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Background: The contralateral seventh cervical (cC7) nerve root transfer represents a cornerstone technique in treating total brachial plexus avulsion injury. Traditional cC7 procedures employ the entire ulnar nerve as a graft, which inevitably compromises its restorative capacity. Objective: Our cadaveric study seeks to assess this innovative approach aimed at preserving the motor branch of the ulnar nerve (MBUN). This new method aims to enable future repair stages, using the superficial radial nerve (SRN) as a bridge connecting cC7 and MBUN. Methods: We undertook a comprehensive dissection of ten adult cadavers, generously provided by the Department of Anatomy, Histology, and Embryology at Fudan University, China. It allowed us to evaluate the feasibility of our proposed technique. For this study, we harvested only the dorsal and superficial branches of the ulnar nerve, as well as the SRN, to establish connections between the cC7 nerve and recipient nerves (both the median nerve and MBUN). We meticulously dissected the SRN and the motor and sensory branches of the ulnar nerve. Measurements were made from the reverse point of the SRN to the wrist flexion crease and the coaptation point of the SRN and MBUN. Additionally, we traced the MBUN from distal to proximal ends, recording its maximum length. We also measured the diameters of the nerve branches and tallied the number of axons. Results: Our modified approach proved technically viable in all examined limbs. The distances from the reverse point of the SRN to the wrist flexion crease were 8.24 ± 1.80 cm and to the coaptation point were 6.60 ± 1.75 cm. The maximum length of the MBUN was 7.62 ± 1.03 cm. The average axon diameters in the MBUN and the anterior and posterior branches of the SRN were 1.88 ± 0.42 mm、1.56 ± 0.38 mm、2.02 ± 0.41 mm,respectively. The corresponding mean numbers of axons were 1426.60 ± 331.39 and 721.50 ± 138.22, and 741.90 ± 171.34, respectively. Conclusion: The SRN demonstrated the potential to be transferred to the MBUN without necessitating a nerve graft. A potential advantage of this modification is preserving the MBUN's recovery potential. [ABSTRACT FROM AUTHOR]

Objective. The surgical treatment scheme of humeral shaft fracture is still controversial with no consensus reached. This meta-analysis was aimed at comparing the efficacy and safety of intramedullary nail (IMN) and locking compression plate (LCP) in the treatment of humeral shaft fractures. Methods. PubMed, Medline, Embase, Ovid, Cochrane Library, ISI Web of Science, Clinical Trials, and Chinese databases, including China National Knowledge Infrastructure Project, Wanfang database, and China biomedical abstracts database, were used to search the literature. Review Manager software was employed for statistical analysis and establishing forest and funnel maps. Categorical variables were measured by relative risk (RR), and standardized mean difference (SMD) was used to measure continuous variables. 95% confidence intervals were used for each variable. The modified Jadad scale, Newcastle-Ottawa scale, and Cochrane's bias risk tools were used to evaluate the bias and risk of eligible studies. Results. A total of 14 studies were included in the analysis with a total of 903 patients with humeral shaft fracture. Significant differences with regard to operation time (Std = − 1.18 , 95% CI: -2.14, -0.22, Z = 2.41 , P = 0.02), blood loss (Std = − 2.97 , 95% CI: -4.32, -1.63, Z = 4.34 , P < 0.001), and postoperative infection rate (RR = 0.32 , 95% CI: -0.15, 0.68, Z = 2.98 , P = 0.003) were noted between the IMN group and LCP group. In addition, the American Shoulder and Elbow Surgeon (ASES) score (Std = − 0.22 , 95% CI: -0.44, 0.01, Z = 2.08 , P = 0.04) and the rate of shoulder and elbow function limitation (RR = 1.88 , 95% CI: 1.06, 3.33, Z = 2.17 , P = 0.03) between the 2 groups were also statistically significant. There were no significant differences in the rate of radial nerve injury, nonunion, delayed healing, and secondary operation between the two groups. Conclusion. IMN is superior than the LCP in terms of the operation time, intraoperative bleeding, and postoperative infection, suggesting its superiority in the humeral shaft fracture fixation. However, IMN is inferior to LCP in ASES score and shoulder elbow function limitation rate, indicating poor early postoperative functional recovery. More studies are required to evaluate and analyze the clinical efficacy between IMN and LCP regarding long-term function after artificial graft removal. [ABSTRACT FROM AUTHOR]

