Objective To discuss CT appearance and differential diagnosis of costal cartilage fracture in adult.Methods CT findings of 30 costal cartilage fractures in 20 cases were analyzed.Results On the basis of fractural location and CT appearanes,the fractures were divided three types:14 line-like fracture in 10 cases,9 local focal cleft within the costal cartilage in 6 cases and 7 massed fractures in 4 cases.Conclusion CT is of great value in diagnosing costal cartilage fracture.

Objective To investigate the expression of phospho-histone H3 (PHH3) protein in pancreatic neuroendocrine neoplasms (PNENs) and explore its potential value for pathological grading of PNENs.Methods Clinical and pathological data of 283 patients with PNENs treated in Changhai Hospital from December 2000 to May 2016 were retrospectively analyzed.PNENs tissue chip was prepared,and immunohistochemistry was used to examine the expression of PHH3 and Ki67.The receiver operating characteristic curve for PHH3 was drawn and the area under the curve(AUC) was calculated to determine the cutoff value for PNENs grading.Ki67 was used for PNENs grading according to domestic and intemational criteria for PNENs classification.The relationship of PHH3 and Ki67 classification with clinical pathological features and prognosis of PNENs as well as the correlation between the two classification methods were analyzed.Results Of 283 patients,132 were male and 151 were female,aged from 16 to 78 years old.The average age was (50 ± 1) years old.There were 44 cases with functional PNENs and 239 with non-functional PNENs.The diameter of tumors ranged from 1.1 cm to 17 cm and the average diameter was (4.1 ± 1.2)cm.According to the Ki67 standard,there were 127,116,33 and 7 cases of Grade G1,G2,pancreatic neuroendocrine tumor(PNET) G3 and pancreatic neuroendocrine cancer(PNEC) G3.According to the PHH3 standard,there were 118,119,3 8 and 8 cases of Grade G1,G2,PNET G3 and PNEC G3.There was a positive correlation between the two grading criteria (r =0.941,P ＜0.001).PHH3 expression and PNENs grading were not correlated with age,gender,tumor functional or not and tumor locations (all P ＞ 0.05),but were both positively correlated with tumor size,histological grade,lymph node metastasis,TNM stage and prognosis (all P ＜0.05).The average time of observing PHH3 and Ki67 staining per case in the immunohistochemistry of tissue chip was 9 min and 45 min,respectively.Conclusions Detection of PHH3 expression in PNENs can be used for the pathological diagnosis,grading and prognostic evaluation,which was more accurate and convenient than Ki67 criteria.

BACKGROUND:Zinc-modified calcium silicate (CaSiO3) bioceramics coating on the titanium surface prepared in preliminary experiments has good chemical stability and antibacterial property. OBJECTIVE:To observe the effects of zinc-modified CaSiO3 bioceramics coating on osteointegration. METHODS:MC3T3-E1 cels were respectively cultured on the titanium with zinc-modified CaSiO3 bioceramics coating (experiment group), titanium with CaSiO3 bioceramics coating (control group) and pure titanium (blank control group). Then, cel adhesion, proliferation, calcification rate and the expression of type I colagen and osteocalcin were detected. The implant materials mentioned above were respectively inserted into the femurs of New Zealand white rabbits, and after 1.5 months, the osteoproliferation and osteointegration between the implants and the host were tested. RESULTS AND CONCLUSION:In vitro experiment: The number of adhesive cels at 12 hours after co-culture was significantly increased in the experimental group compared with the control group and blank control group (P < 0.05). At 14 days after co-culture, cel proliferation ability and ability of calcium nodule formation in the experiment group were significantly better than those in the other groups (P < 0.05). At 21 days after co-culture, there was no significant difference in the expression of type I colagen, but the expression of osteocalcin in the experiment group was higher than that in the control group and blank control group (P < 0.05).In vivo experiment: In the experiment group, a large amount of bone substances were detected, the coating materials directly contacted with the bone interface, new bone tissues and little fibrous tissues were observed at the interface. In contrast, there was a small amount of bone hyperplasia in the control group and almost no bone hyperplase in the blank control group. Moreover, a small part of the implant directly contacted with the bone interface and the most part was separated from bone trabeculae by fibrous tissues. These findings indicate that zinc-modified CaSiO3 bioceramics coating can enhance the ability of osteointegration between titanium implants and the host.

