Tian-fu Yang

The new proximal femoral nail antirotation-Asia: early results.

The proximal femoral nail antirotation system was introduced by the Arbeitsgemeinschaft fur Osteosynthesfragen/Association for the Study of Internal Fixation (AO/ASIF) in 2003 and is suitable for treating unstable trochanteric fractures. However, proximal femoral nail antirotation was designed according to the geometric proportions of the White population, and it is known that important differences exist between Asians and Americans with regard to femoral geometry. Reports of serious postoperative complications also exist when used for the elderly Asian population. Therefore, geometrical mismatch between proximal femoral nail antirotation and the femora of Asians has led the AO/ASIF to design a new proximal femoral nail antirotation for Asia with adapted sizes and geometry. This article reports early clinical results of using proximal femoral nail antirotation for Asians in 84 consecutive patients to stabilize unstable trochanteric fractures (AO classification, 31.A2 and A3). Patients were followed up for an average 8 months (range, 4-11 months). Intraoperative and postoperative complications, surgical details, and outcome measurements were evaluated. Fractures were treated by closed reduction and intramedullary fixation. The proximal femoral nail antirotation Asia position was ideal in 80 cases (95%). No patients showed complication related to the mismatch between the nail and femora. The mean time to bone healing was 14 weeks. Functionally, 90% of the patients regained pretrauma mobility. According to the Harris hip scoring system, 63 patients (78%) had an excellent or good outcome. The new proximal femoral nail antirotation Asia yields better results in the treatment of unstable trochanteric fractures in elderly patients by closely matching Asian femoral anatomy and thereby reducing complications related to the implants.

Comparison of three plate system for lateral malleolar fixation

BackgroundThis study was to compare clinical and radiographic outcomes with three different implants and evaluate the effectiveness of minimally invasive plate osteosynthesis (MIPO) technique for the distal fibular fractures.MethodsWe performed a retrospective cohort single-surgical team single-facility study between 2000 and 2011. 147 patients receiving surgical interventions for closed, displaced distal fibular fractures were included. Based on the different implants, patients were divided into three groups: Group A: one-third tubular plate; Group B: locking compression (LCP) metaphyseal plate; Group C: LCP distal fibula plate. Clinical and radiographic outcomes were compared among the three groups.ResultsTotally, we found that patients in Group C had significant higher functional scores than those in Group A (p1 = 0.004; p2 = 0.002) (p1 stands for the p value for Olerud & Molandar Score, p2 stands for the p value for American Orthopaedic Foot & Ankle Society score). The healing time was significant less in Group C than that in Group A (p < 0.0001) and Group B (p < 0.0001). Subgroup analysis showed that: (1) For Weber A fracture, the functional scores of the Group C were higher than those in Group A (p1 = 0.020; p2 = 0.029) and B (p1 = 0.020; p2 = 0.034). (2) For Weber B fracture, the functional scores of the Group B (p1 = 0.033; p2 = 0.030) and C (p1 = 0.027; p2 = 0.017) were higher than those in Group A. No significant differences were observed in terms of the ankle range of motion, reduction accuracy and complication rate.ConclusionsOur study demonstrated using LCP metaphyseal plate in patients associated with lateral malleolar fracture could achieve significantly better OMS & AOFAS scores and less healing time than using one-third tubular plate. Specifically, For Weber A fracture, LCP distal fibula plate is much better than one-third tubular plate and LCP metaphyseal plate. While for Weber B fracture, LCP distal fibula plate and LCP metaphyseal plate are better than one-third tubular plate. As to the complications, using MIPO technique in patients with distal fibular fractures is at least comparable to the traditional one.

Ipsilateral basicervical femoral neck and shaft fractures treated with long proximal femoral nail antirotation or various plate combinations: comparative study

BackgroundAlthough many treatment methods have been developed, controversy exists regarding the optimal management of ipsilateral femoral neck and shaft fractures. The purpose of this retrospective study was to compare the results of long proximal femoral nail antirotation (PFNA-long) and various plate combinations in the treatment of ipsilateral basicervical femoral neck and shaft fractures.MethodsBetween January 2004 and May 2008, a total of 21 patients with ipsilateral basicervical femoral neck and shaft fractures were treated with PFNA-long or various plate combinations. We divided patients into two groups. Group I included 11 patients who underwent surgery with cancellous lag screws or dynamic hip screws (DHS) combined with compression plate fixation. Group II included 10 patients who underwent surgery with PFNA-long.ResultsThe average follow-up periods were 22.2 and 20.8 months for groups I and II, respectively. The average union times for femoral neck fractures in groups I and II were 15.6 and 16.0 weeks, respectively; and the average union times for shaft fractures were 21.1 and 20.3 weeks, respectively. There were eight good, two fair, and one poor functional result in group I and eight good, one fair, and one poor in group II. One case of implant failure and nonunion of the femoral shaft fracture occurred in group I. There were no significant differences in the functional outcomes or major complications between the two groups.ConclusionsBoth treatment methods achieved satisfactory functional outcomes in patients with ipsilateral basicervical femoral neck and shaft fractures. PFNA-long was a good option for the treatment of complex fractures, with the advantages of closed antegrade nailing with minimal exposure, reduced perioperative blood loss, and biological fixation of both fractures with a single implant.

