Hong-fei Shi

Early application of pulsed electromagnetic field in the treatment of postoperative delayed union of long-bone fractures: a prospective randomized controlled study

BackgroundPulsed electromagnetic field (PEMF) is reported to be an effective adjunct for the management of nonunion long-bone fractures. Most studies implement PEMF treatment after 6 months or longer of delayed union or nonunion following fracture treatment. Despite these variations in treatment, the early application of PEMF following a diagnosis of a postoperative delayed union has not been specifically analyzed. In this study, the outcomes of postoperative delayed union of long-bone fractures treated with an early application of PEMF were evaluated as compared with a sham-treated control group.MethodsIn this prospective, randomized controlled study, a total of 58 long-bone fracture patients, who presented with delayed union of between 16 weeks and 6 months, were randomly split into two groups and subjected to an early application of PEMF or sham treatment. Clinical and radiological assessments were performed to evaluate the healing status. Treatment efficacy was assessed at three month intervals.ResultsPatients in the PEMF group showed a higher rate of union than those in the control group after the first three months of treatment, but this difference failed to achieve statistical significance. At the end of the study, PEMF treatment conducted for an average of 4.8 months led to a success rate of 77.4%. This was significantly higher than the control, which had an average duration of 4.4 months and a success rate of 48.1%. The total time from operation to the end of the study was a mean of 9.6 months for patients in the PEMF group.ConclusionsFracture patients treated with an early application of PEMF achieved a significantly increased rate of union and an overall reduced suffering time compared with patients that receive PEMF after the 6 months or more of delayed union, as described by others.

Increased expression of insulin-like growth factor-1 receptor is correlated with tumor metastasis and prognosis in patients with osteosarcoma.

The aim of this study was to investigate the association of insulin‐like growth factor‐1 receptor (IGF‐1R) with metastasis and prognosis of osteosarcoma patients.

Will the untreated ulnar styloid fracture influence the outcome of unstable distal radial fracture treated with external fixation when the distal radioulnar joint is stable

BackgroundThe ulnar styloid is an important supportive structure for the triangular fibrocartilage complex. However, it remains inconclusive whether or not a fractured ulnar styloid should be fixed in an unstable distal radius fracture (DRF) with a stable distal radioulnar joint (DRUJ). The purpose of this study is to evaluate the effect of an untreated ulnar styloid fracture on the outcome of unstable DRF treated with transarticular external fixation when the DRUJ is stable.Methods106 patients with an unstable DRF and a stable DRUJ were included in this study following external fixation. The patients were divided into the non-fracture, the tip-fracture and the base-fracture groups according to the location of the ulnar styloid fracture at the time of injury. Postoperative evaluation included the range of wrist motion, the radiological index, the grip strength, the PRWE-HK scores, the wrist pain scores, and the instability of DRUJ at the external fixator removal time, three months postoperatively and the final follow-up visit.ResultsThe patients were followed for 12 to 24 months (15 months in average). Sixty-two of 106 patients (58%) had ulnar styloid fracture and 16 patients (26%) showed radiographic evidence of union of ulnar styloid fractures at the final follow-up visit. No significant difference in the radiological findings, the range of wrist motion, the grip strength, the PRWE-HK scores, and the wrist pain scores among three patient groups was detected at the external fixator removal time, three months postoperatively, or the final follow-up visit. Six of the 106 patients (5.7%) complained of persistent ulnar-side wrist pain during daily activities. One patient (0.9%) showed a positive sign in a stress-test, three patients (2.8%) showed a positive sign in a provocative-test, and five patients (4.7%) showed a positive sign in a press-test. There was no significant difference in the percentages of patients who complained of persistent ulnar-side wrist pain or showed a positive sign in the physical examination of the distal radioulnar joint among the three groups at the final follow-up time points.ConclusionWhen the DRUJ is stable, an untreated ulnar styloid fracture does not affect the wrist outcome of the patient with an unstable DRF treated with external fixation.

Haploinsufficiency of endogenous parathyroid hormone-related peptide impairs bone fracture healing

Previous studies have demonstrated that endogenous parathyroid hormone‐related peptide (PTHrP) plays a central role in the physiological regulation of bone formation. However, it is unclear whether endogenous PTHrP plays an important function in enhancing bone fracture healing. To determine whether endogenous PTHrP haploinsufficiency impaired bone fracture healing, closed mid‐diaphyseal femur fractures were created in 8‐week‐old wild‐type and Pthrp+/− mice. Callus tissue properties were analysed 1, 2 and 4 weeks after fracture by radiography, histology, histochemistry, immunohistochemistry and molecular biology. The size of the calluses was reduced 2 weeks after fracture, and the fracture repairs were poor 4 weeks after fractures, in Pthrp+/− compared with wild‐type mice. Cartilaginous callus areas were reduced 1 week after fracture, but were increased 2 weeks after fracture in Pthrp+/− mice. There was a reduction in the number of ostoblasts, alkaline phosphatase (ALP)‐positive areas, Type I collagen immunopositive areas, mRNA levels of ALP, Runt‐related transcription factor 2 (Runx2) and Type I collagen, Runx2 and insulin‐like growth factor‐1 protein levels, the number of osteoclasts and the surface in callus tissues in Pthrp+/− compared with wild‐type mice. These results demonstrate that endogenous PTHrP haploinsufficiency impairs the fracture repair process by reducing cartilaginous and bony callus formation, with downregulation of osteoblastic gene and protein expression and a reduction in endochondral bone formation, osteoblastic bone formation and osteoclastic bone resorption. Together, the results indicate that endogenous PTHrP plays an important role in fracture healing.

