ObjectiveTo discuss the efficacy of skin stretcher applied for repair of postoperative skin and soft tissue defects in tibial fractures.MethodsBetween April 2016 and March 2017, 15 cases with skin and soft tissue defects after tibial fractures fixation were treated with the skin stretcher. There were 11 males and 4 females with an age of 24-59 years (mean, 37.5 years). The causes of injury included traffic accident in 7 cases, bruise in 3 cases, falling from height in 3 cases, and falling in 2 cases; without nerve and vascular injury in all patients. These cases were followed up 1-3 months after their first surgery, consisting of 3 closed fractures treated with open reduction and plate and screw fixation, 12 open fractures treated with external fixation after debridement. The area of skin defects ranged from 14 cm×5 cm to 20 cm×7 cm, all of which were stripped or spindle shaped skin defects. First, the skin was penetrated by two Kirschner wires which were locked by skin stretchers on both sides of the skin defect longitudinally. Then, the tension of skin stretchers was timely adjusted according to the skin flap blood supply and muscle compression. Finally, Kirschner wires and skin stretchers were removed when the edge of skin contacted and been sutured.ResultsAll skin and soft tissue defects were covered after stretching for 6-13 days. The interrupted sutured wounds healed at 12 days. Clinical scores of wound healing decreased from 3.40±0.51 at immediate postoperatively to 1.27±0.46 at 12 days postoperatively, showing significant difference (t=12.911, P=0.000). All the patients were followed up 4-12 months (mean, 6.5 months). After stretching, the skin color, elasticity, and pain and touch feeling were similar with the normal skin, and the hair growth was normal. After operation, 1 case of nail tract infection and 2 cases of calf discomfort occurred, and all were relieved after treatment.ConclusionIt is an effective method for repairing postoperative skin and soft tissue defects in tibial fractures with the application of skin stretchers.
ObjectiveTo review the research progress of the application of internal fixation (INFIX) in the treatment of pelvic anterior ring injuries.MethodsThe recent literature about INFIX in the treatment of pelvic anterior ring injury concerning the surgery technique, biomechanical characteristics, indications, contraindications, advantages, complications, and effectiveness was extensively consulted, reviewed, and summarized.ResultsINFIX is a relatively novel technique for the treatment of pelvic anterior ring injuries at present. The advantages include good biomechanical properties, extensive indications, minimally invasion, convenient nursing, less complications, and excellent effectiveness.ConclusionIt is a clinical method with obvious advantages and development potential for treatment of pelvic anterior ring injuries using INFIX, and further study is needed to improve its effectiveness.
Platelet-rich plasma (PRP) is a platelet-rich plasma protein concentrate extracted from autologous peripheral blood, which contains a variety of blood-derived growth factors and cytokines. As an autologous blood product, PRP is widely used in many fields such as tissue repair and regeneration because of its minimally invasive process, simple preparation process and good biological properties. The acquisition of PRP is mainly achieved by collecting peripheral blood through density gradient centrifugation. Various growth factors and cytokines in PRP can repair various tissues. With the deepening of PRP research, it is now gradually applied to rotator cuff injury, lateral epicondylitis of humerus, carpal tunnel syndrome, knee joint injury, gluteal muscle tendinopathy, achilles tendinopathy, plantar fasciitis, and other soft tissue injuries, and some progress has been made. This article reviews the progress on clinical applications of PRP in chronic soft tissue injuries to provide a theoretical basis.
ObjectivesTo systematically review the safety and efficacy of intraoperative local application of platelet-rich plasma in patients with femoral neck fracture.MethodsDatabases including The Cochrane Library, PubMed, Web of Science, WanFang Data, CBM, EMbase and CNKI were searched to collect randomized controlled trials (RCTs) on operation versus operation combined with platelet-rich plasma for patients with femoral neck fracture from inception to April 30th, 2017. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 8 RCTs, including 916 patients with femoral neck fracture were enrolled in the analysis. The results of meta-analysis showed that compared with the group of internal fixation, the group of internal fixation combined with platelet-rich plasma could significantly shorten healing duration of fracture (MD=−2.18, 95%CI −3.37 to −0.99, P=0.000 3), improve the fracture healing rate (RR=1.14, 95%CI 1.03 to 1.25, P<0.000 01) and hip function score (MD=10.18, 95%CI 5.99 to 14.37, P<0.000 01), and effectively reduce the femoral head necrosis rate after operation (RR=0.35, 95%CI 0.22 to 0.57, P<0.000 1).ConclusionCurrent evidence shows that the method of internal fixation combined with platelet-rich plasma could effectively shorten healing duration, improve healing rate and hip function score, and reduce the rate of femoral head necrosis. Due to the limited quality of the included studies, more large scale, high-quality studies are required to verify the above conclusion.