Sensory neuronopathies are a rare and distinct subgroup of peripheral neuropathies, characterized by degeneration of the dorsal root ganglia neurons. About 50% of sensory neuronopathies are idiopathic and genetic causes remain to be clarified. Through a combination of homozygosity mapping and whole exome sequencing, we linked an autosomal recessive sensory neuronopathy to pathogenic variants in the COX20 gene. We identified eight unrelated families from the eastern Chinese population carrying a founder variant c.41A>G (p.Lys14Arg) within COX20 in either a homozygous or compound heterozygous state. All patients displayed sensory ataxia with a decrease in non-length-dependent sensory potentials. COX20 encodes a key transmembrane protein implicated in the assembly of mitochondrial complex IV. We showed that COX20 variants lead to reduction of COX20 protein in patient's fibroblasts and transfected cell lines, consistent with a loss-of-function mechanism. Knockdown of COX20 expression in ND7/23 sensory neuron cells resulted in complex IV deficiency and perturbed assembly of complex IV, which subsequently compromised cell spare respiratory capacity and reduced cell proliferation under metabolic stress. Consistent with mitochondrial dysfunction in knockdown cells, reduced complex IV assembly, enzyme activity and oxygen consumption rate were also found in patients' fibroblasts. We speculated that the mechanism of COX20 was similar to other causative genes (e.g. SURF1, COX6A1, COA3 and SCO2) for peripheral neuropathies, all of which are functionally important in the structure and assembly of complex IV. Our study identifies a novel causative gene for the autosomal recessive sensory neuronopathy, whose vital function in complex IV and high expression in the proprioceptive sensory neuron further underlines loss of COX20 contributing to mitochondrial bioenergetic dysfunction as a mechanism in peripheral sensory neuron disease. [ABSTRACT FROM AUTHOR]

Giant cell tumour forms 4 percent - 5 percent of all bone tumours & 20 percent of all benign bone tumours. It is responsible for 20 percent of bone tumours in China. It is usually single, aggressive locally & accounts for 5 percent of metastasis & 1 percent - 3 percent with malignant changes. Most commonly it is found in people aged 30 to 40 years and in the long bones mainly the meta-epiphyseal region . It is most commonly affects the distal femur, distal radius, proximal tibia and proximal humerus. But the occurrence in the distal humerus is rare. A 50 year old male patient who came with complaints of pain and swelling over right elbow since 3 years. Patient gave history of trauma to right elbow as he met with a road traffic accident. After few days patient noticed swelling which was insidious in onset and gradually kept increasing in size. Patient also had pain in right elbow which was insidious in onset and increased in severity daily. Pain was managed with total elbow arthroplasty and elbow range of motion improved after the surgery. Patient was managed with total elbow arthroplasty and wide resection of tumour which has good functional outcomes, less complications and lower recurrences rates. Patient was followed up at 18 – month and free range of motion of 10º to 110º without pain along with no proof of reoccurrence was noted . [ABSTRACT FROM AUTHOR]

BACKGROUND: Ulnar coronoid process has special anatomy and it is adjacent to vascular nerve. It is characterized by weak fixation, unstable recurrence, postoperative elbow joint stiffness and pain. These make the treatment of ulnar coronoid process fracture, in particular in complex elbow joint injuries, challenged. OBJECTIVE: To investigate the efficacy of internal fixation with steel plate through an anterior approach on ulnar coronoid process Regan-Morreytype II or type Ill fracture in complex elbow injury. METHODS: Sixteen patients with complex elbow injury and ulnar coronoid process fractures who underwent open reduction and internal fixation were followed up between September 2012 and May 2017. Among these patients, 11 patients had Regan-Morrey type II fracture, 5 patients had Regan-Morrey type Ill fracture, 14 patients had humeral head fracture, and 2 patients had ulnar olecranon fracture. All patients provided written informed consent This study was approved by the Medical Ethics Committee of Hong Hui Hospital, China. Ulnar coronoid process fractures were reduced and fixed with steel plate through the space between the median nerve and the radial artery using an anterior approach. At the same time, all radial humeral head and olecranon fractures were treated by internal fixation. RESULTS AND CONCLUSION: All patients acquired acceptable reduction and firm fixation of fractured fragments. All of them were followed up for 13-28 months. At the final follow-up, solid osseous union was confirmed for all coronoid fractures. The average time to radiologic union was 16.5 weeks. The mean flexion-extension arc was 113.4°, the flexion contracture was 13.8°, and further flexion was 127.2°. The mean pronation arc was 72.5°. The mean supination arc was 74.7°, and the mean forearm rotation arc was 146.9°. 11 patients achieved functional arc of motion. All patients were satisfied with the treatment with the mean Mayo Elbow Performance score of 90.3 points. 11 patients achieved excellent elbow performance and 5 patients achieved good elbow performance. These results suggest that ulnar coronoid process fractures in complex elbow injury can be treated successfully with an anterior surgical approach. This approach allows for accurate and rigid internal fixation with steel plate and early functional exercise, resulting in a reasonable outcome. [ABSTRACT FROM AUTHOR]