Houchen Lv

Bone transport for the treatment of infected forearm nonunion.

OBJECTIVE The objective of this study was to evaluate the effectiveness of the treatment of infected forearm nonunion by bone transport. MATERIALS AND METHODS We retrospectively reviewed 16 patients with infected forearm nonunion treated by bone transport. Our study included 10 males and 6 females with a mean of age 38.25 years. The site of bone defects involved 9 radius and 7 ulna. The average length of the bone defects after radical debridement was 3.81cm (range 2.2-7.5cm). RESULTS The mean follow-up after removal of the frame was 39.63 months (range 26-55 months). No patient was lost to follow-up. All the patients had bone union and no recurrence of infection was observed. The mean external fixation time was 6.19 months (range 3-10 months), and the mean external fixation index was 1.63 months/cm (range 1.14-2.00 months/cm). The mean degrees of wrist flexion were 49.69° (range 45-55°), and the mean degrees of wrist extension were 50.63° (range 40-60°). The mean degrees of elbow flexion were 143.12° (range 135-150°), and the mean degrees of elbow extension were 4.69° (range 0-20°). The mean degrees of forearm pronation were 82.50° (range 70-90°), and the mean degrees of forearm supination were 83.75° (range 75-90°). CONCLUSION Our study suggested that bone transport in the treatment of infected forearm nonunion acquired satisfied functional results. Radical debridement is the key step to control bone infection.

Comparison of lateral and posterior surgical approach in management of extra-articular distal humeral shaft fractures.

OBJECTIVE The objective of this study was to compare treatment results and complication rates between lateral and posterior approaches in surgical treatment of extra-articular distal humeral shaft fractures. MATERIAL AND METHODS Between June 2008 and May 2012, a total of 68 patients with extra-articular distal humeral shaft fractures were treated by lateral and posterior approaches. Of the patients, 30 were operated by a lateral approach (group I) and 26 patients were operated by a posterior approach (group II). There was no statistical significance between the two groups in sex distribution, age, the mechanism of the injury, injured arms, AO/ASIF (Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation) classification, and the time from injury to surgery (P>0.05). Operation time, intraoperative bleeding volume, hospitalisation, clinical outcomes, and complications were compared between the two groups. The elbow functional results were evaluated by the Mayo Elbow Performance Score (MEPS). RESULTS All patients were followed up. The average of follow-up in group I was 15.53±2.636 months (range, 12-22 months), and was 16.12±2.889 months (range, 12-22 months) in group II. There was no significant difference in the operation time, intraoperative bleeding time, and hospitalisation between the two groups (P>0.05). In group I, the mean time of bone union was 12.87±1.852 weeks (range, 10-16 weeks), the mean degrees of elbow flexion was 139.20°±3.274° (range, 134-146°), the mean degrees of elbow extension was 4.77°±1.906° (range, 0-8°), and the mean points of MEPS was 87.00±7.724 (range, 70-100 points). In group II, the mean time of bone union was 12.96±2.218 weeks (range, 10-16 weeks), the mean degrees of elbow flexion was 137.85°±4.076° (range, 130-145°), the mean degrees of elbow extension was 5.15°±2.327° (range, 0-9°), and the mean points of MEPS was 86.15±7.656 (range, 70-100 points). There was no significant difference in the bone union, range of elbow flexion, range of elbow extension and MEPS between the two groups (P>0.05). The overall complication rate in group I was lower than that in group II (P=0.041). CONCLUSIONS Both lateral and posterior surgical approaches acquired satisfied treatment results in the management of extra-articular distal humeral shaft fractures, and there was a lower complication rate using the lateral approach.

Inhibitory effect of super-hydrophobicity on silver release and antibacterial properties of super-hydrophobic Ag/TiO2 nanotubes

