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ABSTRACT: BACKGROUND: Bone marrow-derived mesenchymal stem cells (BMSCs) undergo hypoxia-induced apoptosis when cells are transplanted from a normoxic to a hypoxic microenvironment in vivo. The effect of the osteogenic microenvironment on BMSCs under hypoxic conditions has not yet been revealed. MATERIALS AND METHODS: In the current study, we investigated the effects on BMSCs of hypoxia and osteogenic induction (OI) individually and in combination. We isolated BMSCs from rat bone marrow and confirmed them by recognition of surface antigens using cytometry. After passaging the BMSCs to the third generation, we treated them with the following conditions: 1% oxygen and OI, normoxia and OI, and 1% oxygen without OI; normoxia without OI was the control condition. On days 3, 7, 14, and 21, we detected the expression levels of hypoxia inducible factor-1α and alkaline phosphate via Western blotting. Cellular apoptosis was detected by Hoechst staining and terminal deoxynucleotidyl transferase-mediated 2'-deoxyuridine, 5'-triphosphate nick end labeling; caspase activity was also detected. RESULTS: The expression of hypoxia inducible factor-1α was induced and up-regulated when BMSCs were grown under 1% oxygen. The incidence of terminal deoxynucleotidyl transferase-mediated 2'-deoxyuridine, 5'-triphosphatenick end labeling-positive cells in the hypoxia plus OI group was much lower than that in the hypoxia group without OI. Caspase activity increased on days 3, 7, 14, and 21. The absolute value of caspase was statistically higher in the BMSC hypoxia group than in the other three groups, whose values were similar to each other. CONCLUSIONS: Osteogenic induction could protect BMSCs against hypoxia-induced apoptosis. Bone marrow-derived mesenchymal stem cells may be appropriate candidate cells for cytotherapy for skeletal diseases.
Journal of Surgical Research 04/2013; · 2.25 Impact Factor
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ABSTRACT: Although free vascularized fibular grafting (FVFG) has been successfully employed for precollapsed osteonecrosis of the femoral head (ONFH), there are few reports concerning its radiographic and functional results for ONFH concomitant with osteoarthritis (OA) of the hip. In the current study, 12 patients with OA induced by traumatic ONFH were enrolled, with FVFG employed as the treatment protocol. The collapsed step of the cartilage surface was measured and compared with the postoperative value, and the Merle d'Aubigné scoring system was used to evaluate preoperative and postoperative status of the hip joint. The collapsed step disappeared, and sphericity of the femoral head could be restored at an average duration of 56 months postoperatively in seven patients. With regard to the severity of hip OA, six were improved to Grade 1 and one to Grade 2. In terms of functionality, all patients with a restored femoral head experienced postoperative improvement in pain relief, mobility, and functional capacity. The average Merle d'Aubigné score increased from 6.0 to 16.9 postoperatively (p < 0.001). In conclusion, for traumatic ONFH concomitant with OA, FVFG can confer benefits in the form of restoration of the contour of the femoral head and improvement in joint function.
Journal of Reconstructive Microsurgery 04/2013; · 1.43 Impact Factor
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International Orthopaedics 03/2013; · 2.03 Impact Factor
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ABSTRACT: Progressive pseudorheumatoid dysplasia is an autosomal recessively inherited skeletal disease. Progressive pseudorheumatoid dysplasia can involve multiple synovial joints, which then develop structural deformity and articular dysfunction. We report a case of progressive pseudorheumatoid dysplasia with polyarthropathy in a 17-year-old girl. Total hip arthroplasty was performed to treat persistent pain and stiffness by reconstructing a functional joint. Although we found arthroplasty to be an effective way of reconstructing a functional joint, treatment of the underlying cause is urgently required for this disease in the future.
Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases 03/2013; · 1.19 Impact Factor
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ABSTRACT: To investigate the effect of primary tumorectomy on angiogenesis and pulmonary metastasis in osteosarcoma-bearing nude mice.
