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The management of type 3 lateral condyle fractures (LCFs) remains controversial. The main goal of this study was to evaluate the feasibility of closed reduction and percutaneous pinning (CRPP) in patients with type 3 LCFs and to assess the outcome of such injuries according to the type of treatment, CRPP, or open reduction and internal fixation (ORIF).This is a retrospective review of prospectively enrolled children with type 3 LCF managed by CRPP or ORIF between 2018 and 2021. All patients were followed for at least 12 months. Patients were divided into two groups according to the type of treatment, CRPP or ORIF. Demographic characteristics were recorded for all patients. Standard radiographs were used to identify, evaluate, and classify each fracture and to detect the presence of other concomitant bone lesions. The clinical outcome was assessed according to the Hardacre et al. criteria.Seventy-eight children with type 3 LCF were included; 42 were treated by CRPP (53.8%) and 36 by ORIF (46.2%); the mean follow-up time was 17.7 months (range, 12.3-40.9). The baseline characteristics did not differ between the two groups of patients. Overall, successful CRPP could be achieved in 39 out of 42 patients (92.9%). The mean surgical time was 63.4 and 84.5 min in patients treated by CRPP and ORIF, respectively (p = 0.01). Fluoroscopy time was significantly shorter in patients managed by ORIF than in those treated by CRPP (12 versus 40 s, respectively; p 0.001). Clinical outcome according to the Hardacre et al. criteria was excellent in 37 out of 39 (94.4%) and in 35 out of 36 patients (97.2%) treated by CRPP and ORIF, respectively (p = 0.09).CRPP management of paediatric type 3 LCF has clinical and radiographic outcomes similar to ORIF; if satisfactory reduction cannot be achieved by CRPP, conversion to ORIF should be considered.

There is a paucity of data describing sagittal alignment changes in children with congenital scoliosis (CS) treated by hemivertebra (HV) resection. This study aimed to evaluate the effects of posterior HV resection on spine sagittal alignment in children with CS. This is a retrospective analysis of 31 children with CS (mean age at surgery: 49.61 ± 10.21 months; range, 39-72; mean follow-up time: 5.16 ± 1.21 years; range: 3-7) treated at our Institution. Only patients with single thoracic or single lumbar, fully segmented HV managed by posterior HV resection and two segments fusion with four screws and two robs were included. According to the anatomical location of the HV, patients were divided into two groups: thoracic (group A) and lumbar (group B). Thoracic kyphosis (T1-T12; TK) and lumbar lordosis (L1-S1; LL) were measured pre- and postoperatively at 6 months interval. Postoperative TK and LL were 30.3 ± 11.47 and 28.8 ± 9.47, and were 31.98 ± 9.66 and 46.7 ± 11.37 at the last follow-up visit, respectively. The incidence of thoracic hypokyphosis in group B was 53.3%, and it was significantly higher compared to group A (12.5%, P = 0.04). During follow-up, TK changes were comparable between the two groups of patients while LL improved in all patients 6 months after surgery, and continued to improve thereafter. Posterior HV resection and short segment fusion have limited impact on the evolution of TK; in particular, children with lumbar HV were more likely to be hypokyphotic preoperatively, but less likely postoperatively with an increase in LL and a stabilization of TK.

