Bilateral sequential femoral neck stress fractures in young adult with HIV infection on antiretroviral therapy: A case report

BACKGROUND Femoral neck stress fractures are rarely encountered among young adults and are often associated with either repetitive excessive loading or underlying bone pathology.Preliminary research has indicated human immunodeficiency virus(HIV)/antiretroviral therapy(ART)as predisposing agents to osteopenia and osteoporosis related complications.We report a case of HIV/ART induced insufficiency fracture in a resource limited setting in Central India.Our aim is to increase awareness and promote screening of HIV/ART related osteopenia and osteoporosis in order to prevent catastrophic orthopaedic complications.CASE SUMMARY A 35-year-old HIV positive male presented with a stress fracture of left femoral neck.The patient was on ART and reported no comorbidities.He went on to be successfully managed surgically.However,during work-up osteopenia of the contralateral proximal femur was recognised using Singh’s Index.Six months post-op the patient presented with right-sided femoral-neck stress fracture.At this stage the patient was nonconcordant with ART and denied surgical fixation.CONCLUSION In the absence of co-morbidities,several mechanisms of HIV/antiretroviral therapy may have played a role in predisposing our patient towards such a presentation.We recommend routine screening all HIV-infected patients for osteopenia,especially in younger individuals.In low resource settings and district hospitals,pelvis radiograph&Singh’s index can be used for screening.

Teriparatide anabolic therapy as potential treatment of type Ⅱ dens non-union fractures

Odontoid fractures account for 5% to 15% of all cervical spine injuries and 1% to 2% of all spine fractures. Type Ⅱ fractures are the most common fracture pattern in elderly patients. Treatment(rigid and non-rigid immobilization, anterior screw fixation of the odontoid and posterior C1-C2 fusion) remains controversial and represents a unique challenge for the treating surgeon. The aims of treatment in the elderly is to quickly restore pre-injury function while decreasing morbidity and mortality associated with inactivity, immobilization with rigid collar and prolonged hospitalization. Conservative treatment of type Ⅱ odontoid fractures is associated with relatively high rates of non-union and in a few cases delayed instability. Options for treatment of symptomatic non-unions include surgical fixation or prolonged rigid immobilization. In this report we present the case of a 73-year-old woman with post-traumatic odontoid nonunion successfully treated with Teriparatide systemic anabolic therapy. Complete fusion and resolution of the symptoms was achieved 12 wk after the onset of the treatment. Several animal and clinical studies have confirmed the potential role of Teriparatide in enhancing fracture healing. Our case suggests that Teriparatide may have a role in improving fusion rates of C2 fractures in elderly patients.

Effect of mid-frequency pulse therapy combined with external fixation on bone metabolism, inflammatory response and oxidative stress in patients with osteoporotic distal radial fractures

Objective:To study the effect of mid-frequency pulse therapy combined with external fixation on bone metabolism, inflammatory response and oxidative stress in patients with osteoporotic distal radial fractures.Methods: A total of 72 patients with osteoporotic distal radial fractures who were treated in the hospital between September 2015 and January 2017 were collected and divided into control group (n=36) and observation group (n=36) according to the random number table method. Control group received routine external fixation, and observation group received mid-frequency pulse therapy combined with external fixation. The differences in serum levels of bone metabolism indexes, inflammatory factors and oxidative stress indexes were compared between two groups of patients before and after treatment.Results: Before treatment, differences in serum levels of bone metabolism indexes, inflammatory factors and oxidative stress indexes were not statistically significant between the two groups. After 1 month of treatment, serum BGP, TAC and SOD levels of both groups of patients were higher than those before treatment whileβ-CTX, AKP, TRAP, CRP, IL-1β, IL-6 and MDA levels were lower than those before treatment, and serum BGP, TAC and SOD levels of observation group were higher than those of control group whileβ-CTX, AKP, TRAP, CRP, IL-1β, IL-6 and MDA levels were lower than those of control group.Conclusion: Mid-frequency pulse therapy combined with external fixation can promote fracture healing and reduce postoperative inflammatory response and oxidative stress response in patients with osteoporotic distal radial fracture.

