Object External supports serve as a traditional treatment option for osteoporotic vertebral fractures (OVFs). However, the role of external supports in the treatment of OVF remains inconclusive. The purpose of this study was to determine the role of a rigid external support in the healing of OVFs by prospectively evaluating union (fracture settling) rates and prognostic variables for patients suffering from an incident OVF. Methods Fifty-five patients with acute back pain were enrolled in this study after being diagnosed with an OVF based on MRI findings. Patients were treated using a plastic thoracolumbosacral orthosis (TLSO) and underwent follow-up at 2, 3, and 6 months. Vertebrae were referred to as “settled” when there was no dynamic mobility on sitting lateral and supine lateral radiographs. At the time of the 3- and 6-month follow-up visits, the patients were divided into 2 groups, the “settled group” and the “unsettled group.” Patients in these groups were compared with regard to clinical and radiographic features. Results Of the 55 patients enrolled, 53 patients were followed up for 6 months. There were 14 men and 39 women with an average age of 75.3 years. Fracture settling of the affected vertebra was defined in 54.7% of the patients at 2 months, in 79.2% at 3 months, and in 88.7% at 6 months. All 5 components of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire improved significantly both at 3 months and 6 months. Patients in the unsettled group exhibited a statistically greater likelihood of having fractures at the thoracolumbar junction, Type A3 fractures, and fractures with a diffuse low-intensity area on T2-weighted MRI studies at 3 months. In contrast, at 6 months, the only statistically significant difference between the groups was patient age. Conclusions The biomechanical disadvantages of OVFs (location, type, and size) adversely influencing the fracture healing were overcome by the treatment using a TLSO within 6 months. The authors' findings show that a TLSO plays a biomechanical role in the healing of OVFs.

Progressive valgus ankle deformity is a problematic postoperative donor-site morbidity of a vascularized fibular graft in children. To prevent this complication, tibiofibular metaphyseal synostosis (the Langenskiöld procedure) has been recommended. The authors objectively evaluated the preventive and therapeutic effects of this procedure on five children who had received free vascularized fibular grafts. Their average age at the time of operation was 3 years (range: 1 to 9 years). The Langenskiöld procedure was performed primarily in four patients, and not in one patient. The anteroposterior (A-P) mortise angle and the empirical axis of the donor-site ankle were measured radiographically. With regard to the A-P mortise angle, four of five patients showed valgus with a mild lateral wedging of the distal tibial epiphysis. The patient who did not receive the operation showed the largest A-P mortise angle and mild osteoarthritic changes. The empirical axis exceeded normal range in all of the five patients. These observations indicated that valgus deformity of the ankle in children after harvesting a vascularized fibular graft is inevitable, even if the Langenskiöld procedure is performed. The procedure can delay the ankle valgus. The authors recommend close follow-up of the children who receive the Langenskiöld procedure after harvesting a vascularized fibular graft.

Previous studies have shown that extracranial-intracranial (EC-IC) bypass surgery has no preventive effect on subsequent ipsilateral ischemic stroke in patients with symptomatic atherosclerotic internal carotid occlusion and hemodynamic cerebral ischemia. A few studies have assessed whether an urgent EC-IC bypass surgery is an

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Lmx1b is a homeodomain transcription factor that regulates dorsal identity during limb development and Lmx1b knockout (KO) mice develop nearly symmetrical ventral‐ventral limbs with hypoplastic scapulae. Currently, downstream targets of Lmx1b within dorsal mesoderm that impart the limbs' unique dorsal asymmetry are unknown. To identify genes targeted by Lmx1b, we compared gene arrays from Lmx1b KO and wild type (WT) mouse limbs during limb outgrowth and patterning, i.e., 11.5, 12.5, and 13.5 days post coitum (dpc). Real‐time PCR confirmed microarray results and whole mount in situ hybridization was used to localize and verify differential dorsal‐ventral expression. Microarray analysis identified 23 targets differentially expressed in all three arrays. Real‐time PCR confirmed 17 up‐regulated and 2 down‐regulated targets. Whole mount in situ hybridization of WT 12.5 dpc embryos demonstrated a dorsal‐ventral asymmetric pattern for the validated targets, further categorized as skeletal, soft tissue or other. Skeletal targets, including Emx2, Matrilin1 and Matrilin4, demonstrated a loss of scapular expression in the Lmx1b KO mice. Soft tissue targets which demonstrated dorsal mesodermal staining in WT were drastically reduced in KO limbs. This study provides the most comprehensive characterization of skeletal and soft tissue genes regulated by Lmx1b during limb development to date. Our data also suggest targets which Lmx1b may augment to ensure proper scapular development. Further studies are warranted to determine the mechanism of Lmx1b target regulation during limb dorsalization. NIH HD39421

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