Comparison of the modified Wiltse’s approach with spinal minimally invasive system and traditional approach for the therapy of thoracolumbar fracture

Thoracolumbar fractures are usually treated by open posterior pedicle screw fixation.However,this procedure involves massive paraspinal muscle stripping,inflicting surgical trauma,and prolonged X-ray exposure.In this study,we observed 127 patients with single-segment injury thoracolumbar fractures.Thirty-six patients were treated by the modified Wiltse’s paraspinal approach with minimally invasive channel system,while 91 patients were treated via traditional posterior approach.Operation time,intraoperative blood loss,intraoperative fluoroscopy frequency,screw placement accuracy,visual analogue scale score,and Cobb’s angle of two groups were compared.The X-ray exposure times were notably reduced(4.2±1.6) in the new approach group(P<0.05).The pedicle screw placement accuracy and Cobb’s angle after surgery were similar in the two groups.We conclude that modified Wiltse’s paraspinal approach w ith spinal minimally invasive channel system surgery can significantly reduce the X-ray exposure times and is an alternative therapy for the thoracolumbar fracture.

The DUF579 proteins GhIRX15s regulate cotton fiber development by interacting with proteins involved in xylan synthesis

Cotton provides the most abundant natural fiber for the textile industry.The mature cotton fiber largely consists of secondary cell walls with the highest proportion of cellulose and a small amount of hemicellulose and lignin.To dissect the roles of hemicellulosic polysaccharides during fiber development,four IRREGULAR XYLEM 15(IRX15)genes,GhIRX15-1/-2/-3/-4,were functionally characterized in cotton.These genes encode DUF579 domain-containing proteins,which are homologs of AtIRX15 involved in xylan biosynthesis.The four GhIRX15 genes were predominantly expressed during fiber secondary wall thickening,and the encoded proteins were localized to the Golgi apparatus.Each GhIRX15 gene could restore the xylan deficient phenotype in the Arabidopsis irx15irx15l double mutant.Silencing of GhIRX15s in cotton resulted in shorter mature fibers with a thinner cell wall and reduced cellulose content as compared to the wild type.Intriguingly,GhIRX15-2 and GhIRX15-4 formed homodimers and heterodimers.In addition,the GhIRX15s showed physical interaction with glycosyltransferases GhGT43C,GhGT47A and GhGT47B,which are responsible for synthesis of the xylan backbone and reducing end sequence.Moreover,the GhIRX15s can form heterocomplexes with enzymes involved in xylan modification and side chain synthesis,such as GhGUX1/2,GhGXM1/2 and GhTBL1.These findings suggest that GhIRX15s participate in fiber xylan biosynthesis and modulate fiber development via forming large multiprotein complexes.

Experimental study on the e ect of fracture scale on seismic wave characteristics

In fractured reservoir beds, fracture characteristics affect seismic wave response. Fractured models based on the Hudson＇s fractured medium theory were constructed in our laboratory by a backfilling technique. For the same fracture density, the variations of the velocity and amplitude of the primary wave and shear wave parallel and perpendicular to the fracture were observed by altering the diameter （scale） of the penny-shaped fracture disk. The model test indicated that an increase of fracture scale increased the velocity and amplitude of the primary wave by about 2%. When the shear wave propagated parallel to the fracture, the velocity of the fast shear wave hardly changed, while the velocity of slow shear wave increased by 2.6% with increasing fracture scale. The results indicated that an increase of fracture scale would reduce the degree of anisotropy of the shear wave. The amplitudes of slow shear waves propagating parallel and perpendicular to fractures decreased with increasing fracture scale.