Osteoporosis and fractures in liver disease: Relevance, pathogenesis and therapeutic implications

It is being increasingly recognized that patients with liver disease develop bone loss that can be severe enough to lead to atraumatic fractures and thus markedly diminish life quality and expectancy. The estimated prevalence for liver-related osteoporosis is between 20-420/100000 of the general population, and fractures between 60-880/100000. It should be kept in mind that up to 40% of patients with chronic liver disease may experience a fracture. The pathogenic mediators include fibronectin, insulin like growth factor-I, and various cytokines, but decreased vitamin D and/or treatment with corticosteroids contribute to worsening bone health. Despite the advances in bone biology that have shed some light on the pathogenesis of this bone loss, treatment options remain nonspecific and tightly linked to treatments of other forms of osteoporosis. Thus, treatment should include calcium and vitamin D supplementation in all patients with chronic liver disease. Therapy with bisphosphonates should be considered, especially in patients receiving corticosteroids. This review focuses on the prevalence of this entity as well as the evidence available with regard to the pathogenesis of bone loss in liver disease, the diagnostic steps required in all patients, and the therapeutic options available.

Low-velocity simultaneous bilateral femoral neck fracture following long-term antiepileptic therapy:A case report

BACKGROUND Simultaneous bilateral femoral neck fractures are relatively rare injuries.They are usually associated with underlying metabolic bone disorders or systemic diseases.Long-term use of narcotics and bisphosphonates can also result in similar fracture patterns;however,association of this fracture type with longterm use of antiepileptic drugs is not very common.Only one such case has been reported in the literature.This article describes the second.CASE REPORT We report a case of simultaneous displaced bilateral femoral neck fractures in a 50-year-old epileptic patient,who had taken phenytoin for the past 3 years.The fractures were a result of low-velocity injury following a fall from the bed.The fractures were managed with a bilateral hemi-replacement arthroplasty.Oral bisphosphonates were given to improve the bone quality in the post-operative period.The patient had a good post-operative outcome,that was sustained throughout the entire follow-up period of 1 year.CONCLUSION Antiepileptic drugs should be supplemented with bisphosphonates and vitamin D to improve bone quality and prevent fractures in epileptic patients.

Intramedullary nailing for pathological fractures of the proximal humerus caused by multiple myeloma: A case report and review of literature

BACKGROUND Multiple myeloma(MM)bone disease is indicative of MM,and reduces patient life quality.In addition to oncological,antineoplastic systemic therapy,surgical therapy in patients with MM is an essential treatment within the framework of supportive therapy measures and involves orthopedic tumor surgery.Nevertheless,there are few reports on intramedullary(IM)nailing in the treatment of MM-induced proximal humeral fracture to prevent fixation loss.We here describe a case of pathological fracture of the proximal humerus caused by MM successfully treated with IM nailing without removal of tumors and a review of the current literature.CASE SUMMARY A 64-year-old male patient complaining of serious left shoulder pain and limited movement was admitted.The patient was finally diagnosed with MM(IgAλ,IIIA/II).After treatment of the pathological fracture with IM nailing,the patient's function recovered and his pain was rapidly relieved.Histopathological examination demonstrated plasma cell myeloma.The patient received chemotherapy in the Hematology Department.The humeral fracture displayed good union during the 40-mo follow-up,with complete healing of the fracture,and the clinical outcome was satisfactory.At the most recent follow-up,the patient's function was assessed using the Musculoskeletal Tumor Society score,which was 29.CONCLUSION Early surgery should be performed for the fracture of the proximal humerus caused by MM.IM nailing can be used without removal of tumors.Bone cement augmentation for bone defects and local adjuvant therapy can also be employed.

