee amputation. CONCLUSION: The method of reconstruction depends on the size of defect and area to be covered and need of post-surgery mobilization and need for radiotherapy. The free anterolateral thigh flap has varied uses in orthopedics with very good extent of coverage and provides very potent coverage of neurovascular structures, bones, tendons, and implants.

Despite intense preclinical research focusing on developing potential strategies of mitigating spinal cord injury (SCI), SCI still results in permanent, debilitating symptoms for which there are currently no effective pharmacological interventions to improve the recovery of the fine ultrastructure of the spinal cord. Spirulina platensis is thought to have potential neuroprotective effects. We have previously demonstrated its protective potential on the lesioned corticospinal tracts and behavioral recovery. In this study, spirulina, known for its neuroprotective properties was used to further explore its protective effects on spinal cord gray matter ultrastructural. Twenty-four Sprague-Dawley rats were used and divided into sham group (laminectomy without SCI), control group (SCI without S. platensis), and S. platensis group (SCI + 180 mg/kg S. platensis). All animals were anesthetized via intramuscular injection. A partial crush injury was induced at the level of T12. The rats were humanely sacrificed for 28 days postinjury for ultrastructural study. There were significant mean differences with respect to pairwise comparisons between the ultrastructural grading score of neuronal perikarya of control and the S. platensis following injury at day 28, which correlates with the functional locomotor recovery at this timepoint in our previous study. The group supplemented with spirulina, thus, revealed a better improvement in the fine ultrastructure of the spinal cord gray matter when compared to the control group thereby suggesting neuroprotective potentials of spirulina in mitigating the effects of spinal cord injury and inducing functional recovery.