BACKGROUND:Ankle fracture combined with deltoid ligament injury can disorders the anatomical structure of ankle joint. Improper treatment can cause more serious complication, such as walking disorders.
OBJECTIVE:To evaluate the clinical effect of anchor repair plus open reduction internal fixation in the treatment of ankle fracture combined with deltoid ligament injury.
METHODS:Thirty-five patients with ankle fracture combined with deltoid ligament injury were selected from the Department of Orthopedics, the Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University between May 2009 and January 2011, including 24 males and 11 females, and al the patients were treated with anchor repair plus open reduction internal fixation. The age of the patients was 22-61 years, averaged 35.7 years, and al the patients were closed injury without other fractures. The treatment time was 2-10 days, average 4.6 days. According to Lauge-Hansen classification, 26 patients had supination-eversion ankle fracture and nine patients had pronation-eversion. According to Danis-Weber classification, 26 patients were C type and nine patients were B type. After al the three patients were treated with anchor repair, the treatment effect of anchor repair was evaluated through assessing the improvement of clinical symptoms and signs, as wel as the imaging examination of repair and healing.
RESULTS AND CONCLUSION:Al the 35 patients were fol owed-up for 9-26 months, average 13.8 months. Al the patients got Ⅰ stage healing without complications of infection and screw loosening. Fol ow-up X-ray film showed al the 35 patients with ankle fracture achieved bone union, the healing time was 10-21 weeks, average 13.6 weeks. Modified Baird-Jackson score system showed excel ent in 11 cases, good in nine cases, average in four cases, poor in one case, and the excel ent and good rate was 85.7%. At 6 months after internal fixation, the stress X-ray film examination showed the mal eolus gap of the affect side was (3.49±0.36) mm, the mal eolus gap of the healthy side was (3.37±0.41) mm, and there was no significant difference (P>0.05). The results indicate anchor in the repair of deltoid ligament injury during the treatment of ankle fracture with open reduction internal fixation can achieve satisfactory therapeutic effect.

Objective To evaluate the clinical outcomes of split fractures of humeral greater tuberosity treated by our self-designed new type of anatomical locking plate.Methods From September 2012 to February 2017,23 patients were treated for acute split fracture of the humeral greater tuberosity using our self-designed new type of anatomical locking plate.They were 13 males and 10 females with a mean age of 52.8 years (range,from 25 to 81 years).Of them,6 were beyond 60 years old, 12 had comminuted fracture,10 were complicated with glenohumeral dislocation,and 12 with rotator cuff tear.The patients were evaluated clinically with Constant-Murley score,visual analog scale (VAS),range of motion and complications at the last follow-ups.Results This series were followed up for 12 to 30 months (mean,23.2 months).All the fractures healed after an average time of 10.6 weeks (range,from 8 to 12 weeks).Their mean Constant-Murley Score was 92.1 points (range,from 70 to 100 points),giving an excellent and good rate of 95.7％ (22/23);their VAS scores averaged 0.8 points (range,from 0 to 4 points).Their forward flexion averaged 160.6°,abduction 157.8°,external rotation 46.4°,and internal rotation up to the T11 level,respectively.Their complications rate was 17.4％ (4/23).One case of axillary nerve injury,one case of relapse of glenohumeral dislocation at sports,and 2 cases of stiff shoulder were observed.Conclusion Split fractures of the humeral greater tuberosity can be successfully treated with our new type of anatomical locking plate which serves as a new alternative treatment.

The incidence of fragility fractures of the pelvis (FFP) in elderly patients has been gradually increased. FFP has become another type of injury that threatens the lives of elderly patients because of high disability rate and mortality. The special physical condition of the elderly patients such as osteoporosis, chronic medical diseases and disability determines the specialty in diagnosis and treatment of FFP. The perioperative treatment is more difficult than other patients. FFP in elderly patients is different from the high violent mechanism of pelvis fractures in young patients, and its fracture morphology and classification are also varied. Surgical treatment is to stabilize the mechanical transmission structure of the pelvic ring, improve clinical symptoms, reduce long-term bed-related complications and restore painless daily self-care. In recent years, the surgical treatment of the pelvic fractures has made significant progress. However, there still remains controversy in treating FFP in elderly patients. The authors discuss the perioperative hot issues on FFP in elderly patients, hoping to realize the standard management of FFP.

Benign prostatic hyperplasia(BPH)is one of the major chronic complications of type 2 diabetes mellitus(T2DM),and sex steroid hormones are common risk factors for the occurrence of T2DM and BPH.The profiles of sex steroid hormones are simultaneously quantified by LC-MS/MS in the clinical serum of patients,including simple BPH patients,newly diagnosed T2DM patients,T2DM complicated with BPH patients and matched healthy individuals.The G protein-coupled estrogen receptor(GPER)inhibitor G15,GPER knockdown lentivirus,the YAP1 inhibitor verteporfin,YAP1 knockdown/overexpression lentivirus,targeted metabolomics analysis,and Co-IP assays are used to investigate the molecular mechanisms of the disrupted sex steroid hormones homeostasis in the pathological process of T2DM complicated with BPH.The homeostasis of sex steroid hormone is disrupted in the serum of patients,accompanying with the proliferated prostatic epithelial cells(PECs).The sex steroid hormone metabolic profiles of T2DM patients complicated with BPH have the greatest degrees of separation from those of healthy individuals.Elevated 17β-estradiol(E2)is the key contributor to the disrupted sex steroid hormone homeostasis,and is significantly positively related to the clinical characteristics of T2DM patients complicated with BPH.Activating GPER by E2 via Hippo-YAP1 signaling exacerbates high glucose(HG)-induced PECs prolifer-ation through the formation of the YAP1-TEAD4 heterodimer.Knockdown or inhibition of GPER-mediated Hippo-YAP1 signaling suppresses PECs proliferation in HG and E2 co-treated BPH-1 cells.The anti-proliferative effects of verteporfin,an inhibitor of YAP1,are blocked by YAP1 overexpression in HG and E2 co-treated BPH-1 cells.Inactivating E2/GPER/Hippo/YAP1 signaling may be effective at delaying the progression of T2DM complicated with BPH by inhibiting PECs proliferation.