The objectives of this study were to (1) evaluate the radiographic characteristics of children with congenital thumb duplication (CTD) seen in our institution between August 2015 and April 2021; (2) introduce a modified radiographic classification system (MCS) capable of including all cases of CTD based on their radiographic pathoanatomy; and (3) evaluate the inter- and intrarater reliability of the new classification system.We retrospectively reviewed 2,108 patients with 2,300 CTDs. The MCS is based on the Wassel-Flatt and Chung et al classification systems and includes specific subtypes from the Rotterdam and modified Wassel-Flatt classifications. The MCS is characterized by 4 groups according to the anatomical morphology of the duplication: A (joint), B (epiphysis), C (bone), and D (soft tissues). Each group includes 4 subtypes according to the location of the CTD, with subtypes 1-3 extending from the distal phalanx to the metacarpal or interphalangeal joints, then to the carpometacarpal joint, and with subtype 4 only including the triphalangia of the main thumb.Among the 2,300 fingers, 360 (15.7%), 2 (0.1%), and 3 (0.1%) CTDs could not be classified according to the Wassel-Flatt, Chung et al, and Rotterdam classifications, respectively. According to the MCS, the 2 most common forms of CTD were A2 (680/2,300; 29.6%) and D2 (308/2,300; 13.4%). All cases could be classified according to this classification system. The MCS showed excellent intrarater (0.875) and interrater (0.851) reliability relative to the Wassel-Flatt (0.863 and 0.820, respectively), Chung et al (0.793 and 0.822, respectively), and Rotterdam (0.873 and 0.836, respectively) systems.The MCS is a potential radiographic classification for CTD that enables the classification of all patients and has excellent inter- and intrarater reliability.Existing classification systems do not allow classification of the full spectrum of CTD and are not always related to surgery, and some existing systems are complex, with many categories that are rarely encountered, or are difficult to use widely in clinical practice.

Hereditary multiple exostoses (HME) is a rare skeletal disorder characterized by the formation of multiple benign cartilage-capped tumors, usually in the metaphyseal region of the long bones. Over 70% of HME cases arise from monoallelic mutations in either of the two genes encoding the heparan sulfate (HS) synthesis enzymes, ext1 and ext2. To identify more HME-associated mutations, genomic DNA from members of five independent consanguineous families with HME was sequenced with whole exome sequencing (WES). A novel heterozygous splice site mutation (c.1173+2T>A) in ext2 was detected in all three affected members of family V. Further study showed that the novel mutation caused exon 7 of ext2 mRNA to be skipped during splicing and caused a frameshift after the codon for Arg360, which results in the appearance of new 43 codons, followed by a termination codon. Although the resulting truncated protein was still localized to the Golgi, similar to the full-length EXT2, its HS synthesis activity decreased by 40%. In this study, a novel splice site mutation in ext2 was identified and suggested to be a pathogenic mutation of HME, which may expand the genetic etiology spectrum of HME and may be helpful for clinical genetic counseling and prenatal diagnosis.

Background. To find a better prophylactic regimen, the pathogenesis of acquired heterotopic ossification (AHO) must be more understood. To date, AHO formation is largely thought to be related to inflammation, which is activated by trauma, resulting in AHO by up-regulation of pro-osteogenic genes. Methods. Brain-traumatic/burn/tenotomy model is firstly used in experiment. At first, 44 rats were randomly divided into two groups: E group and C group. Two rats in every group were euthanized during second, third, fourth, sixth, eighth, tenth weeks for collecting tendon. The remaining rats survived until tenth week for X-Ray radiation examination to confirm the size of AHO.Then, 124 rats were randomly divided into four group: P group, L group, M group, H group. The three rats of every group were euthanized during every week of the first seven weeks for collecting tendon to detect P65 protein. The remaining rats survived until tenth week for X-Ray examination to confirm the size of AHO. Results. The success rate of Brain-traumatic/Burn/Tenotomy model is 100%. Difference of P65 expression in E group and in C group are statistically significant,and that in E group is higher.Pharmacologic inhibition of Nf-ҝb signaling pathway limits AHO formation, and that The bone formation content of M group is decreased. Conclusion. Brain-traumatic/Burn/Tenotomy model is highly reliable.Results indicate that the Nf-ҝb /p65 signaling response occurs in the forming process of AHO. PDTC limits formation of AHO. The most effective concentration is 6mg/ml for local injection.