The antibacterial properties of super-hydrophobic silver (Ag) on implant surface have not yet to be fully illuminated. In our study, we investigate the protective effects of super-hydrophobic coating of silver/titanium dioxide (Ag/TiO2 ) nanotubes against bacterial pathogens, as well as its pattern of Ag release. Ag/TiO2 nanotubes are prepared by a combination of electrochemical anodization and pulse electrodeposition. The super-hydrophobic coating is prepared by modifying the surface of Ag/TiO2 nanotubes with 1H, 1H, 2H, 2H-perfluorooctyl-triethoxysilane (PTES). Surface features and Ag release are examined by SEM, X-ray photoelectron spectroscopy, contact-angle measurement, and inductively coupled plasma-mass spectrometry (ICP-MS). The antibacterial activity of super-hydrophobic coating Ag/TiO2 nanotubes is investigated both in vitro and in vivo. Consequently, the super-hydrophobic coating on Ag/TiO2 nanotubes shows a regularly arranged structure; and nano-Ag particles (10-30 nm) are evenly distributed on the surface or inside the nanotubes. The contact angles of water on the super-hydrophobic coating Ag/TiO2 nanotubes are all above 150°. In addition, the super-hydrophobic character displays a certain conserved effect that contributes to the sustained release of Ag. The super-hydrophobic Ag/TiO2 nanotubes are also effective in inhibiting bacterial adhesion, killing the adhering bacteria and preventing postoperative infection in rabbits. Therefore, it is expected that the super-hydrophobic Ag/TiO2 nanotubes which can contain the release of Ag, leading to stable release, may show a consistent surface antibacterial capability.

Red Cell Distribution Width as an Independent Predictor of Long-Term Mortality in Hip Fracture Patients: A Prospective Cohort Study.

Red blood cell distribution width (RDW) has been found to be a significant prognostic factor of mortality in many cardiovascular diseases. However, a link between RDW at admission with long‐term mortality in the hip fracture population has not been well established. Therefore, we sought to evaluate the long‐term prognostic value of RDW in a well‐defined hip fracture cohort, and to compare the effect of RDW in patients with and without anemia. A prospective cohort study was performed on 1479 hip fracture patients admitted at the General Hospital of Chinese PLA between January 2000 and October 2011 with a follow‐up study over a 2‐year period. A total of 1479 patients were used for the evaluation of 2‐year all‐cause mortality, while 804 patients with more than 4 years of follow‐up were extracted for further evaluation of 4‐year all‐cause mortality. Cox proportional regression was used to evaluate the association between admission RDW and long‐term mortality, adjusting for potential confounding variables. Higher RDW values were strongly associated with increased all‐cause mortality. After adjusting for age, mean corpuscular volume, admission hemoglobin, comorbidities, and complications, RDW had a significant independent association with both 2‐year mortality with a hazard ratio (HR) of 1.183 (95% confidence interval [CI], 1.017 to 1.376) and 4‐year mortality with an HR of 1.244 (95% CI, 1.052 to 1.471). In stratified analysis, the effect of RDW was even more pronounced, with 2‐year mortality HR of 1.341 (95% CI, 1.095 to 1.643) and 4‐year mortality HR of 1.345 (95% CI, 1.071 to 1.688) in non‐anemic patients. In non‐anemic patients, elevated RDW values are significantly associated with increased odds of all‐cause mortality, implying that RDW may be a possible laboratory biomarker for risk stratification in non‐anemic hip fracture patients. Further studies are needed to confirm the current finding in different and larger hip fracture cohorts.

Correlation between Parameters of Calcaneal Quantitative Ultrasound and Hip Structural Analysis in Osteoporotic Fracture Patients

Background Calcaneal quantitative ultrasound (QUS), which is used in the evaluation of osteoporosis, is believed to be intimately associated with the characteristics of the proximal femur. However, the specific associations of calcaneal QUS with characteristics of the hip sub-regions remain unclear. Design A cross-sectional assessment of 53 osteoporotic patients was performed for the skeletal status of the heel and hip. Methods We prospectively enrolled 53 female osteoporotic patients with femoral fractures. Calcaneal QUS, dual energy X-ray absorptiometry (DXA), and hip structural analysis (HSA) were performed for each patient. Femoral heads were obtained during the surgery, and principal compressive trabeculae (PCT) were extracted by a three-dimensional printing technique-assisted method. Pearson’s correlation between QUS measurement with DXA, HSA-derived parameters and Young’s modulus were calculated in order to evaluate the specific association of QUS with the parameters for the hip sub-regions, including the femoral neck, trochanteric and Ward’s areas, and the femoral shaft, respectively. Results Significant correlations were found between estimated BMD (Est.BMD) and BMD of different sub-regions of proximal femur. However, the correlation coefficient of trochanteric area (r = 0.356, p = 0.009) was higher than that of the neck area (r = 0.297, p = 0.031) and total proximal femur (r = 0.291, p = 0.034). Furthermore, the quantitative ultrasound index (QUI) was significantly correlated with the HSA-derived parameters of the trochanteric area (r value: 0.315–0.356, all p<0.05) as well as with the Young’s modulus of PCT from the femoral head (r = 0.589, p<0.001). Conclusion The calcaneal bone had an intimate association with the trochanteric cancellous bone. To a certain extent, the parameters of the calcaneal QUS can reflect the characteristics of the trochanteric area of the proximal hip, although not specifically reflective of those of the femoral neck or shaft.

