BackgroundSeverely displaced radial neck fractures in skeletally immature children are rare and can be difficult to reduce. The purpose of this study is to evaluate the results using our reduction maneuver.MethodsFrom October 2011 to December 2015, 26 children with radial neck fractures(O’Brien type II, III and Judet type III, IV) were treated at our institute. All patients underwent percutaneous K-wire leverage and radial intramedullary pinning in an average surgery time of 35 mins (15–80 min). The injured arm was immobilized at the functional position with plaster for 4–6 weeks, evaluated clinically and radiologically. The Metaizeau classification and Mayo elbow performance score were used to evaluate the radiological and clinical results, respectively. Percutaneous K-wire leverage and radial intramedullary pinning were performed for 26 patients. No patients were treated with open reduction. Twenty four patients were followed up for a mean of 33 (range 12–53 months) months.ResultsThere were 15 girls and 9 boys with ages ranging from 1.5 to 12 years and an average age of 7.2 years. Percutaneous K-wire leverage reduction and intramedullary pinning were successfully used in an average total surgery time of 35 mins (range 15–80 min). In total, 2 cases (O’Brien type III and Judet type IVb, angulation = 90°) needed the additional maneuver. Bone union was achieved in all patients within a mean time of 4.2 weeks. The clinical results were evaluated basing on the Mayo elbow performance score, and there were 23 excellent results and one good result. There were no refractures and no incidences of nonunion, suture infection, iatrogenic radial nerve injury, asymptomatic enlargements of the radial head or growth arrest in the proximal radial epiphysis.ConclusionOur modified percutaneous leverage technique with radial intramedullary fixation may be successfully used to avoid open reduction.

Background Management of severely angulated Rockwood and Wilkins’ type C (RW-C) thumb metacarpal base fractures in children is challenging. We report experiences of percutaneous leverage reduction and dual antegrade crossing Kirschner (DACK) wire fixation in these fractures, aiming to assess the results using our reduction technique. Methods From October 2011 to September 2015, A total of 17 patients with severely angulated RW-C thumb metacarpal base fractures were treated at our hospital. The injured arm, including the entire first ray, was immobilized with a thumb-spica cast for 4–6 weeks and evaluated radiologically and clinically. Percutaneous leverage reduction and DACK wire fixation were successfully performed for 17 patients. No patients were treated with open reduction. 16 patients were followed up for a mean of 32 months (range 24–41 months). The results were assessed using the modified Mayo score. The level of significance was set to be p < 0.05. Results The patients included 9 girls (56.2%) and 7 boys (43.8%), with an average age of 10.8 years (range 7.5 to 14.0 years). Percutaneous leverage reduction and DACK wire fixation were successfully performed within an average total surgery time of 20 min (range 12–32 min). Bone union was achieved in all patients within a mean time of 4.2 weeks (range 4–6 weeks). The average angulation (preoperation: 50.5° (range 40.8°–67.0°) vs postoperation: 5.0° (range 0.0°–7.0°)) significantly changed from pre to post-surgery (P < 0.05). The clinical outcomes were evaluated by the modified Mayo score: 15 patients had an excellent outcome, and one patient had a good outcome. Cosmetic results were described as good and satisfactory by all patients. There were no refractures and no incidences of nonunion, growth arrest in the proximal epiphysis. Only one patient suffered from a superficial infection, which was resolved after the removal of the k-wires and the administration of oral antibiotics. Conclusion Our percutaneous leverage technique with DACK wire fixation can be successfully used to treat these fractures. This technique is simple to learn and minimally invasive, and the results are satisfactory. It may be an appropriate choice for the treatment of irreducible RW-C fractures.

The preperitoneal tension-free hernioplasty may be a more effective method of femoral hernia repair; meanwhile, we must re-understand the anatomy of femoral hernia correctly so as to restore the anatomic and physiologic functions at this region optimally.

Osteoporosis is a systemic metabolic bone disease. Osteoporosis is believed to be a systemic inflammatory condition in which inflammatory cytokines play an important role. Among these molecules, tumor necrosis factor-α (TNF-α) plays an important role in the initiation and development of osteoporosis. Atsttrin is an engineered protein derived from the growth factor, progranulin (PGRN). It’s well accepted Atsttrin inhibits TNF-α’s function by binding tumor necrosis factor-α receptors (TNFRs). The aim of this study was to investigate the role of Atsttrin in osteoporosis. Present study use cell TRAP staining to determine the role of Atsttrin in osteoclastogenesis. Alkaline phosphatase staining of cells was examined for ostoblastogenesis. Western blotting and ELISA assay were taken for the measurement of protein level and phorsphorylation. Real time PCR was used to test the transcriptional level expression. Gene silence method was taken for the pathway investigation. By applying these methods, we found Atsttrin inhibited TNF-α-induced osteoclastogenesis and inflammatory destruction. Further mechanism studies indicated Atsttrin inhibited TNF-α- induced osteoclastogenesis though TNFR1 signaling pathway. Moreover, Atsttrin rescued TNF-α-mediated inhibition of osteoblastogenesis via TNFR1 pathway. Importantly, present study found Atsttrin could not induce osteoblast differentiation, however, Atsttrin could significantly enhance osteoblastogenesis through TNFR2-Akt-Erk1/2 signaling.

Background： Management of severely angulated Rockwood and Wilkins’ type C(RW-C) thumb metacarpal base fractures in children is challenging. We report experiences of percutaneous leverage reduction and dual antegrade crossing Kirschner (DACK) wire fixation in these fractures, aiming to assess the results using our reduction technique.Methods：From October 2011 to September 2015, A total of 17 patients with severely angulated RW-C thumb metacarpal base fractures were treated at our hospital. The injured arm, including the entire first ray, was immobilized with a thumb-spica cast for 4-6 weeks and evaluated radiologically and clinically. Percutaneous leverage reduction and DACK wire fixation were successfully performed for 17 patients. No patients were treated with open reduction. 16 patients were followed up for a mean of 32 months (range 24-41 months). The results were assessed using the modified Mayo score. The level of significance was set to be p<0.05.Results：There were 9 girls and 7 boys with ages ranging from 7.5 to 14.0 years and an average age of 10.8 years. Percutaneous leverage reduction and DACK wire fixation were successfully performed within an average total surgery time of 20 minutes (range 12-32 minutes). Bone union was achieved in all patients within a mean time of 4.2 weeks (range 4-6 weeks). The average angulation (preoperation: 50.5° (range 40.8°–67.0°) vs postoperation: 5° (range 0.0°–7.0°)) significantly changed from before to after surgery (P<0.05). The clinical results were evaluated by the modified Mayo score, and there were 15 patients with an excellent outcome and one patient with a good outcome. Cosmetic results were described as good and satisfactory by all patients. There were no refractures and no incidences of nonunion, growth arrest in the proximal epiphysis. Only one patient suffered from a superficial infection, which was resolved after the removal of the k-wires and the administration of oral antibiotics. Conclusion： Our percutaneous leverage technique with DACK wire fixation can be successfully used to treat these fractures. This technique is simple to learn and minimally invasive, and the results are satisfactory. It may be an appropriate choice for the treatment of irreducible RW-C fractures.