We investigated the role of fetuin A during heterotopic ossification (HO) in rats following Achilles tenotomy. We performed a right midpoint Achilles tenotomy on 24 rats. At 5 and 10 h after surgery, we investigated the formation of ectopic bone using X-ray and histological examination. We evaluated the mRNA level of fetuin A using real-time PCR. Presence of fetuin A in the Achilles tendon was assessed by immunohistochemical staining. We also measured the serum concentration of fetuin A using enzyme linked immunosorbent assay (ELISA). The expression of fetuin A was significantly decreased in both the liver and Achilles tendon during HO. ELISA showed a small amount of fetuin A in blood throughout the development of HO. Immunohistochemical staining showed that fetuin A was abundant in the ectopic bone. Fetuin A appears to be involved in the formation of ectopic bone induced by Achilles tenotomy, and a deficiency of fetuin A plays a role in the development of HO.

To investigate the surgical treatment and effectiveness of senile chronic shoulder dislocation.Between October 2011 and April 2014, 7 elderly patients with chronic shoulder dislocation were treated. There were 2 males and 5 females with an average age of 74 years (range, 61-83 years). The causes of injuries were falling injury in 6 patients and traffic accident injury in 1 patient. The interval between injury and confirmed diagnosis was 4-12 weeks (mean, 6.7 weeks). Preoperative apprehension test and Dugas sign of the shoulder joint were positive. Before operation, the forward elevation, abduction, and external rotation were (50.7±8.4), (44.5±3.3), and (35.8±4.8), respectively; and internal rotation reached T6, T11, L4 in 1 case and reached T10, T12 in 2 cases separately. The Constant-Murley score and Neer score were 51.2±8.3 and 45.4±7.3, respectively.All the incisions healed by first intention, and no complication of fracture or neurovascular injuries occurred. Seven patients were followed up 12-18 months (mean, 16 months), and no re-dislocation happened. At last follow-up, apprehension test and Dugas sign of the shoulder joint were negative. The forward elevation, abduction, and external rotation were significantly improved to (117.5±13.1), (72.0±4.6), and (39.0±3.4)° (t= -33.746, P=0.000; t= -30.614, P=0.000; t= -2.802, P=0.031); and internal rotation reached T6, T10, T12, and L3 in 1 case respectively, and L3 in 3 cases, showing no significant difference when compared with preoperative values (Z= -1.732, P=0.083). The Constant-Murley score and Neer score were significantly improved to 85.4±4.3 and 84.0±4.8 when compared with preoperative score (t= -21.016, P=0.000; t= -29.518, P=0.000).Surgical treatment of senile chronic shoulder dislocation can improve the range of motion and function of the shoulder joint obviously.

To explore the value of matrix metalloproteinase 9 (MMP-9) in predicting the occurrence of heterotopic ossification by observing the expression of MMP-9 in heterotopic ossification of the early trauma rat model.A total of 132 male Sprague Dawley rats, aged 4-5 weeks, weighing (135.0 ± 6.5) g, were randomly divided into experimental group and control group (n = 66). In experimental group, the Achilles tendon was cut off and clamped to prepare heterotopic ossification model; in control group, only Achilles tendon was exposed by making a incision. The general condition of the rats was observed after operation; at 2, 3, 4, 5, 6, 7, and 8 days after operation, the Achilles tendon tissue was harvested for gross observation, histological observation, and immunohistochemical staining observation; the serum and Achilles tendon tissue were harvested to detect the expressions of MMP-9 protein and mRNA by ELISA and RT-PCR. The X-ray films at 5 and 10 weeks and histological examination at 10 weeks after operation were used to observe heterotopic ossification.All rats survived to the end of the experiment. The Achilles tendon had no significant change in control group at each time point, showing normal tendon structure. In experimental group, the hardness of Achilles tendon tissue gradually increased with the time; there were a large number of irregular connective tissue and cartilage cells; and immunohistochemical staining for MMP-9 was positive results. The MMP-9 protein and mRNA expression levels of experimental group were significantly higher than those of the control group at each time point (P0.05). MMP-9 protein and mRNA expression levels of experimental group showed an increasing tendency (P0.05). According to the results of X-ray films and histological observation, heterotopic ossification occurred at 10 weeks after operation in experimental group, but no heterotopic ossification was observed in control group.In early heterotopic ossification of rat Achilles tendon, the expression of MMP-9 increases significantly, indicating that it has reference significance in predicting heterotopic ossification.