IRRIGATION AND TRACTION THERAPY FOR OPEN FRACTURE WITH LARGE－SIZED FULL－THICKNESS SKIN－DEFICIT AND SEVERELY INFECTED WOUND

In this paper the results of skeletal traction and irrigation therapy (STIT) used for open fracture complicated with large-sized full-thickness skin-deficit and infection wounds (OFIW) were presented. Fourteen patients of OFIW were treated by the plaster cast and wound dressing (PCWD), and 30 patients of OFIW were treated by STIT. The results indicated that after one week of treatment, the white blood cell count in the STIT group, compared to 17. 6±l. 0×109/L from before treatment, returned to 8. 8±0. 8×109/L,and in contrast, the cell count of the PCWD group was about 13. 0±1. 4×109/L. All of wound exudate culture in the STIT group was negative, and those of 7 cases (7/14) in PCWD group were positive (P<0. 0l). The symptoms and signs such as pain, fever and septic exudate on the wound in the STIT group were much milder than those in the PCWD group. There were 5 cases (35. 7%) of toxicemia and septicemia, 2 cases (14. 3%) of osteomyelitis, 2 cases (14. 3 %) of amputation, 1 case (7. 1%) of delayed union and 3 cases (21. 4 %) of malunion in the PCWD group, and no complications in the STIT group.

Preventing Lower Extremity Deep Vein Thrombosis After Hip Fracture Surgery in Elderly Patients by Acupoint Application Combined with Pneumatic Compression Therapy

Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the elderly.Methods:Sixty elderly patients who had undergone hip fracture surgery from February 2021 to February 2022 were selected as the research subjects.The patients were divided into two groups via drawing lots.Both the groups received nursing care,but the patients in the observation group were treated with TCM acupoint application combined with pneumatic compression therapy,whereas the control group received pneumatic compression therapy.The evaluation indicators included the patients’quality of life and complications.Results:The incidence of lower extremity deep vein thrombosis in the observation group was more than twice(0.3%),whereas the incidence of lower extremity complications in the control group was more than 6 times(20%).There was a significant difference between the two groups(p<0.05).Conclusion:Traditional Chinese medicine acupoint application combined with pneumatic compression therapy is beneficial for the prevention of postoperative lower extremity deep vein thrombosis among elderly patients.In addition,the patients’overall quality-of-life scores in both physiological and psychological aspects improved significantly,which carries significant clinical reference value.

Investigation of Therapeutic Effect of Traditional Mongolian Osteopathy Manual Reduction with Medicinal Wine Spraying Massage and Small Splint External Fixation Therapy for Treatment of Neerll-type Distal Humerus Fracture

Objectives:To investigate the effect of traditional Mongolian osteopathy manual reduction with medicinal wine spraying massage and small splint external fixation therapy for treatment of Neerll-type distal humerus fractures.Methods:Sample selection was carried out during time period from November 2014 to May 2019.Sixty-six patients admitted to our hospital were selected as sample patients.The control group was given plaster treatment,while the observation group was given traditional Mongolian osteopathy manual reduction with medicinal wine spraying massage and small splint external fixation therapy.Efficacy for the two groups of patients was observed.Results:In this study,the total effective rate of observation group patients with treatment of traditional Mongolian osteopathy manual reduction with medicinal wine spraying massage and small splint external fixation therapy was 100%.Meanwhile,total effective rate of patients in control group was 87.88%.The difference was significant,P<0.05.Conclusions:In this study of clinical treatment,traditional Mongolian osteopathy manual reduction with medicinal wine spraying massage and small splint external fixation therapy could provide better therapeutic effect for treatment of patients with Neerll-type distal humerus fracture.At the same time,it reduces economic burden of patients.It has higher promotion value for clinical practice.

Comparison of locomotion therapy between pelvis traction therapy to treat fracture of thoracolumber

Compare the effects of locomotion therapy and pelvis traction therapy to treat Ⅰ～Ⅱ° thoracolumbar compression fracture.Methods Ninety-two cases with Ⅰ～Ⅱ° thoracolumbar compression fracture were selected and divided into 2 groups with locomotion therapy and pelvis traction thepapy respectively.Results Thoracolumbar height was measured according to X-ray results after 1 year follow-up.The height was (17.2±2.3)mm preoperatively and (24.4±3.1)mm postoperatively in locomotion therapy group while (16.8±2.6)mm preoperatively and (23.9±2.7)mm postoperatively in the pelvis traction therapy group.Conclusion There is no significant difference between effects on two groups.5 refs.