Bennett's fracture associated with fracture of Trapezium——A rare injury of first carpo-metacarpal joint

Association of fracture of trapezium with Bennett'sfracture is very rare and makes reduction and stabilisation more difficult. We are reporting a rare case of Bennett's fracture with fracture of the trapezium and subluxation of the carpo-metacarpal joint(CMC) joint. The patient was a 47-year-old school teacher who fell from his motorbike on his outstretched right dominant hand. Radiographs and computed tomography showed fracture of the trapezium with subluxation of the CMC joint, associated with Bennett's fracture. Open reduction and internal fixation was carried out. Trapezium was reduced first and secured with a 2 mm diameter screw. Bennett's fracture was then reduced and fixed with two per-cutaneously placed Kirchner's wires. CMC was stabilised with percutaneous Kirchner's wires. Latest follow up at 12 mo showed a healed fracture with good reduction of the CMC joint. Clinically patient had no pain and normal extension, abduction and opposition of the thumb. QuickD ASH score was 3.9/100. Thus, fracture of trapezium associated with a Bennett's fracture is a rare injury and if ignored it may lead to poor results. This injury is more challenging to manage than an isolated Bennett's fracture as anatomical reduction of the trapezium with reduction of the first CMC is needed. Fracture of the trapezium should be fixed first as this will provide a stable base for reduction of the Bennett's fracture.

Strategy for prevention of hip fractures in patients with Parkinson's disease

Hypovitaminosis D and K due to malnutrition or sunlight deprivation,increased bone resorption due to immobilization,low bone mineral density(BMD)and an increased risk of falls may contribute to an increased risk of hip fractures in patients with Parkinson’s disease.The purpose of the present study was to clarify the efficacy of interventions intended to prevent hip fractures in elderly patients with Parkinson’s disease.Pub Med was used to search the literature for randomized controlled trials(RCTs)regarding Parkinson’s disease and hip fractures.The inclusion criteria were 50 or more subjects per group and a study period of 1 year or longer.Five RCTs were identified and the relative risk and95%confidence interval were calculated for individual RCTs.Sunlight exposure increased serum hydroxyvitamin D[25(OH)D]concentration,improved motor function,decreased bone resorption and increased BMD.Alendronate or risedronate with vitamin D supplementation increased serum 25(OH)D concentration,strongly decreased bone resorption and increased BMD.Menatetrenone(vitamin K2)decreased serum undercarboxylated osteocalcin concentration,decreased bone resorption and increased BMD.Sunlight exposure(men and women),menatetrenone(women),alendronate and risedronate with vitamin D supplementation(women)significantly reduced the incidence of hip fractures.The respective RRs(95%confidence intervals)according to the intention-to-treat analysis were 0.27(0.08,0.96),0.13(0.02,0.97),0.29(0.10,0.85)and 0.20(0.06,0.68).Interventions,including sunlight exposure,menatetrenone and oral bisphosphonates with vitamin D supplementation,have a protective effect against hip fractures elderly patients with Parkinson’s disease.

Outcome of application of primary versus secondary Illizarov＇s fixator in open tibial shaft fractures

BACKGROUND: The present study aimed to compare outcome of primary and secondary Illizarov's fi xator application as a treatment method for type III open tibial fractures in terms of nonunion and wound infection.METHODS: This prospective study was done in a tertiary care center. Forty-eight type III tibial fractures were treated with Illizarov's apparatus between 2008 and 2011. The patients were divided into two groups depending on the treatment protocol, timing of wound closure and Illizarov's application, primary(n=28) and secondary(n=20).RESULTS: In the primary group, healing was achieved in all 28 patients. The median time to recovery was 24 weeks, and the median number of operations was 3. There were 6 patients with a bone defect. In the secondary group, complete recovery was achieved in 18 out of 20 patients. The median time to recovery was 30 weeks, and the median number of operations 5. There were 9 patients with a bone defect. The median time to recovery and the number of operations were signifi cantly smaller in patients undergoing primary operation. Union was 100% in the primary group and more than 95% in the secondary group. Chronic osteomyelitis persisted in one patient and below amputation was done in one patient in the secondary group.CONCLUSION: Primary wound closure and Illizarov's fixation required a smaller number of operations and shorter time to recovery than secondary wound closure and Illizarov's fi xation, mostly due to a signifi cantly less number of patients with a bone defect in the primary group.