ObjectiveTo evaluate the effect of bone morphogenetic protein 7 (BMP-7)/poly (lactide-co-glycolide) (PLGA) microspheres on in vitro proliferation and chondrogenic differentiation of rabbit bone marrow mesenchymal stem cells (BMSCs).MethodsBMP-7/PLGA microspheres were fabricated by double emulsion-drying in liquid method. After mixing BMP-7/PLGA microspheres with the chondrogenic differentiation medium, the supernatant was collected on the 1st, 3rd, 7th, 14th, and 21st day as the releasing solution. The BMSCs were isolated from the bilateral femurs and tibias of 3-5 days old New Zealand rabbits, and the 3rd generation BMSCs were divided into 2 groups: microspheres group and control group. The BMSCs in microspheres group were cultured by 200 μL BMP-7/PLGA microspheres releasing solution in the process of changing liquid every 2-3 days, while in control group were cultured by chondrogenic medium. The cell proliferation (by MTT assay) and the glycosaminoglycan (GAG) contents (by Alician blue staining) were detected after chondrogenic cultured for 1, 3, 7, 14, and 21 days. The chondrogenic differentiation of BMSCs was observed by safranine O staining, toluidine blue staining, and collagen type Ⅱ immunohistochemistry staining at 21 days.ResultsMTT test showed that BMSCs proliferated rapidly in 2 groups at 1, 3, and 7 days; after 7 days, the proliferation of BMSCs in the control group was slow and the BMSCs in microspheres group continued to proliferate rapidly. There was no significant difference of the absorbance (A) value at 1, 3, and 7 days between 2 groups (P>0.05), but theA value at 14 and 21 days in microspheres group was significantly higher than that in control group (P<0.05). Compared with control group at 21 days, in microsphere group, almost all nuclei were dyed bright red by safranine O staining, almost all the nuclei appeared metachromatic purple red by toluidine blue staining, and the most nuclei were yellow or brown by immunohistochemical staining of collagen type Ⅱ. Alcian blue staining showed that the content of GAG in 2 groups increased continuously at different time points; after 7 days, the increasing trend of the control group was slow and the microspheres group continued hypersecretion. There was no significant difference of the GAG content at 1, 3, and 7 days between 2 groups (P>0.05), but the GAG content at 14 and 21 days in microspheres group was significantly higher than that in control group (P<0.05).ConclusionBMP-7/PLGA microspheres prepared by double emulsion-drying in liquid method in vitro can promote proliferation and chondrogenic differentiation of rabbit BMSCs.
Exosomes derived from mesenchymal stem cells are a class of discoid extracellular vesicles with a diameter of 40—100 nm discovered in recent years. They contain abundant nucleic acids, proteins and lipids, and have abundant biological information. Exosomes derived from mesenchymal stem cells regulate cell activities by acting on receptor cells, and promote regeneration of many tissues, such as bone, cartilage, skin, intervertebral disc, and spinal nerves. Studies have shown that exosomes derived from mesenchymal stem cells have similar biological functions as mesenchymal stem cells, and are more stable and easier to be preserved. Therefore, they have been increasingly applied in the field of orthopedic tissue repair in recent years. This paper reviews the application of exosomes derived from mesenchymal stem cells in orthopedics.
ObjectiveTo assess the effectiveness of anterior subcutaneous internal fixation (INFIX) combined with posterior percutaneous iliosacral screw for the treatment of unstable pelvic fractures.MethodsBetween August 2016 and November 2017, 19 cases of unstable pelvic fractures were treated with anterior subcutaneous INFIX combined with posterior percutaneous iliosacral screw. There were 14 males and 5 females, with an average age of 40.6 years (range, 17-69 years). Causes of injury included traffic accident injury in 11 cases, falling from height in 5 cases, bruise injury by heavy object in 3 cases. According to Tile classification, there were 2 cases of type B1, 6 cases of type B2, and 11 cases of type C. Anterior ring injuries included bilateral pubic ischial ramus fractures in 12 cases, unilateral pubic ischial ramus fractures in 5 cases, and symphysis pubis separation in 2 cases. Posterior ring injuries included sacroiliac ligament injuries in 2 cases, unilateral iliac bone fractures in 3 cases, unilateral sacral fractures in 11 cases, unilateral sacroiliac joint dislocation in 2 cases, and bilateral sacral fracture in 1 case. The intraoperative blood loss and operation time were recorded, and the fracture healing and postoperative complications were observed. Matta score was used to evaluate the reduction of fracture, and Majeed score was used to evaluate the postoperative function of patients.ResultsThe operation time was 47-123 minutes (mean, 61.4 minutes) and the intraoperative blood loss was 50-115 mL (mean, 61.1 mL). One case had superficial infection at the site of screw implantation, and 1 case had unilateral cutaneous nerve stimulation, which were cured after corresponding treatment. There was no damage of urinary system, reproductive system, and intestine. All cases were followed up 12-25 months (mean, 18.1 months). All the fractures healed after operation, the average healing time was 9.5 weeks (range, 8-13 weeks); no nonunion, delayed healing, internal fixation loosening, fracture, and other situations occurred. Of the 2 patients with lumbosacral plexus injury before operation, 1 recovered completely and 1 had residual mild claudication. At last follow-up, the reduction of fracture was evaluated by Matta scoring standard, the results were excellent in 13 cases and good in 6 cases, with an excellent and good rate of 100%; the function was evaluated by Majeed scoring standard, the results were excellent in 15 cases and good in 4 cases, with an excellent and good rate of 100%.ConclusionMinimally invasive pelvic stabilization by using anterior subcutaneous INFIX and posterior percutaneous iliosacral screw for treatment of unstable pelvic fractures, can achieve good fracture reduction and definitive stabilization with minimum complications and obtain excellent functional outcomes.