Recent biological trends in management of fracture non-union

Bone regeneration is a complex, well-orchestrated physiological process of bone formation, which can be seen during normal fracture healing, and is involved in continuous remodelling throughout adult life. Currently,there is a plethora of different strategies to augment the impaired or "insufficient" bone-regeneration process, including the "gold standard" autologous bone graft, free fibula vascularised graft, allograft implantation, and use of growth factors, osteoconductive scaffolds, osteoprogenitor cells and distraction osteogenesis. Improved "local" strategies in terms of tissue engineering and gene therapy, or even "systemic" enhancement of bone repair, are under intense investigation, in an effort to overcome the limitations of the current methods, to produce bone-graft substitutes with biomechanical properties that are as identical to normal bone as possible, to accelerate the overall regeneration process, or even to address systemic conditions, such as skeletal disorders and osteoporosis. An improved understanding of the molecular and cellular events that occur during bone repair and remodeling has led to the development of biologic agents that can augment the biological microenvironment and enhance bone repair. Orthobiologics, including stem cells, osteoinductive growth factors, osteoconductive matrices, and anabolic agents, are available clinically for accelerating fracture repair and treatment of compromised bone repair situations like delayed unions and nonunions. A lack of standardized outcome measures for comparison of biologic agents in clinical fracture repair trials, frequent off-label use, and a limited understanding of the biological activity of these agents at the bone repair site have limited their efficacy in clinical applications.

Osteoporotic fracture and parathyroid hormone

Osteoporosis and age-related bone loss is associated with changes in bone remodeling characterized by decreased bone formation relative to bone resorption,resulting in bone fragility and increased risk of fractures.Stimulating the function of bone-forming osteoblasts,is the preferred pharmacological intervention for osteoporosis.Recombinant parathyroid hormone(PTH),PTH(1-34),is an anabolic agent with proven benefits to bone strength and has been characterized as a potential therapy for skeletal repair.In spite of PTH’s clinical use,safety is a major consideration for long-term treatment.Studies have demonstrated that intermittent PTH treatment enhances and accelerates the skeletal repair process via a number of mechanisms.Recent research into the molecular mechanism of PTH action on bone tissue has led to the development of PTH analogs to control osteoporotic fractures.This review summarizes a number of advances made in the field of PTH and bone fracture to combat these injuries in humans and in animal models.The ultimate goal of providing an alternative to PTH,currently the sole anabolic therapy in clinical use,to promote bone formation and improve bone strength in the aging population is yet to be achieved.

Critical review of bone health,fracture risk and management of bone fragility in diabetes mellitus

The risk of fracture is increased in both type 1 diabetes mellitus(T1DM)and type 2 diabetes mellitus(T2DM).However,in contrast to the former,patients with T2DM usually possess higher bone mineral density.Thus,there is a considerable difference in the pathophysiological basis of poor bone health between the two types of diabetes.Impaired bone strength due to poor bone microarchitecture and low bone turnover along with increased risk of fall are among the major factors behind elevated fracture risk.Moreover,some antidiabetic medications further enhance the fragility of the bone.On the other hand,antiosteoporosis medications can affect the glucose homeostasis in these patients.It is also difficult to predict the fracture risk in these patients because conventional tools such as bone mineral density and Fracture Risk Assessment Tool score assessment can underestimate the risk.Evidence-based recommendations for risk evaluation and management of poor bone health in diabetes are sparse in the literature.With the advancement in imaging technology,newer modalities are available to evaluate the bone quality and risk assessment in patients with diabetes.The purpose of this review is to explore the patho-physiology behind poor bone health in diabetic patients.Approach to the fracture risk evaluation in both T1DM and T2DM as well as the pragmatic use and efficacy of the available treatment options have been discussed in depth.

