Objective Proximal humerus fracture is the most common upper-arm osteoporotic fracture in elderly patients and the result of treatment directly affects the physiological function of the shoulder .This article discusses the clinical effect of the locking proximal humeral plate ( LPHP) combined with anti-osteoporosis drugs in the treatment of osteoporotic comminuted proximal humerus fractures in elderly patients . Methods This study included of 47 elderly osteoporotic patients with comminuted proximal humerus fractures treated from April 2009 to March 2012 and with complete follow-up data.According to the Neer classification , the patients were divided into groups A (LPHP treatment, n=23, including 13 cases of three-part fractures and 10 cases of four-part fractures) and B (LPHP+anti-osteoporosis drugs, n=24, including 13 cases of three-part fractures and 11 cases of four-part fractures). Results All the patients were followed up for 14 to 38 (mean 23.6) months.The postoperative healing time was significantly shorter in group B than in group A ([96.57 ±2.59]d vs [115.91 ±2.73]d, P<0.05), and the excellence rate was remarkably higher in B than in A (91.7%vs 78.3%,P<0.05). Conclusion With the advantages of short healing time and high excellence rate , LPHP+anti-os-teoporosis drugs is superior to simple LPHP in the treatment of osteoporotic comminuted proximal humerus fractures in elderly patients.

BACKGROUND:Proximal humeral internal locking system (PHILOS) and locking proximal humerus plate (LPHP) are both new types of internal fixation plates, and have satisfactory effects in the treatment of proximal humerus fractures. However, which is better?
OBJECTIVE:To compare the short-term efficacy of PHILOS and LPHP in the treatment of elderly patients with proximal humeral fractures.
METHODS:The fol ow-up data of 61 elderly patients with proximal humeral fractures were retrospectively analyzed. The patients were divided into PHILOS group (n=34) and LPHP group (n=27). According to the Neer system, there were two parts of fractures in seven cases, three parts of fractures in 11 cases, four parts of fractures in nine cases in LPHP group;there were two parts of fractures in nine cases, three parts of fractures in 14 cases, four parts of fractures in 11 cases in PHILOS group. The operation time, blood loss, and drainage volume were recorded. The time of fracture healing, functional recovery, and complications were observed. Statistical analysis was performed.
RESULTS AND CONCLUSION:Al 61 patients were fol owed up for 12-36 months (mean 20.6 months). There was no statistical difference in operation time, blood loss, drainage volume, time of fracture healing, functional recovery and complications between the two groups (P>0.05). Both LPHP and PHILOS groups could obtain good effects in treatment of senile proximal humeral fractures. The excellent and good rate was respectively 81.5%and 82.4%in two groups. They have advantages of reliable fixation, few complications, and high satisfaction rate. Currently these locking plates have a high clinical value and can be considered as useful implants for ORIF of displaced and unstable proximal humeral fractures.

BACKGROUND:There was no effective method to thoroughly treat tibial bone defect and soft tissue defect. The application of Ilizarov technique solved shortening deformity, soft tissue injury and joint contracture to some degrees.
OBJECTIVE:To discuss the effects of Ilizarov external fixation on treatment of tibial bone defect and the parameter selection of Ilizarov steel ring.
METHODS:We retrospectively analyzed the clinical data of 67 patients with tibial bone defects, who were treated and fol owed up from March 2007 to January 2012. Al patients had fracture of tibia and received one-stage operation. After treatment, postoperative limb suffered from tibia osteomyelitis and soft tissue injury. Ilizarov external fixation was placed in the limb. The length of defected tibia and area of defected soft tissues were compared at 1, 3 and 6 months after external fixation and final fol ow-up. The ankle joint Kofoed score and knee joint ROM score were observed before and after external fixation. In final fol ow-up, functional recovery was evaluated in accordance with diagnosis and treatment criteria of Johner-Wruhs fracture of shaft of tibia.
RESULTS AND CONCLUSION:A total of 67 patients were fol owed up for 6 to 35 months. Bone defects in 67 cases were rebuilt and the fracture was healed, but five cases had poor healing. Among 44 cases of soft tissue injury, wound had healed in 40 cases, and wound had not healed in 4 cases. The length of tibia defect and the area of soft tissue defects were improved at 1, 3, and 6 months after the operation (P<0.05). After operation, the ankle joint Kofoed score and knee joint ROM were significantly better than those before operation (P<0.05). During final fol ow-up, the excellent and good rate of each therapeutic plan was 85%. For the tibial osteomyelitis bone defect with the merged skin defect, the trauma was smal using Ilizarov technique, which can avoid several complicated operations, shorten the time and reduce the expenses of treatment, but there were some weaknesses and limitations. The size and material of Ilizarov external fixation affect the efficiency of the fixation and postfixation adjustment.