Objective:To evaluate the clinical efficacy of the axillary approach in the treatment of scapular glenoid fracture.Methods:A retrospective analysis was performed of the 12 patients who had been treated for scapular glenoid fracture from November 2019 to April 2021 at Department of Upper Limb Orthopaedics, Zhengzhou Orthopaedic Hospital. They were 4 males and 8 females, aged from 30 to 75 years (mean, 53.5 years). According to the Ideberg classification, there were 2 cases of type Ⅰa, 9 cases of type Ⅱ and one case of type Ⅴa. All cases were treated through the axillary approach. Two patients complicated with anterior shoulder dislocation were treated with manual reduction under anesthesia before operation and the other 10 cases with special plate fixation through the axillary approach. The 3 patients complicated with fracture of greater tuberosity were fixated with a special plate through the lateral shoulder split deltoid approach. Constant-Murley score, visual analogue scale (VAS) and Hawkins grading were used at the last follow-up to evaluate shoulder function, pain and stability after operation.Results:All patients were followed up for 9 to 20 months (mean, 14.4 months). The operation time ranged from 55 to 110 min (mean, 76.3 min), intraoperative bleeding from 60 to 160 mL (mean, 103.8 mL), and hospital stay from 8 to 14 d (mean, 11.1 d). All incisions healed primarily and all scapular glenoid fractures got united 6 months after operation. The last follow-up showed no shoulder instability, neurovascular injury or internal fixation failure. At the last follow-up, the range of motion of the shoulder was 159.2°±26.1° in forward bending, 156.7°±29.6° in abduction, 48.3°± 15.3° in external rotation (neutral position), and 73.3°±12.3° in internal rotation (neutral position), and the Constant-Murley score was (94.0±5.3) points. The range of motion of the shoulder and Constant-Murley score were significantly improved compared with those before operation (10.8°±11.6°, 7.5°±11.4°, 5.8°±10.0°, 42.5°±16.0° and 4.9±4.0, respectively) (all P<0.05). The VAS score was 0 in 11 patients and 2 in one patient at the last follow-up. Conclusion:The axillary approach is feasible for the treatment of scapular glenoid fracture, because it is hidden and less invasive, leading to good clinical outcomes.

Objective:To compare proximal humerus internal locking system (PHILOS) and Multiloc intramedullary nail in the treatment of proximal humerus fracture-anterior dislocation.Methods:A retrospective study was performed to analyze the data of 33 patients with proximal humerus fracture-anterior dislocation who had been treated by open reduction and internal fixation from June 2015 to April 2021 at Department of Upper Limbs, Zhengzhou Orthopaedic Hospital. According to methods of internal fixation, the patients were divided into an extramedullary group and an intramedullary group. In the extramedullary group of 18 cases subjected to internal fixation with PHILOS, there were 8 males and 10 females with an age of (53.3 ± 10.6) years, and 1 2-part fracture, 15 3-part fractures and 2 4-part fractures by the Neer classification. In the intramedullary group of 15 cases subjected to internal fixation with Multiloc intramedullary nail, there were 8 males and 7 females with an age of (51.5 ± 11.2) years, and 14 3-part fractures and 1 4-part fracture by the Neer classification. The 2 groups were compared in terms of incision length, operation time, intraoperative blood loss, postoperative complications, and visual analog scale (VAS), range of shoulder motion, and Constant-Murley score at postoperative 12 months.Results:The 2 groups were comparable due to insignificant differences in their preoperative general data ( P>0.05). All patients were followed up for (20.8 ± 4.7) months. The incision length in the intramedullary group [(11.6 ± 1.7) cm] was significantly shorter than that in the extramedullary group [(17.6 ± 2.0) cm], and the intraoperative blood loss in the former [(106.7 ± 34.4) mL] was significantly lower than that in the latter [(151.7 ± 45.7) mL] ( P<0.05). The VAS scores at 1 week and 1 month after surgery [2.0 (2.0, 3.0) and 0.0 (0.0, 1.0) respectively] in the intramedullary group were significantly lower than those in the extramedullary group [3.0 (3.0, 3.3) and 1.0 (0.0, 1.3) respectively] ( P<0.05). The external rotation of the shoulder at the last follow-up in the intramedullary group (65.3° ± 15.5°) was significantly larger than that in the extramedullary group (50.6° ± 13.9°) ( P<0.05). There were no significant differences in operation time, incidence of postoperative complications, VAS score at 12 months after operation, Constant-Murley score or range of shoulder motion at the last follow-up between the 2 groups ( P>0.05). Conclusions:In the treatment of proximal humerus fracture-anterior dislocation, open reduction and internal fixation with both PHILOS and Multiloc intramedullary nail can result in a favorable prognosis when the fracture-dislocation is well reduced and fixated. However, the Multiloc intramedullary nail may lead to better early pain relief, less surgical invasion, and better functional recovery of the external rotation of the shoulder.