Because of the complexity of proximal humeral fractures, the treatment of proximal humeral fractures has always been a challenge for clinicians. The MultiLoc intramedullary nail is a new type of internal fixation device which has been gradually used in the treatment of proximal humeral fractures in recent years. At present, it is mainly used in the Neer two- and three-part fractures, especially surgical neck fractures. Its flexible design can provide personalized and multi-plane fixation for fracture patients, “screw-in-screw” and medial supporting screw can effectively reduce the axial displacement and varus angle of humeral head, and minimally invasive surgical incision can reduce the injury of rotator cuff. This review focuses on the research status and related evidence of the design, operation, prognosis, and postoperative complications of MultiLoc intramedullary nail, in order to provide a theoretical basis for the application of MultiLoc intramedullary nail in fracture treatment, and enhance clinicians’ understanding of MultiLoc intramedullary nail as a new type of internal fixation device.
ObjectiveTo evaluate the effectiveness of a clavicular hook plate with coracoclavicular ligament augmentation by suture anchor in the treatment of Neer types Ⅱ and Ⅴ distal clavicle fractures.MethodsBetween January 2010 and June 2016, 16 patients with Neer types Ⅱ and Ⅴ distal clavicle fractures were treated with clavicle hook plates and coracoclavicular ligament augmentation by suture anchor. There were 12 males and 4 females with an average age of 45.6 years (range, 14-81 years). The injury mechanism included falling in 10 cases, traffic accident injury in 2 cases, falling from height in 2 cases, and heavy object injury in 2 cases. The Neer classification of clavicle fractures included 2 cases of type Ⅱa, 13 cases of type Ⅱb, and 1 case of type Ⅴ. The injury severity score (ISS) was 6-29, with an average of 11.2. The time from injury to operation was 1-18 days, with an average of 6.4 days. The operation time, intraoperative blood loss, hospitalization stay, fracture healing, and postoperative complications were recorded; the disability of arm, shoulder, and hand (DASH) score, the shoulder joint Constant score, and the Oxford shoulder score (OSS) were used to evaluate the shoulder joint at last follow-up.ResultsAll operations were successfully completed. The operation time was 50-100 minutes, with an average of 75.6 minutes; intraoperative blood loss was 30-100 mL, with an average of 52.8 mL; hospitalization stay was 4-47 days, with an average of 13.7 days. All patients were followed up 1.2-7.5 years, with an average of 3.5 years. All clavicle fractures healed, and the healing time was 9.4-13.6 weeks, with an average of 11.9 weeks. No fracture nonunion, fracture displacement, failure of internal fixation, or incision infection, etc. occurred. Fifteen patients took out the hook plate after fracture healing and functional recovery, and 1 case refused to remove the hook plate from the second operation because of no obvious discomfort. At last follow-up, the DASH score was 0-13, with an average of 2.2; the shoulder joint Constant score was 90-100, with an average of 96.8; the OSS score was 12-14, with an average of 12.3.ConclusionClavicular hook plate with coracoclavicular ligament augmentation by suture anchor can help achieve good effectiveness with less postoperative complication in the treatment of Neer types Ⅱ and Ⅴ distal clavicular fractures.
Open reduction and internal fixation with plate and screw is one of the most widely used surgical methods in the treatment of proximal humeral fractures in the elderly. In recent years, more and more studies have shown that it is very important to strengthen the medial column support of the proximal humerus during the surgery. At present, orthopedists often use bone graft, bone cement, medial support screw and medial support plate to strengthen the support of the medial column of the proximal humerus when applying open reduction and internal fixation with plate and screw to treat proximal humeral fractures. Therefore, the methods of strengthening medial column support for proximal humerus fractures and their effects on maintaining fracture reduction, reducing postoperative complications and improving functional activities of shoulder joints after operation are reviewed in this paper. It aims to provide a certain reference for the individualized selection of medial support methods according to the fracture situation in the treatment of proximal humeral fractures.