Treatment for subtrochanteric fracture and subsequent nonunion in an adult patient with osteopetrosis:A case report and review of the literature

BACKGROUND As a congenital metabolic bone disease caused by defective osteoclastic resorption of immature bone,osteopetrosis is characterized by diffused sclerosis of bones,brittle bones,easy fracturing,narrow medullary canals,and a weak fracture healing ability.At present,clear standards and principles for the treatment of fractures in patients with osteopetrosis are lacking.Non-operative treatment can prevent fracture hematoma and preserve the blood supply to the bone fragments,while being associated with frequent failures and higher mortality rates.Meanwhile,closed reduction and internal fixation with intramedullary nail(CRIF+IMN)approaches can also protect blood supply to the fracture site.However,IMN cannot be used for the vast majority of patients with osteopetrosis due to the narrowing of medullary canals.Thus,open reduction and internal fixation with plate remains the most appropriate surgical method for treating fractures in patients with osteopetrosis,but this approach is complicated by the lack of intramedullary hematopoiesis in such patients.Fracture healing primarily depends on the blood supply to the external periosteum.Open reduction can also easily destroy the periosteum and cause delayed fracture healing or even nonunion;however,CRIF may be the most practical approach.As a result,it would be prudent to solve the difficulty of drilling during the operation and the problem of postoperative nonunion.CASE SUMMARY In 2018,we treated an adult patient with osteopetrosis presenting with a subtrochanteric fracture.The fracture was fixed using a femoral locking compression plate.Because of delayed consolidation,at 12 mo postoperatively the patient was further treated with platelet-rich plasma(PRP)combined with radial extracorporeal shock wave therapy(rESWT).Antero-posterior and lateral radiographs obtained at the latest follow-up(10 mo)showed that the callus had grown at the original fracture site,and the medial fracture line almost disappeared.CONCLUSION Osteosynthesis remains the first choice of treatment approach for fractures in patients with osteopetrosis,especially peritrochanteric fractures.Preoperative preparation is necessary to avoid risks such as drill bit breakage and iatrogenic fracture during the operation.Moreover,fractures in a patient with osteopetrosis present with a high risk of delayed union and nonunion,which can be potentially cured with PRP+rESWT.

Effects of different root canal preparation methods on root fracture resistance:A systematic review of the literature

AIM: To study the root fracture resistance after root canal preparation with Ni-Ti rotary instruments and stainless hand instruments by means of meta-analysis.METHODS: Literature was researched in CNKI and CBMDisc, Pub Med, CALIS, Proquest, Web of Scienceand 11 kinds of Chinese or English dentistry journals. Retrieval time on Internet was in all years and hand retrieval time was from January 2013 to October 2013. The literatures were selected through reading abstracts and full texts by two reviewers independently and Revman 5 software was used to analysize the literature. RESULTS: Six articles met the inclusion criteria. According to Meta-analysis of tooth root bending properties, total standardized mean difference(SMD) was 0.63(95%CI:-0.24-1.50, P > 0.05). That indicated there was no statistically significant between the two groups. Subgroup analysis was carried out. SMD were 2.22(95%CI: 0.23-4.20, P < 0.05) and-0.61(95%CI:-1.05--0.17, P < 0.05) when the premolar teeth with a single canal or the mesiobuccal roots of molars were used as the materials for tests to compare the effects of different root canal preparation methods on root fracture resistance. That only indicated that there were statistically significant in two subgroups.CONCLUSION: In vitro experiments, the effects on the fracture resistance of root had no statistical difference with Ni-Ti rotary instruments and stainless steel hand instruments in root canal preparation.