Effect of Plastic Deformation and H_2S on Dynamic Fracture Toughness of High Strength Casing Steel

The effects of plastic deformation and H2 S on fracture toughness of high strength casing steel（C110 steel） were investigated. The studied casing specimens are as follows： original casing, plastic deformation（PD） casing and PD casing after being immersed in NACE A solution saturated with H2S（PD＋H2S）. Instrumented impact method was employed to evaluate the impact behaviors of the specimens, meanwhile, dynamic fracture toughness（JId） was calculated by using Rice model and Schindler model. The experimental results show that dynamic fracture toughness of the casing decreases after plastic deformation. Compared with that of the original casing and PD casing, the dynamic fracture toughness decreases further when the PD casing immersed in H2 S, moreover, there are ridge-shaped feature and many secondary cracks present on the fracture surface of the specimens. Impact fracture mechanism of the casing is proposed as follows： the plastic deformation results in the increase of defect density of materials where the atomic hydrogen can accumulate in reversible or irreversible traps and even recombine to form molecular hydrogen, subsequently, the casing material toughness decreases greatly.

High-cycle Fatigue Fracture Behavior of Ultrahigh Strength Steels

The fatigue fracture behavior of four ultrahigh strength steels with different melting processes and therefore different inclusion sizes were studied by using a rotating bar two-point bending fatigue machine in the high-cycle regime up to 107 cycles of loading. The fracture surfaces were observed by field emission scanning electron microscopy （FESEM）. It was found that the size of inclusion has significant effect on the fatigue behavior. For AtSI 4340 steel in which the inclusion size is smaller than 5.5 μm, all the fatigue cracks except one did not initiated from inclusion but from specimen surface and conventional S-N curve exists. For 65Si2MnWE and Aermet 100 steels in which the average inclusion sizes are 12.2 and 14.9 μm, respectively, fatigue cracks initiated from inclusions at lower stress amplitudes and stepwise S-N curves were observed. The S-N curve displays a continuous decline and fatigue failures originated from large oxide inclusion for 60Si2CrVA steel in which the average inclusion size is 44.4 pro. In the case of internal inclusion-induced fractures at cycles beyond about 1×10^6 for 65Si2MnWE and 60Si2CrVA steels, inclusion was always found inside the fish-eye and a granular bright facet （GBF） was observed in the vicinity around the inclusion. The GBF sizes increase with increasing the number of cycles to failure Nf in the long-life regime. The values of stress intensity factor range at crack initiation site for the GBF are almost constant with Nf, and are almost equal to that for the surface inclusion and the internal inclusion at cycles lower than about 1×10^6. Neither fish-eye nor GBF was observed for Aermet 100 steel in the present study.

EFFECTS OF POISSON’S RATIO ON SCALING LAW IN HERTZIAN FRACTURE

In this paper the Auerbach＇s scaling law of Hertzian fracture induced by a spherical indenter pressing on a brittle solid is studied. In the analysis, the singular integral equation method is used to analyze the fracture behavior of the Hertzian contact problem. The results show that the Auerbach＇s constant sensitively depends on the Poisson＇s ratio, and the effective Auerbach＇s domain is also determined for a given value of the Poisson＇s ratio.

Fractures in Parkinson’s Disease

Parkinson’s disease is a neurodegenerative disorder that is common in older people and is highly associated with depression, anxiety, apathy, psychosis, cognitive impairment, imbalance and sleep disturbances. These patients have an increased risk of fracture compared to the general population. Comprehensive searches of databases are performed to identify reviews about the risk of fractures in this disease. Parkinson’s patients are at increased risk for low bone mineral density due to the effect of drugs, Parkinson’s disease and age factor, leading to an increased risk of falling down and fractures, especially in the hip. So, improved and innovative treatments with the focus on minimizing inadvertent bone resorption with anti-Parkinson’s disease medication will be highly effective in reducing fear of the disease and providing the patient with a better quality of life.