Oestrogen Receptor-α Polymorphism and Risk of Fracture: a Meta-analysis of 13 Studies Including 1279 Cases and 6069 Controls

A meta-analysis was performed to evaluate the effect of oestrogen receptor-α (ESR1) gene PvuII polymorphism on fracture risk. It included published data from relevant studies (up to May 2010) identified from Medline™, Embase™ and Current Contents™. The 13 included studies contained 1279 fracture cases and 6069 controls. The combined results based on these studies showed no relationship between ESR1 gene PvuII polymorphism and fracture risk. No significant difference in genotype distribution was found when stratifying by race. When stratifying by fracture type, it was found that vertebral fracture cases had a significantly higher frequency of the PvuII pp genotype than controls in five studies (552 cases and 2350 controls). This meta-analysis suggests a modest but statistically significant association between the ESR1 PvuII pp genotype and vertebral fracture.

In vitro stress effect on degradation and drug release behaviors of basic fibroblast growth factor – poly(lactic-co-glycolic-acid) microsphere

Objective To study the degradation and basic fibroblast growth factor (bFGF) release activity of bFGF – poly(lactic-co-glycolic-acid) microsphere (bFGF-PLGA MS) under stress in vitro, including the static pressure and shearing force-simulating mechanical environment of the joint cavity. Method First, bFGF-PLGA MSs were created. Meanwhile, two self-made experimental instruments (static pressure and shearing force loading instruments) were initially explored to provide stress-simulating mechanical environment of the joint cavity. Then, bFGF-PLGA MSs were loaded into the two instruments respectively, to study microsphere degradation and drug release experiments. In the static pressure loading experiment, normal atmospheric pressure loading (approximately 0.1 MPa), 0.35 MPa, and 4.0 MPa pressure loading and shaking flask oscillation groups were designed to study bFGF-PLGA MS degradation and bFGF release. In the shearing force loading experiment, a pulsating pump was used to give the experimental group an output of 1,000 mL/min and the control group an output of 10 mL/min to carry out bFGF-PLGA MS degradation and drug release experiments. Changes of bFGF-PLGA MSs, including microsphere morphology, quality, weight-average molecular weight of polymer, and microsphere degradation and bFGF release, were analyzed respectively. Results In the static pressure loading experiment, bFGF-PLGA MSs at different pressure were stable initially. The trend of molecular weight change, quality loss, and bFGF release was consistent. Meanwhile, microsphere degradation and bFGF release rates in the 4.0 MPa pressure loading group were faster than those in the normal and 0.35 MPa pressure loading groups. It was the fastest in the shaking flask group, showing a statistically significant difference (P<0.0001). In the shearing force loading experiment, there were no distinctive differences in the rates of microsphere degradation and bFGF release between experimental and control group. Meanwhile, microsphere degradation and bFGF release rates by shaking flask oscillation were obviously faster than those by shearing force only (P<0.0001). Conclusion There are significant effects on bFGF-PLGA MS degradation and bFGF release due to the interaction between extraction stress and time. Static pressure has a conspicuous influence on bFGF-PLGA MS degradation and release, especially at a pressure of 4.0 MPa. The shearing force has a slight effect on bFGF-PLGA MS degradation and drug release. On the contrary, shaking flask oscillation has a significantly distinctive effect.

Sanders II-III calcaneal fractures fixed with locking plate in elderly patients.

Purpose To evaluate the clinical outcomes of locking calcaneal plate in treating calcaneal fracture (Sanders II–III) in elderly patients. Methods From October 2012 to December 2013, 23 elderly patients suffering from calcaneal fracture (Sanders II–III) were treated and followed up. There were 15 males and 8 females with the mean age of 68.5 years (range: 65–79 years). According to Sanders classification, 16 cases (16 feet) were type II fractures and 7 cases (7 feet) were type III fractures. Anteroposterior, lateral and axial views of X-ray were taken to detect the calcaneum. CT scan was done to assess the amount of comminution and articular depression. Radiological assessment was performed using Bohlers angle and Gissanes angle. Functional outcome was assessed using the Maryland foot score. Results All the patients were followed up for 13.7 months on average (10–20 months). The mean time of bone union was 3.2 months (3–4 months). The mean time of complete weight bearing was 3.2 months (3.1–4.0 months). The soft tissue necrosis was found in 1 case. The mean Bohlers angle and Gissanes angle were 25.31° and 117.5° respectively. The overall excellent to good rate was 82.6%. Conclusion Open reduction and internal fixation with locking calcaneal plate can obtain good functional outcome for Sanders II–III calcaneal fractures in elderly patients.

A comparative study of ipsilateral intertrochanteric and femoral shaft fractures treated with long proximal femoral nail antirotation or plate combinations.

Objective:  To compare the results of long proximal femoral nail antirotation (PFNA‐long) and plate combinations in the treatment of ipsilateral intertrochanteric and femoral shaft fractures.