Osteoporosis and fracture patterns. A study of split-compression fractures of the lateral tibial condyle

A retrospective study of spine injuries in electric bicycles related collisions

BACKGROUND

Electric bicycles related collisions could lead to severe consequences in spine injuries, while no study had comprehensively investigated the epidemiology and demography of spine injuries in electric bicycles related collisions.

QUESTIONS/PURPOSES

The aim of this study is to (1) describe the epidemiological characteristics of spine injuries in electric bicycles related collisions, (2) develop clinical guideline of spine injuries in electric bicycles related collisions and (3) support the new road safety policy for electric bicycle riders.

METHODS

A retrospective review of spine injuries in electric bicycle related collisions was performed from 86 patients in an urban trauma center between 2018 and 2020. The variables including gender, age, radiographic findings, associated injuries, neurologic injuries, treatment, average length of stay were fully collected. Chi-square test and paired sample mean t-test were used to test for statistically significant differences. All statistical analyses were performed using Statistical Product and Service Solutions 20.0.0 software. A P<0.001 was considered as significant.

RESULTS

A total of 86 cases were involved in electric bicycles related collisions lead to spine injuries. The spine injuries victims were predominantly male (79.07%) and middle-aged (41-60years, 44.19%). The most common spine injuries were L1 fractures (10.48%). The most common fracture type was AO Fracture Classification type A (71.40%). Age and multivertebral fractures had significant difference between patients who suffered from an ASOI and from those who did not (P-value: 0.005, 0.005). There was significant difference between patients who suffered from neurologic injuries and from those who did not in AO Classification, multivertebral fractures and ASOI (P-value: 0.0001, 0.001, 0.032). Age, AO Classification, multivertebral fractures, ASOI and neurologic injuries had significant difference to influence patients' ISS and ALOS.

CONCLUSIONS

Spine injuries in electric bicycles related collisions may make patients suffer from severe consequences including their potential permanent disability, economic cost, or even life safety. Patients with spine injuries in electric bicycles related collisions should be paid close attention to avoid missed diagnosis and misdiagnosis. Helmet, protective clothing or other safety gear should be required to use to provide greater protection for electric bicycle riders.

Acceleration of somatic cell reprogramming into the induced pluripotent stem cell using a mycosporine-like amino acid, Porphyra 334

Porphyra 334 (P334), a mycosporine-like amino acid (MAA), is a secondary metabolite found in diverse marine and terrestrial organisms and has several beneficial effects on fibroblast proliferation, wound healing, and antioxidant activity. Here, we report that P334 accelerates the cell reprogramming process of mouse tail-tip fibroblasts (TTFs) and human dermal papilla (HDP) cells into induced pluripotent stem cells (iPSCs). We found that P334 significantly improved the cell reprogramming efficiency by activating the tri-methylation of histone 3 lysine 4 (H3K4me3), which controls mesenchymal to epithelial transition (MET) during the reprogramming process. Thus, we found that P334 directly regulates epigenetic changes, providing an efficient approach for natural compound-based cell reprogramming.

Quantum scale organic semiconductors for SERS detection of DNA methylation and gene expression

Cancer stem cells (CSC) can be identified by modifications in their genomic DNA. Here, we report a concept of precisely shrinking an organic semiconductor surface-enhanced Raman scattering (SERS) probe to quantum size, for investigating the epigenetic profile of CSC. The probe is used for tag-free genomic DNA detection, an approach towards the advancement of single-molecule DNA detection. The sensor detected structural, molecular and gene expression aberrations of genomic DNA in femtomolar concentration simultaneously in a single test. In addition to pointing out the divergences in genomic DNA of cancerous and non-cancerous cells, the quantum scale organic semiconductor was able to trace the expression of two genes which are frequently used as CSC markers. The quantum scale organic semiconductor holds the potential to be a new tool for label-free, ultra-sensitive multiplexed genomic analysis.

Bovine cancellous xenograft in the treatment of tibial plateau fractures in elderly patients

The objective was to evaluate the efficacy of xenografts to improve the outcomes in elderly patients with tibial plateau fractures. Nineteen cases with a mean age of 74 years were followed prospectively from 1998 to 2003. Six patients each belonged to Schatzker types III, IV and V and one patient belonged to type II. Open reduction with fixation and xenograft impaction was carried out. Clinical and radiological union was assessed including infection rate, incorporation of the xenograft and average collapse of the fracture. The average union time was 20 weeks. No patient had wound infection and all had excellent incorporation of the xenograft with union. The average collapse was 4 mm on follow-up. This series shows the use of only an xenograft in acute fixation of these fractures with favourable outcome. Furthermore, it reduces operative time, bleeding and associated co-morbidities, which is of more significance in an elderly age group.

Arthroscopic evaluation of soft tissue injuries in tibial plateau fractures: retrospective analysis of 98 cases

PURPOSE

This investigation arthroscopically assesses the frequency of soft tissue injury in tibial plateau fracture according to the severity of fracture patterns. We hypothesized that use of arthroscopy to evaluate soft tissue injury in tibial plateau fractures would reveal a greater number of associated injuries than have previously been reported.

