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Patients with distal radius fractures involving lunate facet would obtain more slow recovery, especially for wrist flexion, supination, ulnar deviation and VAS in motion. In addition, patients with lunate facet fractures would be at higher risk of loss of reduction and final articular step-off.

Distal radius fracture involving the lunate facet is a tough issue for surgeons, but currently there is scarcity of data on these injuries. This study aims to evaluate results of volar locking plate (VLP) for treatment of die-punch fractures of the distal radius.Between January 2013 and June 2017, a total of 37 patients with die-punch fractures of the distal radius were admitted and underwent VLP fixation. Clinical and radiographic data on these patients were extracted from their electronic medical records. Preoperative radiographs, CT scanning and 3D reconstruction were used to definitely diagnose this injury. Radiographs taken at immediate postoperation and at last follow-up were analyzed. Data on radial subsidence, articular step-off status, volar tilt, radial inclination, wrist motion range, grip strength and related complications at the final follow-up were documented for analysis. The overall outcomes of the injured limb were evaluated, based on the Gartland and Werley scoring system.The mean radial subsidence was 0.8 mm (0–3.3 mm), and articular step-off finally occurred in 4 patients (10.8%). The mean volar tilt was 9.5° (6°–15°), radial inclination 21° (12°–27°). The mean wrist was 84.2% in flexion of the contralateral uninjured wrist, 87.0% in extension, 92.2% in pronation and 94.5% in supination, respectively. The mean grip strength was 86% (range 56%–108%) of the contralateral un-injured upper limb. Gartland and Werley score demonstrated the excellent and good rate of 83.8%, with excellent result in 21 patients, good in 10, fair in 4 and poor in 2. Incidence of overall complications was 27.0% (10/37), with one requiring surgical intervention.VLP demonstrated its efficacy and safety for treatment of die-punch fractures. Prospective comparative studies with larger sample are required to compare the outcomes among different fixation methods, with expectation of precise and individualized treatment for every patient. Type of study/level of evidence: Therapeutic III.

Skin flap transfer is an important method to repair and reconstruct various tissue defects. However, avascular necrosis largely affects the success of flap transfer. The sphingosine-1-phosphate receptor 1 (S1PR1) agonist SEW2871 has been proven to ameliorate ischemic injury. However, its effect on flap survival has not been reported. In this study, an experimental skin flap model was established in rats to investigate the roles of SEW2871. The results indicated that SEW2871 greatly increased the survival of the skin flap, alleviated pathological injury, promoted the angiogenesis, and inhibited cells apoptosis in skin flap tissues. SEW2871 activated S1PR1 downstream signaling pathways, including heat shock protein 27 (HSP27), extracellular regulated protein kinases (ERK) and Akt. In addition, SEW2871 promoted the expression of S1PR1. These findings may provide novel insights for skin flap transfer.

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