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MicroRNAs, which serve as post-transcriptional modulators of numerous genes, have been found to be important regulators during the pathogenesis of osteosarcoma. This study demonstrates for the first time that microRNA-130a (miR-130a) is significantly upregulated in osteosarcoma, and associated with the metastasis of osteosarcoma. Elevated level of miR-130a was closely correlated with poor clinical features and prognosis of osteosarcoma patients. In vitro assays revealed that miR-130a could potentiate the migration, invasion and the epithelial-mesenchymal transtion (EMT) of osteosarcoma cells. Moreover, phosphatase and tensin homolog (PTEN) was confirmed as not only a direct downstream target but also a functional mediator of miR-130a. MiR-130a exerted promoting effects on metastatic behavior and EMT of osteosarcoma cells through suppressing PTEN expression. Based on these findings, we conclude that miR-130a is a promising prognostic biomarker for osteosarcoma patients, and targeting miR-130a may be a potential treatment option for osteosarcoma patients with metastasis.

Objective This study aimed to evaluate outcomes of the sequential one-stage combined procedure for treating bilateral developmental dysplasia of the hip (DDH) that was diagnosed after walking age. Methods Thirty-five patients (70 hips) with late-presenting bilateral DDH were treated with the sequential one-stage combined procedure. Hips were reclassified according to the operative time and divided into the first and the second operated hips. The outcomes were compared clinically and radiographically between the two sides preoperatively and postoperatively. Results The mean interval time between the two procedures was 5.9 months (range: 2–9 months). The first operated hip achieved better results than did the second operated hip. A total of 68.6% (24/35) of the patients in our series had an asymmetric outcome. Conclusions The sequential one-stage combined procedure is a challenge, but a reasonable alternative surgery for bilateral DDH in children after walking age. An asymmetric outcome is a special complication of this procedure.

Background Monteggia equivalent lesion represents a series of combined elbow and forearm injuries that resemble typical Monteggia fracture either in presentation or mechanism. The term has gradually evolved since its introduction, as sporadic case reports continued to complement it. The aim of this study was to present a furthermore type of that lesion which no previous study had reported and arouse pediatric orthopedists’ additional awareness of it. Case presentation A 11-year-old girl, whose injury pattern initially appeared to be a mild radial neck fracture with undisplaced proximal ulnar fracture, and without radial head dislocation, was treated with closed reduction and long-arm splint immobilization. Acceptable results were acquired at first-week follow-up, yet dramatic changes turned up 2 weeks later when the dislocated radial head was found. A further reduction to the fracture and joint site only resulted in a subluxated and incongruous radiocapitellar joint on the three-dimensional computed tomography (3D-CT). Then a definitive operation was performed, which involved a Boyd incision, correction of radial head tilting, opening wedge osteotomy of the proximal ulna and proper fixation respectively. And acceptable results were achieved 1 year later. Conclusions This case, with occult proximal ulna fracture, angulated radial neck fracture, subsequent radiocapitellar dislocation, and articular incongruity, was deemed as a rare Monteggia type-one equivalent fracture-dislocation variant rather than an ordinary radial neck fracture and it facilitates further understanding and management of the Monteggia fracture.

BackgroundMonteggia equivalent lesion represents a group of injury or combined injury patterns that resemble the Monteggia lesion in its presentations and mechanisms. Unlike Monteggia lesions, the equivalent ones, which share vague definitions and mostly occur as sporadic single case reports in the literature, have not been thoroughly reviewed since Bado first proposed the term, especially in the pediatric population. The objective of this review was to elucidate the definition by elaborating on its clinical styles and thus analyzing the mechanism, diagnosis, and management through related literature.Data sourcesBased on the terms of ‘Monteggia equivalent’, ‘radial neck fracture’ and ‘pediatric’, all of the related literature was searched on the PubMed and Google Scholar search engine.ResultsThe advance of the definitions for pediatric Monteggia equivalent lesion (PMEL) was reviewed. The functional roles of the ulnar and the related mechanism theories in this injury were analyzed. The status of the radiocapitellar joint in this injury was emphasized. According to the previous statements, a new classification model was proposed and proper diagnosis and treatment approaches were suggested.ConclusionsPMEL should be defined as an ulnar fracture at any level combined with a proximal radial fracture. According to the status of the radiocapitellar joint, it could be divided into three groups. The occult ulnar bowing and delayed radial head dislocation should be a serious concern of orthopedists. Surgical need is usually warranted. Maintaining the ulnar length and securing the radiocapitellar joint are highly recommended.