In this paper, a novel method to enhance axial ratio bandwidth of circularly polarized (CP) patch antenna using artificial magnetic conductor (AMC) structures with LTCC technology at Ka-band is proposed. In order to improve the axial ratio bandwidth, the traditional PEC plane is replaced by an AMC plane. The AMC is composed of periodic square unit cells with truncated opposite corners. The AMC structure and the antenna are simulated using a full-wave solver and the results show a 10 dB return loss bandwidth of 30% and a 3 dB axial ratio bandwidth of 12.7%, and gain is around 7.5 dB within this band, which compared with the traditional corner-cut square circular polarization patch antenna, the axial ratio bandwidth of proposed antenna increased by 9.5%.

In this paper, a novel low-loss gap waveguide (GWG) transmission line with Low Temperature Co-Fired Ceramic (LTCC) technology for W-band is presented. To illustrate the low-loss characteristics of the proposed line, microstrip line (MSL) and laminated waveguide (LWG) are also designed with LTCC, and the corresponding measured values of insertion loss are given. From the measured results, the value of the dielectric loss tangent is extracted. As an example, two kinds of eight-way power dividers are shown, which are composed of LWG and GWG, respectively. Simulated results of transmission and reflection coefficients are presented. Comparison of two power dividers has shown the low-loss superiority of the new design.

To compare the efficacy of selective cyclooxygenase 2 (COX2) inhibitor and non-selective COX2 inhibitor drugs in prevention of heterotopic ossification in rats model so as to provide reference for clinical drugs selection of heterotopic ossification prevention.Fifty male Sprague Dawley rats, 6 to 8 weeks old, weight (190.0 +/- 8.5) g, were selected; the right Achilles tendon was cut off to induce ectopic bone formation. The rats were randomly divided into 5 groups (n = 10): on the 1st day after modeling, celecoxib was given in groups A [2 mg/(kg x d)] and B [10 mg/(kg x d)], indomethacin in groups C [(2 mg/(kg x d) and D [10 mg/(kg x d)], and 2 mL of saline in group E for 10 weeks. The general condition of rats was observed after operation. At 5 and 10 weeks after operation, X-ray films of the right lower limb were taken to observe new bone formation. At 10 weeks after operation, the right Achilles tendon tissue was harvested for histological observation. Based on X-ray and histological results, heterotopic ossification was assessed. Immunohistochemical staining was used to evaluate COX2 and bone morphogenetic protein 2 (BMP-2) expression levels in local Achilles tendon.During the experiment, 5 rats died (2 in group B, 1 in group C, and 2 in group D), the other rats survived to the end of the experiment. General observation of Achilles tendon tissue showed that the tendon tissue volume of group B was the smallest, with soft texture and no cartilage-like tissue; the tendon tissue volume of group E was the biggest, with hard texture and cartilage-like tissue. The incidence of heterotopic ossification was 80.0% (8/10), 25.0% (2/8), 88.9% (8/9), 50.0% (4/8), and 100% (10/10) in groups A-E respectively at 10 weeks after operation; significant differences were found between groups B, D and group E (P = 0.002, P = 0.023) and between groups B and C (P = 0.015), but no significant difference was found among the other groups (P0.05). COX2 expression level in groups B and D was significantly lower than that in group E (P0.05 ), but no significant difference was found among the other groups (P0.05); BMP-2 expression level in group B was significantly lower than that in groups A, C, and E (P0.05), but no significant difference was found among the other groups (P0.05).Celecoxib at a dose of 10 mg/(kg x d) can effectively reduce the incidence of heterotopic ossification in rats.