Osteosarcoma was introduced to nude mice via subcutaneous injection of MG-63 cells. One hundred and eighty osteosarcoma-bearing mice were used equally in 3 parallel experiments. The effect of tumorectomy (TR) on the expression of vascular endothelial growth factor (VEGF) and endostatin was investigated by ELISA. Meanwhile, the effect on angiogenesis was evaluated by Matrigel plug assay, and pulmonary metastasis assessed by calculating the metastatic foci. Sham-operation (SO) and untreated (UT) groups served as controls.
The VEGF (TR: 79.55 ± 7.82 pg/mL vs. SO: 110.01 ± 5.69 pg/mL, UT: 123.50 ± 10.41 pg/mL; p < 0.01) and endostatin (TR: 47.09 ± 6.22 ng/mL vs. SO: 117.64 ± 7.39 ng/mL, UT: 126.73 ± 6.55 ng/mL; p<0.01) were down-regulated significantly after tumorectomy, and angiogenesis was significantly promoted simultaneously. The incidence of pulmonary metastatic foci was 80.0% in the TR group, 40.0% in the SO group and 35.0% in the UT group.
Primary tumorectomy can down-regulate the expression of VEGF and endostatin and promote angiogenesis which leads to the acceleration of pulmonary metastasis. These findings imply that anti-angiogenic treatment can be considered after primary tumorectomy.
Acta cirurgica brasileira / Sociedade Brasileira para Desenvolvimento Pesquisa em Cirurgia 03/2013; 28(3):190-4. · 0.48 Impact Factor
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ABSTRACT: BACKGROUND: Traditional methods to establish animal model of osteonecrosis of the femoral head (ONFH) are not satisfactory because of the undefined underlying mechanism, low rate of the disease, and high incidence of mortality. The present study was to induce ONFH in a rat model through periarticular injection of vascular endothelial growth factor (VEGF) receptor 2 antibody. MATERIALS AND METHODS: Eighty Sprague-Dawley rats were divided into four groups randomly and equally. VEGF receptor 2 antibody solution with a concentration of 50 μg/mL (group A), 25 μg/mL (group B), and 12.5 μg/mL (group C) was injected periarticularly to the capsular attachment to proximal femur, respectively. The injection lasted 4 continuous days, with a total volume of 2 mL. The rats in the fourth group were treated by saline for control (group D). Two weeks after the first injection, histologic and micro-computed tomographic examinations were used to investigate the presence of ONFH. RESULTS: Histologically, there were 90% of rats that developed ONFH in group A, 60% in group B, and 20% in group C, whereas no ONFH was found in group D. The density of intraosseous vessels was suppressed significantly by the antibody. Radiologically, the features of ONFH including deformation of the femoral head were revealed. There was no occurrence of lethal complications. CONCLUSIONS: VEGF receptor 2 antibody can induce ONFH in the rat with a high incidence of the disease. Local blockage of angiogenesis can be used as an effective method to establish animal model of ONFH.
Journal of Surgical Research 02/2013; · 2.25 Impact Factor
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ABSTRACT: Osteonecrosis of the femoral head (ONFH) is a common and severe complication following femoral neck fractures in young adults. Despite significant advances in surgical techniques, radiological evaluation and comprehensive treatment for the prevention of ONFH, the incidence of traumatic ONFH has remained unchanged at approximately 20% in recent decades. The injury-to-surgery interval is considered as a principal factor affecting the occurrence of ONFH, and traditionally, femoral neck fractures are treated emergently. However, the relationship between the injury-to-surgery interval and ONFH occurrence is poorly understood, and previous reviews have not provided a precise explanation due to the lack of strict selection criteria for studies.
We reviewed previously published articles and included in current systematic review those studies with accurate multivariate analyses that included age, fracture type, operation method, follow-up, ONFH occurrence and injury-to-surgery interval.
