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Background The minimally invasive plate osteosynthesis procedure has been widely applied for long-bone fixations; however, this technique is not commonly used for clavicular midshaft fractures. In this study, we introduced this technique for midshaft clavicular fractures using superior anatomic locking plates and evaluated its clinical and radiographic outcomes. Materials and methods From June 2013 to July 2014, 15 patients with acute midshaft clavicular fractures were treated with the minimally invasive plate osteosynthesis technique using a 3.5-mm clavicular superior anatomic locking plate. Anteroposterior plain X-ray images of the clavicle were taken at 4-week intervals until union was observed. The last clinical follow-up assessments were performed postoperatively at a mean of 16.54 months (range, 10-23 months). In addition, for clinical evaluations, the Constant score and the Disability of the Arm, Shoulder and Hand score were assessed. Results The average operative time was 60.2 ± 20.1 minutes (range, 40-80 minutes), with blood loss of 25 ± 5 mL (range, 20-30 mL) during the operation. The mean union time for the patients was 10.1 ± 1.4 weeks (range, 8-12 weeks), and no delayed union or nonunion was observed. There were no major complications, including infections, plate breakages, or neurovascular injuries. No skin irritation was observed, and only 2 patients felt local incision numbness. All patients obtained satisfactory shoulder functions. The mean Constant score was 99 ± 1.8 (range, 95-100), and the mean Disability of the Arm, Shoulder and Hand score was 3.8 ± 2.9 (range, 0-10) at the last control visit. Conclusion The minimally invasive plate osteosynthesis procedure that was introduced in this study for midshaft clavicular fractures with superior anatomic locking plate is a reproducible procedure and an alternative to conventional operative methods.

Fractures of the pubic rami due to low energy trauma are common in the elderly, with an incidence of 26 per 100,000 people per year in those aged more than 60 years. The purpose of this study was to evaluate the clinical application of this minimally invasive technique in patients with pubic ramus fractures combined with a sacroiliac joint complex injury, including its feasibility, merits, and limitations. Fifteen patients with pubic ramus fractures combined with sacroiliac joint injury were treated with the minimally invasive technique from June 2008 until April 2012. The quality of fracture reduction was evaluated according to the Matta standard. Fourteen cases were excellent (93.3 %), and one case was good (6.7 %). The fracture lines were healed 12 weeks after the surgery. The 15 patients had follow-up visits between four to 50 months (mean, 22.47 months). All patients returned to their pre-injury jobs and lifestyles. One patient suffered a deep vein thrombosis during the peri-operative period. A filter was placed in the patient before the surgery and was removed six weeks later. There was no thrombus found at the follow-up visits of this patient. The minimally invasive technique in patients with pubic ramus fractures combined with a sacroiliac joint complex injury provided satisfactory efficacy.

Purpose To discuss surgical technique, operative efficacy and clinical outcome of intramedullary fixation in the treatment of subtrochanteric femur fractures. Methods From February 2011 to February 2013, 76 cases of subtrochanteric femur fractures were treated by intramedullary fixation in our hospital, including 53 males and 23 females, with the age range of 37–72 years (mean 53.5 years). According to Seinsheimer classification, there were 2 cases of type I, 7 type II, 15 type III, 23 type IV and 29 type V. Firstly, all patients underwent closed reduction with the guidance of C-arm fluoroscopy in a traction table. Two cases of type I and 3 cases of type III fractures had ideal closed reduction followed by internal fixation. The others needed additional limited open reduction. Radiographic examination was used to evaluate callus formation and fracture healing in postoperative 1, 3, 6 and 12 months follow-up. Functional recovery was evaluated by Harris Hip Scoring (HHS) system. Results Patients were followed up for 6–12 months. All fractures were healed except one patient with delayed union. The average bone union time was 4.5 months. According to HHS system, 65 cases were considered as excellent in functional recovery, 8 good, 2 fair and 1 poor. The proportion of the patients with excellent and good recovery was 96.05%. Conclusion Intramedullary fixation is feasible for the treatment of subtrochanteric femur fracture. The accuracy of intraoperative reduction and surgical skill are important for the clinical outcome and the patients' prognosis.

Background Hook plate (HP) is popularly used for acute and severely displaced acromioclavicular (AC) dislocations. However, subacromial impingement and acromion osteolysis induced by transarticular fixation are notorious. The current case–control study was to compare transarticular fixation by HP to coracoclavicular (CC) stabilization by single multistrand titanium cable (MSTC). Methods Between January 2006 and August 2009, 24 patients with acute AC dislocations were surgically treated by open reduction and transarticular fixation with HP. These patients were matched to a series of 24 patients, who were managed by CC stabilization with MSTC in the same period. All AC dislocations were graded as Rockwood type V. Implant was removed 8 -- 12 months after the primary operation in all patients, and 12 months at least were needed to assess the maintenance of AC joint. Functional results were evaluated before implant removal as well as in the last follow-up based on Constant-Murley criteria. Results There were no differences of demographic data including age, dominant gender and side, injury-to-surgery interval, operation time and follow-up period. In terms of functionality, Constant score was 95.8 ± 4.1 in MSTC group, while 76.7 ± 8.0 in HP group before implant removal (P