METHODS

From March 1996 to December 2003, 98 patients with closed tibial plateau fractures were treated with arthroscopically assisted reduction and osteosynthesis, with precise diagnosis and management of associated soft tissue injuries. Arthroscopic findings for associated soft tissue injuries were recorded, and the relationship between fracture type and soft tissue injury was then analyzed.

RESULTS

The frequency of associated soft tissue injury in this series was 71% (70 of 98). The menisci were injured in 57% of subjects (56 in 98), the anterior cruciate ligament (ACL) in 25% (24 of 98), the posterior cruciate ligament (PCL) in 5% (5 of 98), the lateral collateral ligament (LCL) in 3% (3 of 98), the medial collateral ligament (MCL) in 3% (3 of 98), and the peroneal nerve in 1% (1 of 98); none of the 98 patients exhibited injury to the arteries. No significant association was noted between fracture type and incidence of meniscus, PCL, LCL, MCL, artery, and nerve injury. However, significantly higher injury rates for the ACL were observed in type IV and VI fractures.

CONCLUSIONS

Soft tissue injury was associated with all types of tibial plateau fracture. Menisci (peripheral tear) and ACL (bony avulsion) were the most commonly injured sites. A variety of soft tissue injuries are common with tibial plateau fracture; these can be diagnosed with the use of an arthroscope.

LEVEL OF EVIDENCE

Level III, diagnostic study.

Treatment of displaced bicondylar tibial plateau fractures (OTA-41C2&3) in patients older than 60 years of age

OBJECTIVE

To investigate the outcome (clinical, radiographic, and general health status) of the surgical treatment of displaced bicondylar tibial plateau fractures (OTA-41C) in patients >60 years old.

DESIGN

Prospective cohort study.

SETTING

Limb reconstruction service, university teaching hospital.

PATIENTS

Eleven consecutive patients >60 years old with a mean age of 72 years (range 60 to 90 years). The indications for surgery were displaced bicondylar tibial fractures, open fractures, and fractures with severe soft tissue injury.

INTERVENTION

All patients were treated according to a standard protocol, which involved limited articular reconstruction and percutaneous intrafragmentary screw fixation, followed by neutralization with a stable beam-loading external fixator and early mobilization.

MAIN OUTCOME MEASUREMENTS

The clinical outcome was assessed using Rasmussen's system and the Iowa knee score. For general health assessment, the anglicized SF-36 was used. Radiographic assessment was performed for redisplacement and angulation on digitized radiographs.

RESULTS

After a mean follow-up of 38 months (range 18 to 51 months), bony union was achieved in all patients. Seven of 11 patients started full weight bearing 2 to 6 weeks postoperatively. According to Rasmussen's system, 9 of 11 (82%) scored satisfactory results. Radiographic redisplacement was found in three severely comminuted cases resulting in >/=10 degrees of valgus malunion. One patient received a corrective osteotomy while still in the fixator. Another needed TKA. Limited knee flexion was found in three patients with cross knee fixation. Superficial pin site infection occurred in five patients, but there were no cases of deep infections or septic arthritis.

CONCLUSIONS

All-ring external fixation, as a beam-loading system applied in a neutralizing mode, is a safe, stable, and reliable technique for the treatment of displaced bicondylar tibial plateau fractures in elderly patients.

Failure of fixation of tibial plateau fractures

OBJECTIVE

To define the failure of fixation in tibial plateau fractures, detect its incidence, and determine the contributing factors.

DESIGN

Mail survey and literature review were used to define the fixation failure; this definition was applied to a radiologic review of patients who were treated surgically for tibial plateau fracture at a Level 1 trauma unit for a three-year period from 1993 to 1995.

PATIENTS AND SETTING

Forty-two consecutive patients treated surgically at our trauma unit for tibial plateau fractures were studied retrospectively, specifically for loss of fixation. Factors that might affect the fracture fixation were reviewed, including age, mechanism of injury, type of fracture, bone quality, severity of fragmentation, severity of displacement, time to surgery, operating time, fixation method, use of bone graft, postoperative bracing, and mobilization.

MAIN OUTCOME MEASURES

The main outcome measure was failure of fixation, by using criteria defined by the result of a mail survey of experts and literature review.

RESULTS

Using a strict definition of radiologic failure of fixation, we reported an overall 31 percent rate of failure of fixation: 79 percent in patients older than sixty years compared with 7 percent in younger patients. The statistically significant associations with loss of reduction were age more than sixty years, premature weight bearing, preoperative displacement, fracture fragmentation, and severe osteoporosis.

CONCLUSION

It is logical to define failure of fixation using the same measures considered as indications for reduction and fixation. Using these strict criteria, the incidence of radiologic failure was much higher than previous published series. In the elderly this was unacceptably high, and treatment goals should be limited to restoring stability and alignment.