Hypoxic pulmonary hypertension (HPH) is a common complication in patients with chronic obstructive pulmonary disease (COPD), sleep-disordered breathing, or dwellers in high altitude. The exact mechanisms underlying the development of HPH still remain unclear. Reactive oxygen species (ROS), hypoxia inducible factors (HIF), and potassium channels (K) are believed as the main factors during the development of HPH. We propose that the "ROS/Kv/HIF axis" may play an important initiating role in the development of HPH. Being formed under a hypoxic condition, ROS affects the expression and function of HIFs or K, and consequently triggers multiple downstream signaling pathways and genes expression that participate in promoting pulmonary vasoconstriction and arterial remodeling. Thus, further study determining the initiating role of "ROS/Kv/HIF axis" in the development of HPH could provide theoretic evidences to better understand the underlying mechanisms of HPH, and help identify new potential targets in the treatment of HPH.

OBJECTIVETo investigate the clinical effects of manipulative reduction and percutaneous locking compression plate internal fixation for the treatment of mid-distal tibiofibula shaft fractures.

METHODSFrom January 2006 to October 2009,46 patients suffering from mid-distal tibiofibula shaft fractures were treated with closed manipulative reduction and LCP, involved 27 males and 19 females with an average age of 39 years old ranging from 17 to 56 years. According to AO classification, there were 12 cases of type A, 24 of type B, 10 of type C. The duration of visiting hospital were from 2 hours to 3 days after being injured for these patients. The injured limbs of the patients were swollen and painful,even with bony crepitus. The wound, function of the injured limb and union of fractures were observed after operation.

RESULTSAll the patients were followed up from 12 to 18 months (averaged 15 months). It was found that the wound of all patients had primary healing without any infection. The fracture healing time was 12 to 18 weeks (means 14 weeks). The results were excellent in 40 cases,good in 4 and fair in 2.

CONCLUSIONLess invasive, more stable fixation, shorter healing time and better functional rehabilitation are observed in the treatment of mid-distal tibiofibula shaft fractures after manipulative reduction and percutaneous locking compression plate internal fixation.

Adolescent ; Adult ; Aged ; Bone Plates ; Female ; Fibula ; diagnostic imaging ; injuries ; surgery ; Fracture Fixation, Internal ; instrumentation ; Fractures, Bone ; diagnostic imaging ; surgery ; therapy ; Humans ; Male ; Middle Aged ; Musculoskeletal Manipulations ; methods ; Tibia ; diagnostic imaging ; injuries ; surgery ; Tomography, X-Ray Computed ; Young Adult