The effect of sequential therapy for postmenopausal women with osteoporosis: A PRISMA-compliant meta-analysis of randomized controlled trials.

Background: Osteoporosis, more likely to occur in postmenopausal women, is a chronic condition that usually requires a long-term treatment strategy, but the use of either antiresorptive or anabolic drugs should be limited to 18 to 24 months. Discontinuing antiosteoporosis drugs may result in rapidly declining bone mineral density (BMD). Therefore, many patients are treated with the sequential use of 2 or more drugs. However, whether switching treatment from anabolic to antiresorptive drugs or the reverse could maintain or further increase BMD; and whether the sequential therapy could outperform the monotherapy under the same treatment duration still remains unclear. Nowadays, no firm conclusions were drawn. Methods: We searched Medline, Embase, and Cochrane Library from January 1, 1974 until February 1, 2016 to identify all randomized controlled trials for evaluating the effectiveness of sequential therapy of antiresorptive and anabolic drugs in postmenopausal osteoporosis women with the BMD changes of lumbar spine, femoral neck, and total hip as the outcomes. We evaluated the methodological quality and abstracted relevant data according to the Cochrane Handbook. Results: Eight trials involving 1509 patients were included. The pooled data showed that after switching treatment, the alternative drugs maintained the BMD and significantly increased the percentage change in BMD at the lumbar spine (MD, 3.59; 95% CI, 2.26–4.93), femoral neck (MD, 1.44; 95% CI, 0.60–2.27), and total hip (MD, 1.24; 95% CI, −0.12 to 2.60), although change in BMD was not significantly increased at the total hip. The sequential therapy significantly increased BMD from baseline at the lumbar spine (SMD, 0.59; 95% CI, 0.26–0.91), femoral neck (SMD, 0.22; 95% CI, 0.06–0.37), and total hip (SMD, 0.28; 95% CI, 0.01–0.56). Conclusions: After switching treatment, sequential therapy further increased BMD. The sequential therapy showed a more significant improvement in BMD compared with any anti-resorptive drug given for the same treatment duration and was as effective as anabolic drugs. Thus, sequential therapy may be recommended as an effective treatment for osteoporotic women. However, more randomized controlled trials are still needed to determine the best sequence and the most appropriate drugs of sequential therapy.

The Effect of Teriparatide on Fracture Healing of Osteoporotic Patients: A Meta-Analysis of Randomized Controlled Trials

Purpose. This meta-analysis is to assess the effectiveness of teriparatide in fracture healing and clinical function improvement of the osteoporotic patients. Methods. We searched PubMed, Embase, Web of Science, and the Cochrane databases for randomized and quasi-randomized controlled trials comparing teriparatide to placebo, no treatment, or comparator interventions in the osteoporotic patients. Results. Five studies with 251 patients were included. Patients treated with teriparatide therapy had a significant shorter radiological fracture healing time compared with those in the control group (mean difference [MD] −4.54 days, 95% confidence interval [CI] −8.80 to −0.28). Stratified analysis showed that lower limb group had significant shorter healing time (MD −6.24 days, 95% CI −7.20 to −5.29), but upper limb group did not (MD −1 days, 95% CI −2.02 to 0.2). Patients treated with teriparatide therapy showed better functional outcome than those in the control group (standardized mean difference [SMD] −1.02, 95% CI −1.81 to −0.22). Patients with therapy duration over 4 weeks would have better functional outcome (SMD −1.68, 95% CI −2.07 to −1.29). Conclusions. Teriparatide is effective in accelerating fracture healing and improving functional outcome of osteoporotic women. However, more clinical studies are warranted in order to determine whether the results are applicable to males and the clinical indications for teriparatide after osteoporotic fractures.