Objective: To explore the treatment strategy for traumatic posterior dislocation of shoulder joint with concomitant reverse Hill-Sachs lesion on the humeral head. Methods: Data of 8 consecutive traumatic posterior shoulder dislocations with concomitant compression on anteromedial portion of the affected humeral heads (reverse Hill-Sachs lesion), which resulted from the collision between the posterior rim of the glenoid and anterior portion of the humeral head, who had undergone treatment in our department since July 2015 to June 2018 were retrospectively analyzed. Seven males and 1 female have been included in the case series, with the age between 30-70 years (mean 44.5±12.3 years), 6 on the right shoulder and 2 on the left. 7 were acute injuries and 1 chronic. One patient received closed reduction under brachial plexus block anesthesia, and the rest cases underwent open surgeries. Modified Judet approach was performed in one case due to the concomitant fracture on the postero-inferior glenoid. The other 6 patients received modified delto-pectoral approach. 4 concomitant rotator cuffswere found during the procedures, including1 full thickness tears 3 partial. One patient received McLaughlin surgery, allograft and anchor suture fixation. 2 underwent cannulated screw fixation. Allograft and PHILOS fixation was placed on 4 cases. All 8 patients were required maintaining in mild abduction and external rotation the affected arms, with the protection of the casts. All patients were followed up for 20.6±8.4 months (range, 9-36 months). Constant-Murley scores and visual analogue score (VAS) were used to evaluate the clinical outcomes at the latest follow-up. Results: Infection occurred in 1 case, the humeral head has been resected subsequently and antibiotic cement spacer was inserted for further arthroplasty. Necrosis of the humeral head has been observed in one CT follow up 9 months after surgery, with no limitation of the range of motion of the shoulder. Stage 1 wound closure and bony union were witnessed on the rest 6 patients. No neuromuscular injures or re-dislocations on the affected shoulders was found. The range of motion of the affected shoulder has been recorded at the latest follow-up: 123.8°±30.1° (90°-180°) in flexion, 124.4°±34.2° (80°-180°) in abduction, 36.9°±20.9° (0°-70°) in external (neutral position), 58.8°±10.9° (50°-80°) in internal rotation (neutral position) and 83.5±12.1 (70-95) in Constant-Murley score. Among the 8 patients, 7 patients were at the rank of VAS 0-3, and 1 of 4-6. Conclusion Optimal treatment options should be chosen based on the humeral head defect status, in case of traumatic posterior shoulder dislocation with concomitant reverse Hill-Sachs lesion. Closed reduction can be tried on < 20% humeral head defect with the help of anesthesia, and surgical option is the optimal one for the defect between 20%-40%.