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Background Medial epicondyle fracture comprises a considerable proportion of pediatric elbow injury. The fracture fragment is typically pulled distally by the muscle and the ligament. This study aims to suggest proper recognition of a subset of the fracture that differs from its usual presentation. Methods A retrospective case study was conducted during 2011–2016. Of those cases, a subset was identified as proximally displaced (atypical) ones. Distinctive radiologic images, as well as the injury causes, demographic data, clinical signs, treatment ways, and final follow-ups regarding these atypical ones, were presented and discussed. The fracture mechanism was carefully inferred from former theories and the operative findings, and a tentative management strategy was suggested. Results Seven out of 112 cases were distinguished as the atypical, which represents 6.25% of the whole sample. Injury causes were all direct or combined direct/indirect force injuries instead of indirect force mostly seen in the typical. Five were operated while two nonoperatively treated. Operated cases revealed stripping of medial epicondyle from its surrounding periosteum/muscle origin or even cartilage. The fracture fragment was either pulled by proximal periosteum or even proximally dissociated. The outcomes of those atypical were mostly acceptable despite some minor defects. Conclusion The proximally displaced cases do constitute a portion of medial humeral epicondyle fracture in children. As well as its skeletal manifestation, awareness of its injury mechanism and soft tissue damage is required. Precise restoration of its anatomical structure might be vital for its treatment. Further scientific work is needed regarding its mechanism and management. Level of evidence: Level 4.

Background Acute suppurative osteomyelitis is a common disease in pediatric orthopedics, but there are few studies on the etiology and treatment of this disease in children.Objective To investigate the etiology and clinical characteristics of acute suppurative osteomyelitis in children.Methods A retrospective study was conducted of pediatric in-patients with acute suppurative osteomyelitis between January 2011 and December 2017. Subperiosteal or intramedullary specimens were collected from each patient for culture. Bacterial identification and antibiotic susceptibility test were performed with the Vitek system. Results A total of 104 patients were included and 64 (61.5%) were male. Sixty-six isolates were obtained from 65 (62.5%) patients. The most common pathogen was Staphylococcus aureus (51.0%, 53/104), followed by Escherichia coli (2.9%, 3/104), Pseudomonas aeruginosa (1.9%, 2/104), Streptococcus pneumoniae (1.9%, 2/104), Ochrobactrum anthropi (1.9%, 2/104), and other bacteria (3.0%, 3/104). Two pathogens were isolated from one patient. The etiology was unknown based on culture in 39 (37.5%) patients. The age of the patients infected with S. aureus was 6.67 (1.7, 9.1) years, which was significantly higher than that of patients infected with non-S. aureus, whose age was 2.42 (0.7, 7.8) years (Z = 2.20, P=0.028). Results of the antibiotic susceptibility test in 53 S. aureus strains showed that the resistance rates to oxacillin, trimethoprim-sulfamethoxazole, clindamycin, and erythromycin were 43.4%, 11.3%, 67.9%, and 69.8%, respectively. All S. aureus strains were sensitive to linezolid and vancomycin. More patients with sequelae were found among those infected with oxacillin-resistant S. aureus (26.1%, 6/23) compared with oxacillin-sensitive S. aureus (3.3%, 1/30, χ2༝4.06, P༝0.044) or other pathogens (2.5%, 2/81, χ2༝10.94, P = 0.001). Conclusion S. aureus was the most common pathogen causing acute suppurative osteomyelitis in children and its resistance rate to oxacillin was high. Further study is needed to determine the etiology in the patients in whom the pathogen cannot be identified based on culture.