Anemia on Admission Is an Independent Predictor of Long-Term Mortality in Hip Fracture Population: A Prospective Study With 2-Year Follow-Up

Abstract Anemia is a disputable factor for long-term mortality in hip fracture population in previous studies. Previous studies indicated that the level of hemoglobin (Hb) might fluctuate due to various factors, such as comorbidities and in-hospital interventions, and the changing level of Hb, may lead to discordance diagnosis of anemia and thus to the conflicting conclusions on prognostic value of anemia. So in this study, we aim to compare factors affecting the diagnosis of anemia at different time-points, admission, postoperation, and discharge, and to determine which the time point is most suitable for mortality prediction. This prospective cohort study included 1330 hip fracture patients from 1 January 2000 to 18 November 2012. Hb levels at 3 different time points, such as admission, postoperation, and discharge, were collected and used to stratify the cohort into anemia and nonanemia groups. Candidate factors including commodities, perioperative factors, blood transfusion, and other in-hospital interventions were collected before discharge. Logistic regression analyses were performed to detect risk factors for anemia for the 3 time points separately. Kaplan–Meier and multivariate Cox regression analyses were used to evaluate the association between anemia and 2-year mortality. Factors affecting the diagnosis of anemia were different for the 3 time points. Age, female sex, American Society of Anesthesiologists score (ASA), and intertrochanteric fracture were associated with admission anemia, while surgical procedure, surgical duration, blood transfusion, blood loss during the operation, and drainage volume were major risk factors for postoperation anemia. Cox proportional-hazards regression analysis suggested that the risk of all-cause mortality was higher in the anemia group on admission (1.680, 95%CI: 1.201–2.350, P < 0.01), but not postoperation or on discharge, after adjustment for confounding factors. Our study showed that risk factors for anemia varied at different time points, and therapy interventions would greatly affect the status of postoperation and discharge anemia in hip fracture patients. The take-home message is when anemia is used for mortality prediction in these patients, a specific time point should be chosen. We suggest that only admission anemia should be used for mortality prediction, but not postoperation nor discharge anemia.

Comparison of microstructural and mechanical properties of trabeculae in femoral head from osteoporosis patients with and without cartilage lesions: a case-control study

BackgroundDegeneration of cartilage will change load distribution, affecting bone remodeling progress and trabecular structure and strength. However, in human primary osteoporosis, whether cartilage lesions would also affect properties beneath trabecular bone remains unknown. In this study, we explored the differences in local trabecular properties between osteoporosis patients with and without cartilage lesions.MethodsEighteen pairs of femoral heads with and without cartilage lesions in a weight-bearing area were collected from senile femoral neck fracture patients. The Mankin score and glycosaminoglycan (GAG) content were used to evaluate the severity of the cartilage lesions. Micro-CT and compression tests were used to obtain structural and mechanical characteristics of each trabecular column. Multivariate linear regression was performed to evaluate the association between mechanical parameters and the degree of cartilage lesion.ResultsIn osteoporosis patients with cartilage lesions, the bone volume fraction (BV/TV) and trabecular thickness (Tb.Th) of the trabecular column were significantly higher than that of osteoporotic control patients (all P < 0.05), while the Young’s modulus was lower (P = 0.024). Multivariable linear regression indicated that in both groups, bone mineral density (BMD) significantly correlated with Young’s modulus (all P < 0.05). While in patients with cartilage lesion, GAG content was also correlated with Young’s modulus (standardized coefficient 0.443, P < 0.01).ConclusionsOsteoporosis patients with cartilage lesions exhibited a weaker mechanical property of trabeculae. The intimate association of cartilage lesions and impairment of trabecular mechanical properties indicate that cartilage and trabeculae belong to an interdependent functional unit. Previously proposed adaptive mechanisms in osteoarthritis might also be applicable to the progression of osteoporosis.

Exosome-Mediated Genetic Information Transfer, a Missing Piece of Osteoblast–Osteoclast Communication Puzzle

The skeletal system functions and maintains itself based on communication between cells of diverse origins, especially between osteoblasts (OBs) and osteoclasts (OCs), accounting for bone formation and resorption, respectively. Previously, protein-level information exchange has been the research focus, and this has been discussed in detail. The regulative effects of microRNAs (miRNAs) on OB and OC ignite the question as to whether genetic information could be transferred between bone cells. Exosomes, extracellular membrane vesicles 30–100 nm in diameter, have recently been demonstrated to transfer functional proteins, mRNAs, and miRNAs, and serve as mediators of intercellular communication. By reviewing the distinguishing features of exosomes, a hypothesis was formulated and evaluated in this article that exosome-mediated genetic information transfer may represent a novel strategy for OB–OC communication. The exosomes may coordinately regulate these two cells under certain physiological conditions by transferring genetic information. Further research in exosome-shuttered miRNAs in OB–OC communication may add a missing piece to the bone cells communication “puzzle.”