Hoffa's fracture in a five-year-old child diagnosed and treated with the assistance of arthroscopy:A case report

BACKGROUND Hoffa’s fracture is a coronal-oriented fracture of the femoral condyle.It is rarely observed in pediatric patients that isolated coronal fracture of the medial femoral condyle accompanies an intact lateral femoral condyle.Only a few cases involving Hoffa’s fracture of the medial femoral condyle have been reported in patients with undeveloped skeletons.Such a fracture cannot be observed by routine imaging examinations,thus resulting in possible misdiagnosis and further treatment challenges.CASE SUMMARY A 5-year-old boy with Hoffa’s fracture of the medial femoral condyle suffered from right knee pain and severe swelling after being hit by a heavy object.The patient was misdiagnosed and initially treated in a local primary healthcare center.No improvement in his right knee’s extension was observed following conservative treatment for 2 wk.The patient was transferred to our hospital,rediagnosed using arthroscopy,and underwent open reduction and internal fixation.The therapeutic outcome was satisfactory with the screws removed 7 mo after fixation.At the final follow-up of 40 mo,the range of motion in the knee had recovered.There was no varus-valgus instability.CONCLUSION Hoffa’s fracture is rarely seen in children aged 5 years,let alone in the medial condyle,and can easily be misdiagnosed due to limited physical and imaging examinations.Suspected Hoffa’s fracture in preschool children should be confirmed based on arthroscopic findings.Open reduction and internal fixation should be performed to protect the articular surface and prevent long-term complications.

Seismic and Tectonic Correspondence of Major Earthquake Regions in Southern Ghana with Mid-Atlantic Transform-Fracture Zones

For four centuries now, southern Ghana has been known to be seismically active, and there is no clear geological explanation for the cause of the seismicity. By evaluating new field data and information with re-interpreted historical earthquake data of southern Ghana, the nature of the seismicity of southern Ghana has been elucidated. The mutual connection between the earthquake epicentres and the remote causes by Mid-Atlantic transform faults and fracture zones has been established. The seismic regions of southern Ghana have been linked separately to tectonic faults and activities of the St. Paul’s and Romanche transform-fracture zone systems offshore in the Gulf of Guinea to onshore. It is concluded that the seismicity of southern Ghana is due to tectonic activities of the St. Paul’s and Romanche transform-fracture systems. The Accra region earthquakes originate from reactivation of faults in the Romanche transform-fracture zone, and propagate onshore through Accra and environs. The Axim region earthquakes come from reactivated faults linked to the St Paul’s fracture zone, which go through southern Cote D’Ivoire to Ghana. Seismotectonic movements along the St Paul’s transform and fracture zones have quieted since 1879. But movement along the Romanche Transform fault and Fracture zone is active, causing ongoing seismicity of southern Ghana.

Fracture Femur in a Case of Pyle’s Disease: A Case Report

Pyle’s disease is a rare genetic skeletal disorder also known as Metaphyseal dysplasia. A case of 36 yrs old female with fracture supracondylar femur in Pyle’s disease is presented. She had mild facial dysmorphism, dental malformation & mild genu valgum. Skeletal radiology revealed the characteristic Erlenmeyer flask sign at distal femoral and proximal tibial metaphysis. The fracture supracondylar femur was treated with interlocking nail. The fracture was united in sixteen weeks period. The patient is followed up for two years. The aim of the case report is the rarity of the condition with fracture supracondylar femur in adult female successfully treated with interlocking nail.

Comparison between Distractor Application on Both Radial &Ulnar Side and Radial Side Only for Fracture Distal Radius with Ulnar Styloid Fracture

Background: Fracture of distal radius with involvement of the ulnar styloid process is a common clinical problem. It can be treated conservatively, usually involving wrist immobilization in plaster cast or surgically. A key method of surgical fixation is external fixation by distractor. Distractor can be applied either only on the radial side or on both ulnar and radial sides. Materials and Methods: A prospective randomized and comparative study of 1 year duration was conducted on 32 patients admitted in the Department of Orthopaedics of BSMC & H in the age group of 20 to 75 years old with AO types B and C distal radius fracture along with involvement of the ulnar styloid process. The parameters studied were restoration of radial length, restoration of radial angle, intracarpal step-off and palmar tilt which were statistically evaluated and Fisher’s exact test was performed. The two tailed P-value was calculated and both the groups were statistically compared. Results: In our study, 37.5% patients in Group A and 81.25% in Group B had a radial difference Table 1, Chart 1). 43.75% patients in Group A and 87.5% in Group B had radial angle Table 2, Chart 2). 31.25% in Group A and 75% had intra carpal step off Table 3, Chart 3). 62.5% had an abnormal palmar tilt in Group A while only 6.25% had an abnormal palmar tilt in Group B which is extremely statistically significant. On an average, 2 mm of distraction was required in 75% patients of Group A while only 30% patients in Group B required distraction (Table 4, Chart 4). Conclusion: In our study, the radial difference, radial angle, intra carpal step off and palmar tilt returned significantly to normal in the patients treated with distractor on radial side only when compared with distractor application on both radial and ulnar sides for distal radius fracture with ulnar styloid process involvement. Also post-operative distraction required under image intensifier was higher in the group treated with distractor on either side than those with distractor only on radial side.

