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Abstract Background Studies have reported mixed results on the importance of medial calcar support for the treatment of proximal humeral fractures. The purpose of this study was to compare radiographic and functional outcomes of patients who had displaced proximal humeral fractures with varying levels of medial support. Methods We performed a retrospective comparative cohort study. The study was conducted at a Level III trauma center in Taiwan. Seventy patients with proximal humeral fractures were collected retrospectively from 2015 to 2019. Only patients with two-, three-, or four-part types (Neer type I, II, or III) of displaced proximal humeral fractures were included in this study. However, patients with head-split fracture patterns, shoulder dislocation, prior shoulder trauma, and poor fracture reduction present in postoperative films were excluded. We assessed the radiographic outcomes, including the reduction score and amount of impaction in the humeral head. The functional outcome was evaluated based on the Constant score. Results Patients were grouped into the intact medial calcar group and the medial calcar deficiency group. In a subgroup analysis, the group with intact medial support had a significantly lower amount of impaction and a higher Constant score compared with the medial calcar deficiency group. Additionally, the groups with intact medial support had a nonsignificant difference in the Constant score between the affected side and the contralateral side. Conclusion The amount of impaction and the reduction score in the humeral head at the 12-month radiographic follow-up were significantly higher in the group with medial support deficiency. However, the reduction score after surgery exhibited no difference. This implies that the inherent nature of medial comminution of proximal humeral fracture may lead to inferior radiographic outcomes.

Abstract Objective With or without screw stabilization for diastatic syndesmosis in advanced pronation‐external rotation (PE) ankle injuries has not yet been well‐determined. Both techniques were retrospectively compared to investigate the superiority of either of the two. Methods A retrospective cohort study was carried out. From January 1, 2008, to December 31, 2017, 81 consecutive adult patients (average, 42 years; range, 18–78 years; 44 men and 37 women) with advanced PE ankle injuries (stage 3 or 4 PE type) were treated. After malleolar fractures were internally stabilized with screws and plates, the syndesmotic stability was rechecked by external rotation and hook tests. The necessity of cortical screw insertion to stabilize diastatic syndesmosis was decided by the individual orthopaedic surgeon. Postoperatively, a short leg splint was used for 6 weeks. The syndesmotic screw was removed based on the surgeon's policy. The removal of internal fixation for malleolar fractures was required after 1 year. The outcomes of both approaches were compared clinically, and ankle function was compared using the American Orthopaedic Foot and Ankle Society (AOFAS) score. For statistical comparison, the chi‐square test was used for categorical data and the Mann–Whitney U test was used for numerical data. Results Seventy‐one patients (average, 40 years; range, 18–78 years; 40 men and 31 women) were followed for at least 1 year (87.7%; average, 2 years; range, 1–11 years). Group 1 (with syndesmotic stabilization) had 22 patients and Group 2 (without syndesmotic stabilization), 49 patients. The union rate in Group 1 patients was 100% (22/22), and in Group 2 patients, 91.8% (45/49; p = 0.17). One deep wound infection occurred in Group 1 patients and two in Group 2 patients. Syndesmosis re‐diastasis occurred in 13.6% (3/22) of Group 1 patients and 30.6% (15/49) of Group 2 patients (p = 0.13). One syndesmotic screw broke at 6 months. Satisfactory ankle function according to the AOFAS score was noted in 86.4% (19/22) of Group 1 patients and 65.3% (32/49) of Group 2 patients (p = 0.07). Conclusion Insertion of syndesmotic screws to promote ligament healing after internal fixation of malleolar fractures in advanced PE ankle injuries may be reasonable.

Abstract Background Combined ipsilateral femoral neck and shaft fractures are an uncommon type of fractures. A number of different implant options are available for the management of this injury. Two-device procedures were suggested because of the higher rate of malunion by single-device treatment. However, surgical treatment using a cephalomedullary nail is still an alternative option that provides better mechanical advantage and minimal invasion. This study details the technique of treating these pattern fractures with proximal femoral nail anti-rotation II (PFNA-II) to achieve an acceptable reduction in both fracture sites. Methods Ten cases of ipsilateral femoral neck and shaft fractures under reduction by PFNA II were included and reviewed. A saw-bone model was also utilized to perform the detailed technique of reduction and fixation of PFNA II. Results Under the special technique by using the PFNA II, all ten cases achieved optimal reduction and alignment of both fracture sites in intra-operative fluoroscopy. There was no intra-operative complication noted. After 6 months of follow-up, radiography revealed proper alignment and well union of the fractures. Conclusions Fixation of ipsilateral femoral neck and shaft fractures with a single construct provides advantages of good biomechanical function, minimal invasion, reduced blood loss, and less operation time when comparing to two-device fixation. Thus, if acceptable reduction could be achieved, fixation by one PFNA II was a good alternative choice for this injury pattern.

Abstract Background Local injections of anesthetics, NSAIDs, and corticosteroids for tendinopathies are empirically used. They are believed to have some cytotoxicity toward tenocytes. The maximal efficacy dosages of local injections should be determined. A commercial 2D microfluidic xCELLigence system had been developed to detect real-time cellular proliferation and their responses to different stimuli and had been used in several biomedical applications. The purpose of this study is to determine if human tenocytes can successfully proliferate inside xCELLigence system and the result has high correlation with conventional cell culture methods in the same condition. Methods First passage of human tenocytes was seeded in xCELLigence and conventional 24-well plates. Ketorolac tromethamine, bupivacaine, methylprednisolone, and betamethasone with different concentrations (100, 50, and 10% diluted of clinical usage) were exposed in both systems. Gene expression of type I collagen, type III collagen, tenascin-C, decorin, and scleraxis were compared between two systems. Results Human tenocytes could proliferate both in xCELLigence and conventional cell culture systems. Cytotoxicity of each drug revealed dose-dependency when exposed to tenocytes in both systems. Significance was found between groups. All the four drugs had comparable cytotoxicity in their 100% concentration. When 50% concentration was used, betamethasone had a relatively decreased cytotoxicity among them in xCELLigence but not in conventional culture. When 10% concentration was used, betamethasone had the least cytotoxicity. Strong and positive correlation was found between cell index of xCELLigence and result of WST-1 assay (Pearson’s correlation [r] = 0.914). Positive correlation of gene expression between tenocytes in xCELLigence and conventional culture was also observed. Type I collagen: [r] = 0.823; type III collagen: [r] = 0.899; tenascin-C: [r] = 0.917; decorin: [r] = 0.874; and scleraxis: [r] = 0.965. Conclusions Human tenocytes could proliferate inside xCELLigence system. These responses varied when tenocytes were exposed to different concentrations of ketorolac tromethamine, bupivacaine, methylprednisolone, and betamethasone. The result of cell proliferation and gene expression of tenocytes in both xCELLigence and conventional culture system is strongly correlated. Clinical relevance xCELLigence culture system may replace conventional cell culture, which made real-time tenocyte proliferation monitoring possible.

The hamstring autograft is one of the most popular grafts for anterior cruciate ligament (ACL) reconstruction. Although many techniques for arthroscopic ACL reconstruction using hamstring autografts have been invented, hamstring harvest techniques have not been focused. Hamstrings are harvested using an open technique that requires a 2- to 5-cm skin incision. In this Technical Note, we describe an endoscopic harvest technique of autogenous gracilis and semitendinosus tendon. This technique needs only a 1- to 1.5-cm skin incision and provides surgeons a sufficient view to safely harvest the hamstrings.