Short-term Effects of Discoid Lateral Meniscectomy on the Axial Alignment of the Lower Limb in Adolescents

BACKGROUND A discoid lateral meniscus in the knee is more common in Asian populations. The aim of this study was to evaluate the influence of arthroscopic meniscectomy of the discoid lateral meniscus on the axial alignment of the lower limb in adolescents (younger than twenty years of age). METHODS We retrospectively reviewed the data from 298 adolescent patients (younger than twenty years of age) who underwent arthroscopic treatment in our center from 2004 to 2013. Patients were divided into three groups according to the meniscus type: torn discoid lateral meniscus (Group A), torn nondiscoid lateral meniscus (Group B), and nondiscoid lateral meniscus without a tear (Group C). The tibiofemoral angle (TFA) and mechanical axis deviation (MAD) of both lower limbs were examined on standing anteroposterior radiographs before and after arthroscopy. RESULTS The preoperative TFA and MAD of the ipsilateral lower limbs demonstrated significantly more varus in Group A than in Group B (p < 0.001) or Group C (p < 0.001) after we controlled for the contralateral lower limbs as a covariate factor. Moreover, the TFA and MAD of the ipsilateral knees were significantly reduced (indicating a reduction in varus inclination) postoperatively, as compared with preoperatively, in Group A (p < 0.001) and Group B (p < 0.001), with no difference between the preoperative and postoperative values in Group C (p > 0.01), after we controlled for the contralateral lower limb as the covariate factor. Additionally, the reductions in the TFA and MAD (varus inclination) in Group A were significantly greater than those observed in Group B (p < 0.001). CONCLUSIONS The axial alignment of the lower limb in adolescents (younger than twenty years of age) with a torn discoid lateral meniscus was altered immediately after arthroscopic meniscectomy: the varus deformity was significantly reduced, and a valgus inclination developed in some of these patients. The valgus inclination was more pronounced in the patients with a torn discoid lateral meniscus compared with those with a torn nondiscoid lateral meniscus.

Distal Femoral Fractures in Post-poliomyelitis Patients Treated with Locking Compression Plates

Treatment of distal femoral fracture in post‐polio patients is difficult because the bone is usually osteopenic, small and deformed. This retrospective study aimed to investigate the outcomes of distal femoral fracture in post‐polio patients treated by locking compression plates (LCP).

Mechanical property and biological performance of electrospun silk fibroin-polycaprolactone scaffolds with aligned fibers.

Abstract The mechanical strength, biocompatibility, and sterilizability of silk fibroin allow it to be a possible candidate as a natural bone regenerate material. To improve mechanical character and reinforce the cell movement induction, silk fibroin (SF)–polycaprolactone (PCL) alloy was fabricated by electrospinning techniques with a rotating collector to form aligned fibrous scaffolds and random-oriented scaffolds. The scanning electron microscope image of the scaffold and the mechanical properties of the scaffold were investigated by tensile mechanical tests, which were compared to random-oriented scaffolds. Furthermore, mesenchymal stem cells were planted on these scaffolds to investigate the biocompatibility, elongation, and cell movement in situ. Scanning electron microscopy shows that 91% fibers on the aligned fibroin scaffold were distributed between the dominant direction ±10°. With an ideal support for stem cell proliferation in vitro, the aligned fibrous scaffold induces cell elongation at a length of 236.46 ± 82 μm and distribution along the dominant fiber direction with a cell alignment angle at 6.57° ± 4.45°. Compared with random-oriented scaffolds made by artificial materials, aligned SF-PCL scaffolds could provide a moderate mesenchymal stem cell engraftment interface and speed up early stage cell movement toward the bone defect.

A Randomized Controlled Trial Evaluating the Effects of Diosmin in the Treatment of Radicular Pain

Diosmin has been widely used to treat patients with vascular pain for its potent anti-inflammatory and analgesic effects. To evaluate the therapeutic effects of Diosmin in the treatment of radicular pain, we conducted an investigator-initiated, randomized, active-controlled noninferiority trial between January 1, 2009, and December 1, 2010. Diosmin (50 mg/kg/day) was orally administered to treat the radicular pain in 150 patients for one month. Another 150 patients with the same symptom were given 20% 250 ml mannitol (1 g/kg/day) for 7 days and dexamethasone (10 mg/day) for 3 days intravenously guttae. Short-term relief and long-term relief were measured. Secondary outcomes include improvement in functional and psychological status, return to work, and reduction in anti-inflammatory analgesic drugs intake. Patients treated with oral Diosmin achieved reduction in radicular pain. The total satisfaction rate of Diosmin group was 84.7% [95% confidence interval (CI): 77.9%, 90.0%], and the complete satisfaction rate was 50.7% (95% CI: 42.4%, 58.9%). No statistically significant difference was found between the Diosmin group and the active-control group regarding patient satisfaction. No adverse effects were found during the study period. Our study suggests that clinical application of Diosmin with a dose of 50 mg/kg/day might reduce the radicular pain. This trial is registered with ISRCTN97157037.