A retrospective study of unfavorable fractures during sagittal split osteotomy:A single surgeon’s experience

Background:Unfavorable fractures are among the most common complications of bilateral sagittal split ramus osteotomy(BSSRO).This study aimed to evaluate unfavorable fracture patterns during BSSRO and assess the related risk factors and treatment measures.Methods:The clinical records and radiographs of 679 patients(1358 sides)who underwent BSSRO at Shanghai Ninth People’s Hospital between September 2013 and December 2021 were examined.Results:Patients with unfavorable fractures who underwent surgical restoration were studied.The incidence of unfavorable fractures was 0.8%(n¼11),with the highest rate in the third year.The unfavorable fractures were divided into three types by location and clinical treatment:(1)SSRO could still be completed after buccal/lingual plate unfavorable fracture(0.6%,n=8);(2)condylar/coronoid process fractures/intermaxillary fixation needed(0.1%,n=2);(3)additional osteotomy required(0.07%,n=1).Conclusion:These results suggest that as a surgeon’s experience increases,the rate of unfavorable fractures may decrease.The novel classification of unfavorable fractures for SSRO might be useful for surgeons to make appropriate treatment choices during orthognathic surgery.

Treatment of Bilateral Proximal Humeral Fracture in Patients with Parkinson’s Disease: A Case Report

There are only a few reports about upper extremity fractures in patients with Parkinson’s disease (PD). This is a case report of a PD patient with severe tremors who had proximal humeral fracture. We performed surgery for the left side and conservative treatment for the right side. The patient was a 73-year-old woman who had been diagnosed with PD 10 years prior to presentation. Open reduction internal fixation was conducted for the left proximal humeral fracture. 7 months after the left shoulder fracture, she fell resulting in a right proximal humeral fracture for which she underwent conservative treatment. Although bone union was obtained bilaterally, anterior subluxation occurred in the operated side 9 months postoperative. Screw remove was performed because perforation of the screw was observed in the humeral head and was causing pain. Currently, restriction in range of motion and subluxation may be seen on the side that received conservative treatment, although pain is absent and patient satisfaction is high. On the operated side, there is a marked restriction in range of motion, subluxation, and pain. Our experience revealed that conservative treatment was effective for proximal humeral fractures and that optimal bone union might be obtained even in patients with suboptimal PD control.

Surgical Treatment for Proximal Humerus Fractures Comparison between Plate Fixation and Kapandji’s Pinning

Introduction: Proximal humerus fractures are common, however, there is no consensus on a decision-making algorithm for the therapeutic management of these fractures, the aim of this study is to evaluate and compare functional results between two surgical techniques and to deduce the satisfactory results of the Kapandji’s pinning which, compared to the screw plate, should keep its place in the therapeutic arsenal. Patients and Methods: It’s a retrospective study, including two groups: The first of 18 patients treated with palm-tree pinning using kapandji’s technique, the second of 16 patients treated with anatomical screw plate at the orthopedic trauma service of the Mohamed VI university hospital between July 2013 and July 2018. We compared the results of the two techniques by studying three parameters which are the healing time, the anatomical reduction, and the functional outcomes. The average age was 46 years, and the sex ratio (M/F) was 2.3. Results: The statistical analysis of functional and radiological results showed no significant difference between the two techniques, indeed the average healing time was 56.3 days in the group treated by screw plate and 55.2 days in the group treated by Kapandji’s pinning (p = 0.46), Constant’s score was 73.18 and 79.05 respectively (p = 0.27) and the average cephalodiaphyseal angle was 49.03° and 52.07°, respectively (p = 0.35). Discussion: This study has clearly shown, as reported in the literature, that there is no conclusive evidence to suggest superiority of os-teosynthesis by anatomical plate versus kapandji’s pinning. However, the simple achievement of pinning according to kapandji’s technique, the preservation of soft tissues and the low cost make us prefer this technique. Furthermore, despite the progress noted in the development of osteosynthesis means of the proximal humerus, percutaneous pinning should always keep its place.

