Knee dislocations of morbidly obese patients after a trivial fall are not uncommon. We report a case of closed reduction for a dislocated right knee of a 26-year-old obese woman. After closed reduction under general anaesthesia, her knee was supported by pillows in 30 degrees flexion. No external splint was used because of the enormous size of the leg. At day 4 after reduction, the patient had numbness over the dorsum of the right foot and was unable to dorsiflex. She was diagnosed as having peroneal nerve palsy and was fitted with a foot drop splint. One week after reduction, she started active, assisted knee mobilisation and tip-toe weight bearing. At 24 months after reduction, the patient was able to walk unaided and had 100 degrees of knee flexion. She had a good foot function and a grade II in the Lachman's test, with no varus or valgus instability. This case highlights the importance of early mobilisation, which can result in good outcome even without operative treatment.
Zein nanoparticles as a carrier system for BMP6-derived peptide were prepared by liquid-liquid phase separation procedure and characterized with SEM, DLS, FTIR and thermogravimetric methods. After peptide encapsulation, nanoparticle size increased from 236.3 ± 92.2 nm to 379.4 ± 116.8 nm. The encapsulation efficiency of peptide was 72.6% and the release of peptide from Zein nanoparticles was partly sustained in trypsin containing phosphate buffered saline (pH 7.4) for up to 14 days. Peptide-loaded nanoparticles showed similar cell viability compared with blank ones. ALP activity of C2C12 cells treated with peptide-loaded nanoparticles (500 mg/mL) was evaluated 7, 14, 21 and 28 days after culture. In peptide-loaded nanoparticles, ALP activity was significantly higher (p < .05) compared with other groups at day 14. Alizarin Red S staining showed, C2C12 cells behind peptide-loaded nanoparticles had significantly (p < .05) higher calcium deposition at day 21. The results of RT-qPCR show that the BMP-6 peptide activated expression of RUNX2 as a transcription factor. In turn, RUNX2 regulates SPP1 and BGLAP gene expression, as osteogenic marker genes. The results confirm that the peptide-loaded Zein nanoparticles, as osteoinductive material, may be used to repair small area of bone defects, with low load bearing.
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