To evaluate the application of inferior vena cava filter (IVCF) in prevention of peri-operative pulmonary embolism in patients with bone fracture combined with deep venous thrombosis (DVT).From July 2007 to April 2011, 572 cases of bone fractures consequent with DVT that confirmed by Duplex were deployed IVCF to avoid fatal pulmonary embolism in the para-operative period. There were 318 male and 254 female patients with a mean age of (51±23) years (ranging from 16 to 94 years).All the operations of deployment of the IVCFs were successfully. There were 174 permanent and 399 temporary IVCFs deployed. In all 399 temporary filters, 389 filters were taken out successfully. The mean station time in the IVC of the temporary filters was 22.8 days (7 to 60 days), among which, 118 were found of captured thrombus. After the follow-up of mean 16 months (3 to 40 months) of 566 patients, no pulmonary embolism occurred, but symptomatic DVT were revealed in 15 patients, and the conditions were improved after anticoagulation treatment. No serious complication of post thrombotic syndrome occurred.IVCF deployment can prevent the trauma patients with deep vein thrombosis of fatal pulmonary embolism in the peri-operative period, which may also offer a safe condition to the orthopedic operations.

Paraquat (PQ) poisoning induces many physiological and histological changes in the human body, but PQ-induced pulmonary fibrosis is most often associated with death. The signaling pathway associated with pulmonary fibrosis is reliant on transforming growth factor-beta 1 (tgf- β1) activation of Smad3, as evidenced by Smad3-deficient mice being resistant to tgf- β1-induced pulmonary fibrosis. Thus, we sought to determine whether targeted silencing of Smad3 gene expression could inhibit PQ-induced pulmonary fibrosis in mice. We developed an RNA interference (RNAi) method using short hairpin RNAs (shRNAs) targeting Smad3. The shRNA expression cassettes capable of effectively silencing Smad3 in L929 mouse fibroblasts were transferred to an adenovirus vector and intratracheally administered into mouse lung. Treated mice presented with inhibited Smad3 mRNA and protein and were resistant to PQ-induced pulmonary fibrosis, as evidenced by suppressed expressions of procollagen type I mRNA and hydroxyproline amino acid. Thus, silencing of Smad3 appears to be a promising alternative strategy for the treatment of PQ-induced pulmonary fibrosis.

The molecular aetiology of steroid-induced osteonecrosis (ON) is unclear. The aim of this study was to investigate changes in the femoral head blood supply and vascular endothelial growth factor (VEGF) protein levels following steroid-induced ON of rabbit femoral heads in the early stage of the disease, and to investigate a possible mechanism for ON. Using a classic protocol, ON was induced in 30 male 28-week old New Zealand white rabbits. An additional 15 untreated rabbits served as controls. Change of blood supply in the proximal femur was assessed by dynamic magnetic resonance imaging and microangiography. The VEGF protein and mRNA levels were assessed by immunohistochemistry and quantitative real-time polymerase chain reaction, respectively. After 6 weeks, the results indicated that VEGF protein and mRNA levels were significantly lower and femoral head blood supply had also decreased significantly in ON+ rabbits compared with controls. The down-regulation of VEGF may play a critical role in the disease process of ON.

The purpose of this study was to review the radiographs of symptomatic femoral head osteonecrosis in patients with systemic lupus erythematosus (SLE) and to assess the results of treatment using free vascularised fibular grafting. We retrospectively reviewed 50 patients (80 hips) with SLE who underwent free vascularised fibular grafting for osteonecrosis of the femoral head. All patients were followed up for at least 2 or more years (average, 4.3 years). The mean Harris hip score improved from 72 to 88. At the latest follow-up, we found improved or unchanged radiographs in 12 of initially Stage II hips and in 60 of 64 Stage III or IV hips. No hips failed treatment and underwent total hip arthroplasty. The data suggest that free vascularised fibular grafting was successful in maintaining joint function and in delaying the need for joint replacement procedure.