中性粒细胞在骨折愈合中的作用方式及干预后的促愈合效应

背景:巨噬细胞存在特殊的促炎/抗炎表型,通过组织工程技术调节表型转变,使得其成为了在骨损伤修复中研究最多的免疫细胞。最近的研究发现中性粒细胞在骨损伤修复过程中同样发挥重要作用,但目前尚无此类综述。目的:总结目前中性粒细胞在骨折愈合中的作用方式,以及干预中性粒细胞促进骨折愈合的治疗措施。方法:检索2000年1月至2024年2月Web of Science、PubMed、中国知网及万方数据库,中文检索词为“中性粒细胞、骨折愈合、骨损伤、骨修复、骨重建”,英文检索词为“neutrophil,fracture healing,bone damage,bone repair,bone remodeling”。通过纳入排除标准筛选文献,最终纳入72篇进行综述。结果与结论:①发现中性粒细胞的历史漫长,早期由于缺乏染色技术忽视了其重要性,1900年Paul Ehrlich发明三酸染料区别出中性粒细胞,开启了研究的序幕;②正常状态下,中性粒细胞迁移到各器官辅助其发挥生理功能;病理状态下,中性粒细胞依赖吞噬作用、脱颗粒及中性粒细胞胞外陷阱发挥抗菌作用;③中性粒细胞主要参与骨折愈合早期血肿炎症阶段,通过释放细胞因子募集其他免疫细胞及间充质干细胞,同时产生纤连蛋白促进血肿形成构建局部微环境;④中性粒细胞在骨折愈合的不同阶段转化为N1/N2两种不同亚型,两者相互协调促进骨修复;⑤骨折断端募集的中性粒细胞通过分泌肿瘤坏死因子α、白细胞介素6、白细胞介素10、成纤维细胞生长因子2、单核细胞趋化蛋白1、血小板源性生长因子等细胞因子参与骨折愈合的过程;⑥中性粒细胞通过与骨折愈合不同阶段主要细胞成分的相互作用,调节成骨/破骨平衡;⑦类似于组织工程技术调节巨噬细胞极化在骨折愈合中的广泛研究与应用,未来针对干预中性粒细胞促进骨折愈合的疗法具有广阔前景。

β-catenin mRNA encapsulated in SM-102 lipid nanoparticles enhances bone formation in a murine tibia fracture repair model

Fractures continue to be a global economic burden as there are currently no osteoanabolic drugs approved to accelerate fracture healing.In this study,we aimed to develop an osteoanabolic therapy which activates the Wnt/β-catenin pathway,a molecular driver of endochondral ossification.We hypothesize that using an mRNAbased therapeutic encodingβ-catenin could promote cartilage to bone transformation formation by activating the canonical Wnt signaling pathway in chondrocytes.To optimize a delivery platform built on recent advancements in liposomal technologies,two FDA-approved ionizable phospholipids,DLin-MC3-DMA(MC3)and SM-102,were used to fabricate unique ionizable lipid nanoparticle(LNP)formulations and then tested for transfection efficacy both in vitro and in a murine tibia fracture model.Using firefly luciferase mRNA as a reporter gene to track and quantify transfection,SM-102 LNPs showed enhanced transfection efficacy in vitro and prolonged transfection,minimal fracture interference and no localized inflammatory response in vivo over MC3 LNPs.The generatedβ-cateninGOF mRNA encapsulated in SM-102 LNPs(SM-102-β-cateninGOF mRNA)showed bioactivity in vitro through upregulation of downstream canonical Wnt genes,axin2 and runx2.When testing SM-102-β-cateninGOF mRNA therapeutic in a murine tibia fracture model,histomorphometric analysis showed increased bone and decreased cartilage composition with the 45μg concentration at 2 weeks post-fracture.μCT testing confirmed that SM-102-β-cateninGOF mRNA promoted bone formation in vivo,revealing significantly more bone volume over total volume in the 45μg group.Thus,we generated a novel mRNA-based therapeutic encoding aβ-catenin mRNA and optimized an SM-102-based LNP to maximize transfection efficacy with a localized delivery.

Effects of Roughly Focused Extracorporeal Shock Waves Therapy on the Expressions of Bone Morphogenetic Protein-2 and Osteoprotegerin in Osteoporotic Fracture in Rats