Six case studies were included and reevaluated. The studies included 263 hips for final analysis, with an overall incidence of postfracture ONFH of 17.5%. Patients were categorized into groups of less/more than 8 h, less/more than 24 h, less/more than 48 h and less/more than 3 weeks based on the individual injury-to-surgery interval. The postfracture ONFH incidence ranged from 13.3% (<8 weeks) to 21.7% (>3 weeks). Operations performed within 3 weeks of injury resulted in a lower ONFH incidence compared with operations performed after 3 weeks; however, this difference was not statistically significant. The ONFH incidence remained relatively stable when the operations were performed within 3 weeks of injury.
The injury-to-surgery interval did not significantly affect the incidence of postoperative ONFH.
European Journal of Orthopaedic Surgery & Traumatology 02/2013; 23(2):203-9. · 0.10 Impact Factor
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ABSTRACT: BACKGROUND: Risk factors for femoral neck fracture-induced avascular necrosis of the femoral head have not been elucidated clearly in middle-aged and elderly patients. Moreover, the high incidence of screw removal in China and its effect on the fate of the involved femoral head require statistical methods to reflect their intrinsic relationship. METHODS: Ninety-nine patients older than 45 years with femoral neck fracture were treated by internal fixation between May 1999 and April 2004. Descriptive analysis, interaction analysis between associated factors, single factor logistic regression, multivariate logistic regression, and detailed interaction analysis were employed to explore potential relationships among associated factors. RESULTS: Avascular necrosis of the femoral head was found in 15 cases (15.2 %). Age × the status of implants (removal vs. maintenance) and gender × the timing of reduction were interactive according to two-factor interactive analysis. Age, the displacement of fractures, the quality of reduction, and the status of implants were found to be significant factors in single factor logistic regression analysis. Age, age × the status of implants, and the quality of reduction were found to be significant factors in multivariate logistic regression analysis. In fine interaction analysis after multivariate logistic regression analysis, implant removal was the most important risk factor for avascular necrosis in 56-to-85-year-old patients, with a risk ratio of 26.00 (95 % CI = 3.076-219.747). CONCLUSION: The middle-aged and elderly have less incidence of avascular necrosis of the femoral head following femoral neck fractures treated by cannulated screws. The removal of cannulated screws can induce a significantly high incidence of avascular necrosis of the femoral head in elderly patients, while a high-quality reduction is helpful to reduce avascular necrosis.
Journal of Orthopaedic Science 11/2012; · 0.84 Impact Factor
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ABSTRACT: Between June 2007 and May 2008, 21 patients with bilateral osteonecrosis of the femoral head were surgically treated with implantation of free vascularized fibula obtained from the unilateral donor site. All patients were followed up clinically and radiographically for an average of 3.5 years. The evaluation included operative duration, blood loss, Harris hip score, incidence of complications, and radiological examinations. The time for fibular harvesting was 20min on average. Total operative duration was 100-240min, with an average of 150min. Blood loss averaged 300ml. All transplanted fibula integrated well to the femoral head 3.5years postoperatively with no severe complications observed. The results revealed that unilateral free vascularized fibula is effective for the treatment of bilateral osteonecrosis of the femoral head.
The Journal of arthroplasty 11/2012; · 1.79 Impact Factor
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ABSTRACT: The aim of this study was to evaluate clinical outcomes and complications following minimally invasive plate osteosynthesis (MIPO) with the proximal humeral internal locking system (PHILOS) for treating proximal humeral shaft fracture through the deltopectoral approach.
Between November 2008 and March 2010, 74 patients with unilateral proximal humeral shaft fractures were treated using the MIPO technique with the PHILOS through the deltopectoral approach. Patients received an average follow-up of 16.9 (range, 12-24) months, and the final follow-up included anteroposterior and lateral imaging and recording of postoperative complications. The Constant-Murley shoulder score was used to evaluate function.
No intraoperative complications occurred. Postoperative complications included subacromial impingement in four patients. There was no deep infection, neurovascular damage, breakage or implant loosening. All fractures united in an average time of 17.4 (15-25) weeks. In terms of function, the Constant-Murley score was 85.8 points on average (range, 67-100). The range of motion of the involved shoulder was satisfactory, and pain-free in 83.8 % of patients.
