BackgroundClavicular hook plates are effective fixation devices for distal clavicle fractures and severe acromioclavicular joint dislocations. However, increasing number of studies has revealed that subacromial portion of the hook may induce acromial bony erosion, shoulder impingement, or even rotator cuff damage. By sonographic evaluation, we thus intended to determine whether the presence of hook plate may induce subacromial shoulder impingement and its relationship relative to surrounding subacromial structures.MethodsWe prospectively followed 40 patients with either distal clavicle fracture or acromioclavicular joint dislocation that had surgery using the Arbeitsgemeinschaft für Osteosynthesefragen (AO) clavicular hook plate. All patients were evaluated by monthly clinical and radiographic examinations. Static and dynamic musculoskeletal sonography examinations were performed at final follow-up before implant removal. Clinical results for pain, shoulder function, and range of motion were evaluated using Constant-Murley and Disability of Arm, Shoulder, and Hand (DASH) scores.ResultsClinically, 15 out of 40 patients (37.5%) presented with subacromial impingement syndrome and their functional scores were poorer than the non-impinged patients. Among them, six patients were noted to have rotator cuff lesion. Acromial erosion caused by hook pressure developed in 20 patients (50%).ConclusionsWe demonstrated by musculoskeletal sonography that clavicular hook plate caused subacromial shoulder impingement and rotator cuff lesion. The data also suggest an association between hardware-induced impingement and poorer functional scores. To our knowledge, the only solution is removal of the implant after bony consolidation/ligamentous healing has taken place. Thus, we advocate the removal of the implant as soon as bony union and/or ligamentous healing is achieved.

BackgroundBioelectrical impedance analysis (BIA) is a convenient and child-friendly method for longitudinal analysis of changes in body composition. However, most validation studies of BIA have been performed on adult Caucasians. The present cross-sectional study investigated the validity of two portable BIA devices, the Inbody 230 (BIA8MF) and the Tanita BC-418 (BIA8SF), in healthy Taiwanese children.MethodsChildren aged 7–12 years (72 boys and 78 girls) were recruited. Body composition was measured by the BIA8SF and the BIA8MF. Dual X-ray absorptiometry (DXA) was used as the reference method.ResultsThere were strong linear correlations in body composition measurements between the BIA8SF and DXA and between the BIA8MF and DXA. Both BIAs underestimated fat mass (FM) and percentage body fat (%BF) relative to DXA in both genders The degree of agreement in lean body mass (LBM), FM, and %BF estimates was higher between BIA8MF and DXA than between BIA8SF and DXA. The Lin’s concordance correlation coefficient (ρc) for LBM8MF met the criteria of substantial to perfect agreement whereas the ρc for FM8MF met the criteria of fair to substantial agreement. Bland-Altman analysis showed a clinically acceptable agreement between LBM measures by BIA8MF and DXA. The limit of agreement in %BF estimation by BIA and DXA were wide and the errors were clinically important. For the estimation of ALM, BIA8SF and BIA8MF both provided poor accuracy.ConclusionsFor all children, LBM measures were precise and accurate using the BIA8MF whereas clinically significant errors occurred in FM and %BF estimates. Both BIAs underestimated FM and %BF in children. Thus, the body composition results obtained using the inbuilt equations of the BIA8SF and BIA8MF should be interpreted with caution, and high quality validation studies for specific subgroups of children are required prior to field research.

Nitric oxide (NO) contributes to the regulation of osteoblast activities. In this study, we evaluated the protective effects of NO pretreatment on oxidative stress-induced osteoblast apoptosis and its possible mechanism using neonatal rat calvarial osteoblasts as the experimental model. Exposure of osteoblasts to sodium nitroprusside (SNP) at a low concentration of 0.3 mM significantly increased cellular NO levels without affecting cell viability. However, when the concentration reached a high concentration of 2 mM, SNP increased the levels of intracellular reactive oxygen species and induced osteoblast injuries. Thus, administration of 0.3 and 2 mM SNP in osteoblasts were respectively used as sources of NO and oxidative stress. Pretreatment with NO for 24 h significantly ameliorated the oxidative stress-caused morphological alterations and decreases in alkaline phosphatase activity, and reduced cell death. Oxidative stress induced osteoblast death via an apoptotic mechanism, but NO pretreatment protected osteoblasts against the toxic effects. The mitochondrial membrane potential was significantly reduced following exposure to the oxidative stress. However, pretreatment with NO significantly lowered the suppressive effects. Oxidative stress increased cellular Bax protein production and cytochrome c release from mitochondria. Pretreatment with NO significantly decreased oxidative stress-caused augmentation of Bax and cytochrome c protein levels. In parallel with cytochrome c release, oxidative stress induced caspase-3 activation and DNA fragmentation. Pretreatment with NO significantly reduced the oxidative stress-enhanced caspase-3 activation and DNA damage. Results of this study show that NO pretreatment can protect osteoblasts from oxidative stress-induced apoptotic insults. The protective action involves a mitochondria-dependent mechanism. ß