SURGERY ON INTERCONDYLAR FRACTURE OF HUMERUS

Objective To evaluate the results of surgery on intercondylar of humerus. Methods Fifty-eight cases (26 males, 32 females), in an average age of 46. 6 (13 ~ 82 years), of intercondylar fracture of the humerus operated from September 1988 to September 1998 were followed up 29 months (8 ~ 63 months). According to the AO/MSIF classification 8, 7 and 5 cases were divided into type B1, B2 and B3 respectively while other 13, 10 and 15 patients into C1, C2 and C3 respectively. All the cases were evaluated by modified Jupiter assessment. Results Twenty-eight patients gained excellent results, while the good, fair and poor outcomes were found in twenty-two, three and five cases respectively. Conclusion Surgical treatment from posterior trans-olecranon approach with combination of internal fortion and bone graft, follwed by early active motion and adhesion relief procedure for elbow if necessary, was advocated in intercondylar fracture of humerus.

Experimental observation of rat's early-stage fracture healing with different kinds of nerve injuries

To investigate the impact of different kinds of nerve injuries of early-stage fracture healing.Methods Three groups of rats were included in the experiment among which group 1 was inflicted with femoral fracture and T10 spinal cord transsection (SCI),group 2 was inflicted with femoral and peripheral nerve resection (PNR),and group 3 with simple femoral fracture as control group.Two weeks after operation the femoral bones were collected for X-ray checking and 2 more weeks later X-ray checking was performed again followed by pathomorphologic exams.Results X-ray result showed no massive calluses in the bones in the 2nd week postoperatively,while in the 4th week,callus appeared with larger size in group 3 than that of group 1 and with smaller size than that of group 2.It was the same with the result of pathomorphologic examining.Cortical bone bridges between fracture point and osteiod were also found in group 2 and there were less normal blood vessels and worse bone remodeling than that of group 3.There were relatively immature calluses with more fibroblast-like cells and disordered bone structure in group 2.Group 3 showed normal healing process and callus structure.Conclusion Early-stage bone fracture healing can be influenced significantly by different kinds of nerve injuries.6 refs,6 figs.

Clinical significance of Baumann's angle in the percutaneous pinning fixation for supracondylar fractures of the humerus in children

To evaluate the clinical significance of Baumann’s angle in the closed reduction and percutaneous pinning fixation for supracondylar fractures of the humerus in children.Methods There were 97 children (male 59,female 38,mean age of 6.8 years) with displaced supracondylar fracrtures of the humerus were treated in this hospital.Under fluoroscopy guidance,three-dimensional displacement of fractures was corrected by closed reduction.The percutaneous Kirschner wire pinning was applied only if the radiographs demonstrated that Baumann’s angle was less than 4 degree compared to that on the normal side.All of them were followed up for 34.5 months (range,12 to 48 months).Results There was one case with ulnar nerve palsy associated with the pinning.There were no Volkmann’s contracture in this group.X-ray examinations revealed an average 73.7 degrees of Baumann angle on the injured and 72.8 on uninjured side.An average 7.6 degrees of the carrying angle on the injured and 9.7 on uninjured side were also demonstrated by radiography.Five patients developed slight cubitus varus deformity.The result according to Flynn criteria were excellent in 85 patients (87.6%),good in 12 patients (12.4%).Conclusion The satisfactory results can be gained in children with displaced supracondylar fractures of the humerus by restoration of the normal Baumann angle and percutaneous pinning fixation.18 refs,2 figs.