Using the MIPO technique with the PHILOS through the deltopectoral approach is a valid and safe method of treating proximal humeral shaft fractures.
International Orthopaedics 09/2012; 36(11):2341-5. · 2.03 Impact Factor
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ABSTRACT: It is controversial whether an early reduction and internal fixation can reduce the occurrence of femoral neck fracture-induced osteonecrosis of the femoral head (ONFH). This prospective study was designed to reflect the relationship between injury-to-surgery interval (ISI) and traumatic ONFH based on a canine model of femoral neck fractures.
Twenty-four dogs were equally divided randomly into 3 groups. A lateral L-shape approach centered left great trochanter was used for exposure of the femoral neck. A low-speed drill was used for making displaced fractures in the narrow femoral neck, with the femoral head kept in situ with ligamentum teres intact. In Group A, the fracture was immediately reduced and fixed with 3 parallel pins; while the operation was done 3 days later in Group B, and 3 weeks later in Group C. Another 2 dogs had their fractures untreated. Postoperatively, all dogs were fed separately and received regular x-ray examination. Left femoral heads were harvested for histological examination with a postoperative follow-up of 3.5 months.
The canine model of femoral neck fractures could be achieved successfully. Radiological signs of post-fracture ONFH could not be detected at intervals of 2 weeks, 4 weeks, 1 month and 2 months. Histologically, there were 2 cases with ONFH in Group A, 1 case in Group B, and 2 cases in Group C. The difference had no statistical significance. For untreated fractures, obvious ONFH could be found radiologically.
A shorter ISI may not reduce the incidence of fracture-induced ONFH, which suggests that intrinsic factors play an important role in the occurrence of ONFH.
Medical science monitor: international medical journal of experimental and clinical research 06/2012; 18(7):BR259-64. · 1.70 Impact Factor
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ABSTRACT: The aim of the current study was to investigate the local expression of caspase-3 following femoral neck fractures in a canine model and to investigate its effect on the occurrence of fracture-induced osteonecrosis of the femoral head (ONFH). Eight dogs had surgically-induced femoral neck fractures on the left side which remained untreated. Radiological and histological examinations were employed to detect morphological changes of the femoral head. Immunohistochemical staining of caspase-3 was used to evaluate cell apoptosis, which may play an important role in ONFH. The results were compared to the normal side for statistical analysis. As a result, all eight dogs had ONFH, with non-union in five and malunion in three on radiological examination. Histologically, the untreated femoral heads developed osteonecrosis with an accumulation of bone marrow cell debris, empty lacunae and/or ghost nuclei in the lacunae, and an increase in the number of fat cells. Immunohistochemical staining of caspase-3 indicated that it was upregulated in fracture-induced ONFH two weeks postoperatively, which showed a statistical difference when compared to the normal side. In conclusion, the local expression of caspase-3 was upregulated in fracture-induced ONFH, suggesting that cell apoptosis is crucial in traumatic ONFH. Caspase-3 may therefore be employed as an effective and early predictor for fracture-induced ONFH.
Molecular Medicine Reports 06/2012; 6(3):611-4. · 0.42 Impact Factor
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ABSTRACT: BackgroundHemipelvic defect could be reconstructed with homolateral proximal femur, and an acetabulum could be smartly created in the
trochanter region. Several issues concerning the peculiar reconstruction of hemipelvis and acetabulum with autograft of homolateral
proximal femur have not been revealed clearly yet.
MethodsSeventy cases of radiographic data were investigated and measured retrospectively to determine the maximum diameter that could
be contained in the trochanter. A dual-energy X-ray absorptiometry was employed to detect bone mineral density of natural
acetabulum and trochanter on eight volunteers to reflect the differences of bone mineral density and determine whether postoperative
protection is needed. Finally, a mock operation was designed to reflect the reconstruction method.