Modern bioelectrical impedance analysis (BIA) provides a wide range of body composition estimates such as fat mass (FM), lean body mass (LBM), and body water, using specific algorithms. Assuming that the fat free mass (FFM) and LBM can be accurately estimated by the 8-electrode BIA analyzer (BIA8MF; InBody230, Biospace), the bone mineral content (BMC) may be calculated by subtracting the LBM from the FFM estimates based on the three-compartment (3C) model. In this cross-sectional study, 239 healthy Taiwanese adults (106 male and 133 female) aged 20–45 years were recruited for BIA and dual-energy X-ray absorptiometry (DXA) measurements of the whole body and body segments, with DXA as the reference. The results showed a high correlation between BIA8MF and DXA in estimating total and segmental LBM, FM and percentage body fat (r = 0.909–0.986, 0.757–0.964, and 0.837–0.936, respectively). For BMC estimates, moderate to high correlations (r = 0.425–0.829) between the two methods were noted. The percentage errors and pure errors for BMC estimates between the methods ranged from 33.9% to 93.0% and from 0.159 kg to 0.969 kg, respectively. This study validated that BIA8MF can accurately assesses LBM, FM and body fat percentage (BF%). However, the estimation of segmental BMC based on the difference between FFM and LBM in body segments may not be reliable by BIA8MF.

The video-assisted technique with the extended manipulating channel method presented in this report simplifies thoracoscopic spinal surgery in the thoracolumbar junction and makes it easier. It avoids division of the diaphragm, removal of the rib, and wide spread of the intercostal space, and it allows greater control of intraoperative vessel bleeding. Using this technique, the number of portals required during the procedure can be reduced. In addition, the technique reduces the endoscopic materials required, thus lowering overall cost. It is an effective and promising approach.

No abstract

Although video-assisted thoracoscopy has only recently been applied to treat a variety of thoracic spine lesions, many problems and difficulties are encountered with this technique owing to limited trocar space and lack of suitable endoscopic instruments. Between November 1995 and March 1996, we practiced a new approach for video-assisted thoracoscopic surgery, the "extended manipulating channel method," for treating 18 patients with thoracic spinal lesions endoscopically. The thoracoscopic portals were made larger (usually 3-4 cm) and placed slightly more posterior than usual, which allows use of a combination of conventional spinal instruments and video-assisted thoracoscopy to enter the chest cavity and be manipulated similar to that with techniques used for standard open surgical procedures. In our series the endoscopic spinal procedures included biopsy only (n = 1), thoracic discectomy (n = 1), multilevel anterior discectomy and fusion (n = 1), corpectomy for decompression (n = 4), decompressions and interbody fusions (n = 10), and internal instrumentations (n = 4). Throughout the operation only one trocar was used for introducing the thoracoscope. There were no intraoperative deaths, and no patients showed neurologic deterioration due to the procedures. We conclude that such a technique makes thoracoscopy-assisted spinal surgery simpler and easier and has proved to be an effective, promising procedure. It does not appear to compromise the therapeutic goals set for the patients. The intraoperative vessel bleeding can be easily controlled, and the number of portals for the procedures can be reduced (on average, three portals are enough). Few endoscopic materials were used with our patients, and thus the total economic cost to the patients was reduced.

Joint stiffness is a common complication of elbow trauma. Treating elbow stiffness is challenging, especially in patients with severe elbow stiffness with distal humeral nonunion. To improve treatment outcomes, the authors applied a hinged external fixator after performing open reduction and internal fixation and evaluated the clinical outcome. Between 2005 and 2011, eleven patients with elbow stiffness and distal humeral nonunion underwent open arthrolysis, surgical reduction, internal fixation, hinged external fixation, and selective bone grafting. The ulnar nerve was anteriorly transposed in all patients. Elbow range of motion, Mayo Elbow Performance Score, and radiographs were assessed pre- and postoperatively. All patients achieved solid union in an average of 5.6 months. Preoperatively, mean flexion was 86.8°, mean extension was 45.5°, and mean total range of motion was 41.3°. Postoperatively, mean flexion was 125.9°, mean extension was 11.8°, and mean total range of motion was 114.1°. Mean Mayo Elbow Performance Score also significantly improved from 59 points preoperatively to 87.2 points postoperatively, and 6 patients were scored as excellent (more than 90 points), 3 good (75-90 points), and 2 fair (60-74 points) according to the Mayo Elbow Performance Score. A stiff elbow with distal humeral nonunion can be treated successfully using a unilateral hinged external fixator to supplement the open reduction and internal fixation. A hinged external fixator was an effective rehabilitation method for improving range of motion and maintaining joint stability.