Tang Peifu

Volar locking plate versus external fixation for the treatment of unstable distal radial fractures: a meta-analysis of randomized controlled trials.

BACKGROUND The choice between volar locking plates (VLP) and external fixation (EF) for unstable distal radius fractures have not reached a consensus. The meta-analysis of randomized controlled trials was performed to compare VLP with EF to determine the dominant strategy. MATERIALS AND METHODS Meta-analysis was performed with a systematic search of studies conducted by using the PubMed, Embase, and Cochrane Central Register of Controlled Trials databases. The randomized controlled trials that compared VLP with EF was identified. Characteristics, functional outcomes, radiological results, and complications were manually extracted from all the selected studies. RESULTS Six studies encompassing 445 patients met the inclusion criteria. There was significant difference between two procedures in disabilities of the arm shoulder and hand scores at 3,6, and 12 mo, visual analogue scale at 6 mo, grip strength at 3 mo, supination at 3 and 6 mo, extension at 3 mo, ulnar variance at 12 mo, and reoperation rate at 12 mo, postoperatively. However, there was no significant difference between flexion, pronation, radial deviation, and ulnar deviation at all follow-up points postoperatively and overall complications at 12 mo, postoperatively. CONCLUSIONS EF had less reoperative rate due to complications, however, VLP had advantages in functional recovery in the early period after surgery, but two methods had similar functional recovery at 12 mo, postoperatively. Clinician should make the treatment decision with great caution for the patients who sustained unstable distal radial fractures.

Autologous uncultured bone marrow-derived mononuclear cells and modified cannulated screw in repair of femoral neck fracture†

The purpose of this study was to assess whether autologous uncultured bone marrow‐derived mononuclear cells (BMMNCs) combined with modified cannulated screw would accelerate the healing of canine femoral neck fracture. BMMNCs were encapsulated within fibrin glue (FG) and implanted into the fractured femoral neck via modified cannulated screw in experiment group, and the control group was treated by modified cannulated screw. Gross observation, radiological examination, histological analysis, and blood vessel microdensity counting were used to compare bone healing of each group at 1, 2, and 3 months. FG was confirmed as an ideal cell‐delivery vehicle for BMMNCs proliferation and differentiation in vitro testing. In vivo animal testing, faster new bone formation and fracture healing were confirmed by gross observation, radiological examination, histological analysis in experimental group than in control group at all times points. The blood vessel microdensity counting increased gradually both in the experimental group and control group, but was more obviously in experimental group at 3 months (p < 0.01). These data suggest that autologous BMMNCs combined with modified cannulated screw treatment is an effective therapy for femoral neck fracture and thus, may be an option for clinical applications.