Objective: The aim of this study was to evaluate the security and effectiveness of AO/ASIF clavicle hook plate in the treatment of distal clavicle fractures and acromioclavicular joint dislocations. Methods: One hundred patients with distal clavicle fractures and acromioclavicular joint dislocations who were admitted in our hospital from January 2012 to January 2013 were selected as the study subjects. They were then randomly divided into a control group and an observation group (n=50). The observation group was treated with AO/ASIF clavicle hook plates, and the control group was treated with Kirschner-wire tension bands. The outcomes were recorded and compared. Results: The JOA scores of the two groups were similar before surgery (P>0.05). The two groups both had obviously increased JOA scores in the postoperative 6th and 12th weeks, and the score in the postoperative 12th week was higher. There were statistically significant intra-group differences (P<0.05). The postoperative 6th-week and 12th-week JOA scores of the observation group were (83.2±1.8) and (97.4±1.5) respectively, and those of the control group were (71.6±2.2) and (82.3±2.6) respectively, with statistically significant inter-group differences (P<0.05). Significantly more patients in the observation group (100%) were evaluated as excellent or good outcomes after fixation than those in the control group (60%). After removal of the surgical apparatus, the recurrence rates of bone fracture and joint dislocation in the observation group were significantly lower than those of the control group (P<0.05). Conclusion: AO/ASIF clavicle hook plate functioned more effectively than Kirschner-wire tension band in clinical treatment of distal clavicle fractures and acromioclavicular joint dislocations. The former protocol enjoyed small incisions, firm fixation and early shoulder mobility. Therefore, it is a safe and effective surgical method that is worthy of being widely applied in clinical practice.

Background: The aim of this study was to investigate the effect of Toll like receptor 4 (TLR4) on fracture healing. Methods: The open tibial fracture models in TLR4 knockout (TLR4-/-) and wild type (WT) C57BL-6J mice were established. The radiological examination, tartrate-resistant acid phosphatase (TRAP) staining , Micro-CT scan and biological torsion test were performed on 7, 14 and 21 days after operation. Enzyme Linked Immunosorbent Assay (ELISA) kit was used to detect the expression levels of tumor necrosis factor-α (TNF-α), interleukin-1 beta (IL-1β) and interleukin 6 (IL-6). Western blotting was used to detect the expression of β-catenin, Wingless-type MMTV integration site family, member 4 and 5B (Wnt4 and Wnt5B), proliferating cell nuclear antigen (PCNA) and bone morphogenetic protein-2 (BMP-2) of the callus tissue obtained from mice. Results: TLR4 knockout promoted fracture healing, reduced the number of osteoclasts, increased bone callus volume (BV) and callus mineralized volume fraction (BV/TV%) (P < 0.05), increased the maximum torque and torsional stiffness of callus (P < 0.05), reduced TNF-α, IL-1β and IL-6 expression (P < 0.01), and increased the expression of β-catenin, Wnt4, Wnt5B, PCNA and BMP-2 (P < 0.01). Conclusions: TLR4 knockout reduced inflammatory and promoted fracture healing by activating Wnt/β-catenin signaling pathway.

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Background: The aim of this study was to investigate the effect of Toll like receptor 4 (TLR4) on fracture healing. Methods: The open tibial fracture models in TLR4 knockout (TLR4 -/- ) and wild type (WT) C57BL-6J mice were established. The radiological examination, tartrate-resistant acid phosphatase (TRAP) staining , Micro-CT scan and biological torsion test were performed on 7, 14 and 21 days after operation. Enzyme Linked Immunosorbent Assay (ELISA) kit was used to detect the expression levels of tumor necrosis factor-α (TNF-α), interleukin-1 beta (IL-1β) and interleukin 6 (IL-6). Western blotting was used to detect the expression of β-catenin, Wingless-type MMTV integration site family, member 4 and 5B (Wnt4 and Wnt5B), proliferating cell nuclear antigen (PCNA) and bone morphogenetic protein-2 (BMP-2) of the callus tissue obtained from mice. Results: TLR4 knockout promoted fracture healing, reduced the number of osteoclasts, increased bone callus volume (BV) and callus mineralized volume fraction ( BV/TV% ) ( P < 0.05), increased the maximum torque and torsional stiffness of callus (P < 0.05), reduced TNF-α, IL-1β and IL-6 expression ( P < 0.01), and increased the expression of β-catenin, Wnt4, Wnt5B, PCNA and BMP-2 ( P < 0.01). Conclusions: TLR4 knockout reduced inflammatory and promoted fracture healing by activating Wnt/β-catenin signaling pathway.