Background：Roughly focused extracorporeal shock waves therapy （ESWT） is characterized by a wide focal area,a large therapy zone,easy positioning,and less pain during treatment.The purpose of this study was to investigate the effects of roughly focused ESWT on the expression of osteoprotegerin （OPG） and bone morphogenetic protein-2 （BMP-2） in osteoporotic fractures in rats.Methods：Seventy-two female Sprague-Dawley （SD） rats,3 months old,were divided into sham-operated group （n =6） and an ovariectomized （OVX） group （n =66）.Sixty OVX SD rats were used as a model of double proximal tibial osteotomy and inner fixation.The osteotomy site in the left tibia was treated with roughly focused ESWT once at an energy density of 0.26 mJ/mm^2,60 doses/min,and 2000 pact quantities.The contralateral right tibia was left untreated and served as a control.Expression of OPG and BMP-2 in the callus of the osteoporotic fracture area was assessed using immunohistochemistry,real-time polymerase chain reaction （PCR）,and Western blotting analysis.Results：Bone mineral density （BMD） at the proximal tibia,femur,and L5 spine was significantly reduced after ovariectomy.BMD of proximal tibia was 12.9% less in the OVX group than that in the sham-operated group.Meanwhile,bilateral oophorectomy resulted in a lower trabecular bone volume fraction （BV/TV） in the proximal tibia of the sham-OVX animals.Three months after bilateral oophorectomy,BV/TV was 14.29% of baseline BV/TV in OVX legs versus 45.91% in the sham-OVX legs （P 〈 0.001）.These data showed that the SD rats became a suitable model of osteoporosis,3 months after they were OVX.Immunohistochemical analysis showed higher levels of BMP-2 and OPG expression in the treatment group than those in the control group.Compared with the contralateral controls,decreased expression of OPG and BMP-2 at 3 days after roughly focused ESWT,followed by a later increase at 7 days,was indicated by real-time PCR and Western blotting analysis.The OPG messenger RNA （mRNA） expression levels peaked at 6 weeks after the shock wave treatment,paired with a much earlier （at 4 weeks） increase of BMP-2,and declined close to normal at 8 weeks.Conclusions：Roughly focused ESWT may promote the expression of OPG and BMP-2 in the osteoporotic fracture area in rats.BMP-2 and OPG may act synergistically and may lead to a significant enhancement of bone formation and remodeling.

Low-intensity extracorporeal shock wave therapy for midshaft clavicular delayed union: A case report and review of literature

BACKGROUND One of the most common complications following surgery for midshaft clavicle fracture is nonunion/delayed union.Extracorporeal shock wave therapy(ESWT)is an alternative to promote new bone formation without surgical complications.To date,no literature has reported low-intensity ESWT(LI-ESWT)in delayed union of midshaft clavicle fracture.CASE SUMMARY We reported a 66-year-old Chinese amateur cyclist with clavicle delayed union treated with 10 sessions of LI-ESWT(radial,0.057 mJ/mm^(2),3 Hz,3000 shocks).No anesthetics were applied,and no side effects occurred.At the 4 mo and 7 mo follow-ups,the patient achieved clinical and radiographical recovery,respectively.CONCLUSION In conclusion,our findings indicated that LI-ESWT could be a good option for treating midshaft clavicular delayed union.

Clinical observation on electroacupuncture plus hydro-acupuncture for low back pain caused by compression fractures

Objective： To observe the effect of electroacupuncture （EA） at Jiaji （EX-B 2） points plus hydro-acupuncture with sinomenine hydrochloride for low back pain caused by compression fractures in the elderly. Methods： Ninety-five elderly in-patients with low back pain caused by compression fractures were randomly divided into an observation group and an EA group according to the visit sequence. Both groups received the same basic treatment. In the EA group, 48 cases were treated with EA at Jiaji （EX-B 2） points plus the basic therapy; 47 cases in the observation group received the basic treatment plus EA and hydro-acupuncture with sinomenine hydrochloride at Jiaji （EX-B 2） points. The levels of osteoprotegerin （OPG） and interleukin-1β（IL-1β） in peripheral blood were measured by enzyme-linked immunosorbent assay （ELISA） before and at the 21st day of treatment in both groups. Oswestry disability index （ODI） and visual analog scale （VAS） scores were used to analyze the clinical efficacy. Results： After treatment, the OPG content in the observation group was higher with statistical significance compared with that before treatment in the observation group and after the treatment in the EA group, respectively （both P〈0.05）; the content of IL-1β, ODI and VAS scores were lower than those before treatment in the observation group and after treatment in the EA group with statistical significances （all P〈0.05）. Conclusion： The combination of EA and hydro-acupuncture with sinomenine hydrochloride at Jiaji （EX-B 2） points is effective for low back pain caused by compression fractures in the elderly, and is superior to EA at Jiaji （EX-B 2） points alone.