To evaluate the contribution of the deep circumflex iliac arterial vascularized iliac bone grafting to the reconstruction of the blood supply of the femoral head through the digital subtraction angiography (DSA) or computied tomographic scanning angiography (CTA) of the both deep circumflex iliac artery and ECT, MRI judgement.Forty-five patients with the intracapsular fracture of femoral neck included 30 males and 15 females with an average age of 36.5 years ranging from 16 to 50. The course was from 6 to 25 days(means 10.2 days). There were 20 cases of sub-headfractures, 10 cases of head-neck, 15 cases of trans-neck. All patients were treated by 3 titanium alloy cannulated screws and deep circumflex iliac arterial vascularized iliac bone grafting. A follow-up for an average of 3 years and 6 months was performed. The engorging of the artery and reconstruction of the blood supply of the femoral head was viewed dynamicly,using digital subtraction angiography (DSA) or computied tomographic scanning angiography (CTA) of the both deep circumflex iliac artery and ECT, MRI judgement of the femoral head.Three weeks after operation, 38 transferred arteries were engorging via DSA, 2 of 7 not via CTA, but engorging via DSA. One year later after operation, all arteries were engorging via DSA or CTA. ECT examination in 3, 6, 12 months after operation displayed nuclide enriching in the femoral head and distributing uniformity. The region of interest (ROI) ratios of the fractured head of femur to contralateral counterpart (D/N) in all cases1.0. The average D/N after 3 months was (2.12 +/- 0.21), (2.04 +/- 0.14) after 6 months, (l1.71 +/- 0.11) after 12 months. There was statistical differation between D/N after 12 months and 3 or 6 months (P0.05), but not between 3 and 6 months (P0.05), and MRI examination in all cases no founded decreasing of the density and changing of the form of the femoral head.DSA, CTA, ECT, MRI confirmed that the deep circumflex iliac arterial vascularized iliac bone can provide effective blood supply and is profit to the reconstruction of the blood supply of the femoral head after the fracture of the femoral neck.

Dear Editor, We are grateful for the insightful comments on the PHILOS plating technique for proximal humeral fractures from Nicholas Clement. He has collected prior published data for pooling analysis, found obvious heterogeneity of these studies and revealed marked variations of Constant scores following PHILOS stabilisation. The epidemiological study by Court-Brown and Caesar showed that the mean age of patients suffering proximal humeral fractures is 65 years [1]; however, pooling of data yields an average age of 62 years. We believe the latter might be more representative, for inclusion in the latest studies from more regions. Moreover, we should realise that the population of adults suffering fractures has become younger in past decades due to industrialisation and high-speed transportation. Of course, we have noted that the indications for the PHILOS plating technique might have been broadened. However, we also know all treatment protocols are individualised, and patients should be informed about full consideration of previous outcome, potential risks and prospective results. It is certain that the PHILOS plate can be given priority for use in young active patients. Indeed, the post-operative Constant score varies greatly in these studies even though the variation of age has been adjusted. It might not be difficult to find answers to the question. First, surgical techniques using the PHILOS plate for proximal humeral fractures are currently not consistent. For pooling analysis, the effect of the surgical approach on functional results should be taken into consideration. Moreover, intra-operative repair of concomitant rotator cuff injuries contributes greatly to functional recovery. Second, apart from the age, potential factors, including fracture patterns, dislocation, smoking, reduction quality, systemic diseases and iatrogenic impingement, might affect early and mid-term clinical results [2]. Third, some unrevealed factors might exist, such as psychogenic status, lifestyle and so on. The high incidence of complications has attracted great attention when PHILOS is employed for the elderly [3]. For the majority of stable and extra-articular fractures of the proximal humerus, conservative treatment can yield satisfactory results. However, shoulder arthroplasty cannot resolve all complicated fractures due to the inherent limitation of current shoulder prostheses [4]. Therefore, internal fixation using a plating technique currently seems reasonable and indispensable for proximal humeral fractures in the elderly. Improvement of orthopaedic implants and surgical techniques (such as minimally invasive surgery) continues to be attractive [5]. It is also valuable to reveal and avoid potential risk factors to decrease post-operative complications.

Background Fractures of the intertrochanteric hip are common and the treatment of unstable fractures generally requires an operative approach. In elderly patients, osteoporosis makes internal fixation problematic and frequently contributes to failed fixation and poor clinical results. We have attempted to apply the Less Invasive Stabilization System (LISS) in reverse position for the repair of intertrochanteric hip fractures in elderly patients with osteoporotic bones. A retrospective review is presented of the cases of 28 elderly patients with stable and unstable fractures of the intertrochanteric hip treated using the reverse LISS. Methods We treated 28 elderly patients with a mean age of 82.3 years. According to the Evens classification, there were 2 Type I fractures, 2 Type II fractures, 3 Type III fractures, 13 Type IV fractures, 6 Type V fractures and 2 Type R fractures. All fractures were treated using the reverse LISS. Radiographic and clinical evidence of functional outcome and complications were evaluated. Results Mean perioperative blood loss was 92.4 milliliters (range 35 to 245 milliliters), and the mean postoperative hospital stay was 8.7 days (range 3 to 14 days). Complications included one minor wound hematoma. Radiographically, no collapses, screw cutouts, or head penetrations were seen. All surviving patients (28 of 28; 100 percent) had uneventful fracture healing with union achieved by six months in all patients. Conclusions Use of the Reverse LISS plating for intertrochanteric hip fractures resulted in event-free fracture healing.