ResultsThe section of great trochanter was round and the max diameter was 44.2±5.75mm averagely. The bone mineral density of natural
acetabulum was 1.224±0.183g/cm3 while 0.866±0.132g/cm3 in the trochanter region, which was lower statistically than the former. The hemipelvis and acetabulum could be well reconstructed
with autograft of homolateral proximal femur through mock operations.
ConclusionsIt is feasible to reconstruct the hemipelvis and hip joint with autologous homolateral proximal femur combined with normal-size
total hip replacement. Postoperative protection is mandatory for the new acetabulum could not replace the natural one in the
level of bone density.
KeywordsPelvis–Hip joint–Femur–Autograft–Bone mineral density
European Journal of Orthopaedic Surgery & Traumatology 04/2012; 21(3):145-149. · 0.10 Impact Factor
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ABSTRACT: Fractures of the clavicle are common injuries and some of them need open reduction and internal fixation. As one of economical
and practical implants, Kirschner pins (K-pins) are widely employed to treat clavicle fractures through percutaneous fixation
in minimal invasion. However, as one of rare and severe complications, K-pins migrations to ascending aorta, thorax, spine
and neck have been published previously. Here, a case of migration of a broken K-pin to thoracic spinal canal 4years following
internal fixation of a clavicle fracture is reported, and concerning attention in clinical practice is discussed.
KeywordsClavicle fractures-Kirschner pin-Migration-Complication-Breakage
European Journal of Orthopaedic Surgery & Traumatology 04/2012; 20(6):493-495. · 0.10 Impact Factor
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ABSTRACT: Chronic osteomyelitis associated with soft-tissue defect following surgical management is a severe complication for orthopaedic surgeons. Traditionally, the treatment protocol for the notorious complication involved thorough debridement, bone grafting, long-term antibiotic use and flap surgery. Alternatively, platelet-rich plasma (PRP), a high concentration of platelets collected via centrifugation, has been successfully used as an adjuvant treatment for bone and soft-tissue infection in medical practices. PRP has numerous significant advantages, including stypsis, inflammation remission and reducing the amount of infected fluid. It increases bone and soft-tissue healing and allows fewer opportunities for transplant rejection. Through many years of studies showing the advantages of PRP, it has become preferred organic product for the clinical treatment of infections, especially for chronic osteomyelitis associated with soft-tissue defect. To promote the clinical use of this simple and efficacious technique in trauma, we report the case of a patient with chronic calcaneal osteomyelitis associated with soft-tissue defect that healed uneventfully with PRP.
International Wound Journal 02/2012; · 1.46 Impact Factor
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ABSTRACT: Free vascularised fibular grafting (FVFG) could be a good option for the restoration of massive bone defects in lower limbs when combined with use of a locking plate. The progress of fibular hypertrophy is closely related to regain of function, as well as to prevention of stress fractures. Multiple variables affecting fibular hypertrophy were investigated in the current study to elucidate correlative factors.
Eighteen patients with a massive bone defect in a lower limb reconstructed by FVFG combined with a locking plate were retrospectively enrolled in the current study. The degree of fibular hypertrophy was calculated based on the measurements from anteroposterior imaging at regular intervals of 3 months, 6 months, 1, 2 and 3 years postoperatively. Repeated measures analysis of variance was employed to evaluate and compare correlative factors including gender (male vs. female), age distribution (<30 years vs. >30 years), site (femur vs. tibia) and length of bone defect (6-10 cm vs. >10 cm), previous number of operations (once vs. more than twice) and concomitant infection (detected vs. non-detected).
All defects could be successfully repaired by FVFG and bone union was achieved uneventfully. The degree of fibular hypertrophy was 0.14%, 11.27%, 31.53%, 58.14% and 71.81% retrospectively at the five follow-up time points. Statistical analysis revealed that the above-mentioned factors did not affect the progress of fibular hypertrophy.
FVFG could be a good choice for the reconstruction of massive bone defects when combined with a locking plate. Factors including gender, age distribution, site and length of bone defects, number of previous operations and infection do not impact the progress of fibular hypertrophy, which implies that intrinsic factors might play an important role in restoration.