Objective To assess the number of peripheral blood Th17 cells and mRNA expressions of IL-17A and IL-23R and their correlations with disease severity in patients with psoriasis vulgaris (PV).Methods Tissue specimens were resected from the lesions of 25 patients with PV and normal skin of 10 human controls,and venous blood samples were obtained from 20 of the patients and all of the normal human controls.Reverse transcription PCR and flow cytometry were carried out to measure the mRNA levels of IL-17A and IL-23R in these tissue specimens and quantify the number of peripheral blood CD4+IL-17+ T lymphocytes.Psoriasis area and severity index (PASI) was calculated for these patients.Results A significant increase was observed in the IL-17A and IL-23R mRNA levels in the patients compared with the controls (0.996 ± 0.231vs.0.437 ± 0.096,t =10.572,P ＜ 0.05; 1.006 ± 0.339 vs.0.491 ± 0.196,t =6.015,P ＜ 0.05).The levels of both IL-17A mRNA and IL-23R mRNA were positively correlated with PASI (r,=0.67,0.70,respectively,both P ＜ 0.05).The number of CD4+IL-1 7+ T lymphocytes in peripheral blood showed no significant differences between the patients and controls.No statistical correlation was observed between the counts of CD4+IL-17+ T lymphocytes and expression levels of IL-17A or IL-23R mRNA in psoriatic lesions.Conclusions In patients with PV,there is an increase in the expressions of IL-17A and IL-23R mRNA in lesions,which are correlated with disease severity,while no significant change is observed in the number of peripheral blood CD4+IL-17+ T cells.

BACKGROUND:The surgical method for the treatment of unstable distal radius fracture mainly includes plate internal fixation and external fixator, but both of these two methods have the advantages and disadvantages. Which treatment is more conducive to the rehabilitation of patients, there is stil controversy.
OBJECTIVE:To evaluate the clinical effectiveness of internal fixation and external fixator for the treatment of unstable distal radius fractures.
METHODS:The relative databases and literatures were searched with the computer and hand to col ect the randomized control ed trials of internal fixation versus external fixator for the treatment of unstable distal radius fractures. After extraction literature data and quality evaluation, RevMan 5.2 software was used for system evaluation. The grip strength, disabilities of arm, shoulder&hand score, complications rates, infection rates, deformity rates and ulnar variance rates were compared between two groups.
RESULTS AND CONCLUSION:A total of 9 literatures, involving total y 524 patients were included, 286 patients in the internal fixation group and 238 patients in the external fixator group. There was no significant difference in grip strength between internal fixation group and the external fixator group. The results of Meta-analysis showed that the internal fixation group was better than the external fixator group in the aspects of disabilities of arm, shoulder&hand score, complications rate, infection rate, deformity rate and ulnar variance rate at 3 months and 1 year after treatment. The results indicate that the plate internal fixation is better than external fixator in the treatment of unstable distal radius fractures, but the large sample, double-blind, and high quality randomized control ed trials are stil needed to identify the results.