Injury 02/2012; 43(7):1090-5. · 1.98 Impact Factor
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ABSTRACT: With the advent of superb microsurgery techniques and advanced stabilization instruments, recent decades have seen great progress in treating nonunions secondary to traumatic fractures. However, those nonunions that are secondary to primary non-Hodgkin's lymphoma of bone and often related to irradiation still remain a challenging problem. The condition could be more perplexing when bone healing abilities are greatly compromised and reliable stabilization is difficult.
We performed an operation using free vascularized fibular graft in combination with a locking plate on a 47-year-old female patient who had suffered from a three-year femoral nonunion after courses of radiochemotherapy for the treatment of primary non-Hodgkin's lymphoma of bone, a spontaneous femoral shaft fracture, an intramedullary nailing, and some nonoperative interventions in sequence. Primary union of the graft was obtained at 9 months without wound infection. No recurrence of lymphoma occurred in the 61-month follow-up, nor did a stress fracture or failure of fixation. Limb salvage was achieved and the range of motion of the adjacent joints was acceptable.
Free vascularized fibular graft in combination with a locking plate can effectively enhance bone union in compromised bone and soft tissue milieu. More cases have yet to be further investigated.
Medical science monitor: international medical journal of experimental and clinical research 11/2011; 17(11):CS138-143. · 1.70 Impact Factor
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Microsurgery 05/2011; 31(5):417-8. · 1.61 Impact Factor
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ABSTRACT: The lack of an experimental animal model that can reliably mimic all stages of osteonecrosis of the femoral head has hindered progress toward the successful prevention and treatment of the disease.
A goat model of osteonecrosis of the femoral head (ONFH) was established and observed from the early to the intermediate-to-late stage of mechanical failure. Absolute alcohol was injected slowly into the center of bilateral femoral heads in 12 adult Small Tail Han goats. Postoperatively, the femoral heads were harvested and examined using macrostructural and histological analyses and radiographic and MRI examinations at weeks 4, 8, 12, and 25.
Macrostructural and radiographic examinations revealed that the contour of both femoral heads was deformed slightly at 12 weeks, but a contour deformation with joint space narrowing was observed at 25 weeks. Histologically, a strong concordance with the natural history of ONFH in humans was found. The present model demonstrated bone trabeculae, marrow necrosis, a reconstruction deficiency and destruction of the microcirculation.
Among quadrupedal models, the goat model of ONFH, which is induced by a single injection of absolute alcohol, may be suitable and valuable for the evaluation of various therapeutics and side effects in the treatment of ONFH.
Medical science monitor: international medical journal of experimental and clinical research 04/2011; 17(4):BR97-102. · 1.70 Impact Factor
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ABSTRACT: High-energy fractures of posterior tibial plateau always need surgical treatment. Generally, posterior fragments of these fractures could not be exposed and reduced well in conventional anterior approaches. Although a posterolateral/posteromedial approach to manage posterior tibial plateau fractures can achieve satisfactory results, there are few presentations concerning the treatment of these high-energy injuries based on posterior approaches combined with anterior approach if necessary.
Ten cases of posterior tibial plateau fractures from high-energy injuries were retrospectively reviewed and followed up for mean 26.5 months (range 14-45 months). A posterolateral/posteromedial approach was adopted primarily to fix main fragment in posterior tibial plateau, and intraoperative assessment of the stability of knee was done. An anterior approach was added if required.
Posterolateral approach was employed in seven cases, posteromedial in three, and additional anteromedial in three, and anterolateral in two cases. The average time to union of all 10 fractures was 3.7 months (range 3-5.5 months). Nine patients had satisfactory articular reduction. The range of motion of the knee averaged 2° of extension to 110.5° of flexion. No patient complained of knee instability. The average postoperative HSS score at the final followup was 92.70.
High-energy fractures of posterior tibial plateau could be well treated based on posterior approaches combined with necessary anterior approach if required.
Indian Journal of Orthopaedics 03/2011; 45(2):125-31. · 0.50 Impact Factor
