Objective: To investigate the effectiveness of ulnar shortening osteotomy combined with elastic suspension fixation for ulnar impaction syndrome caused by relatively long ulna. Methods: Between October 2015 and August 2016, 3 cases of ulnar impaction syndrome were treated. One patient was male and 2 patients were females. The age was 32, 29, and 59 years, respectively. One patient was dislocation and impaction of distal radioulnar joint for more than 1 year after internal fixation due to ulnar and radial open fractures. Other patients had no trauma and surgery, but long-term manual history. The visual analogue scale (VAS) scores were 7, 5, and 5, respectively. Cooney wrist function scores were rated as poor. Preoperative X-ray measurements of the ulnar variance was 12.7, 9.0, and 8.7 mm, respectively. The ulna was transversely osteotomy and fixed with plate and screws. The distal radioulnar joint was elastic suspension fixed with mini plate. Results: Postoperative X-ray film showed that the matching of the distal radioulnar joint had no significant difference compared with the contralateral side. All the incisions healed by first intention without complication such as neurovascular injury, infection, and dislocation of the distal radioulnar joint. The patients were followed up 27, 17, and 23 months, respectively. At last follow-up, X-ray film showed that all osteotomy segments achieved bony union without internal fixation failure. The VAS scores were 2, 0, and 1, respectively, and the Cooney wrist function scores were rated as excellent. Conclusion: The ulnar shortening osteotomy combined with elastic suspension fixation can correct the ulna variation, avoid the instability of the distal radioulnar joint caused by the extensive dissection of the tissue around the ulnar, and avoid stiffness of the joints caused by rigid fixation. It is an ideal treatment for ulna impaction syndrome.

Objective To evaluate the clinical outcomes of locking plate combined with allogenic fibular intramedullary support in the elderly patients with varus proximal humeral fracture.Methods From May 2015 to July 2017,21 elderly patients with varus proximal humeral fracture were treated with locking plate combined with allogenic fibular intramedullary support at Department of Orthopaedics,The Second Clinical Medical College,Guangzhou University of Traditional Chinese Medicine.They were 6 men and 15 women,from 65 to 90 years of age (average,74.8 years).According to the Neer classification,2-part fracture was identified in 2 patients,3-part fracture in 14 and 4-part fracture in 5.Their operation time,amount of intraoperative bleeding,postoperative complications and functional scores at the last follow-up were recorded.The humeral neck angles and humeral head heights were compared between preoperation,postoperation and the last follow-up.Results Their operation time averaged 89.5 minutes (from 70 to 110 minutes) and intraoperative bleeding 179.5 mL (from 160 to 400 mL).They obtained follow-up from 12 to 26 months (average,18.1months).All the wounds were healed by the first intention.No such complications occurred as neurovascular lesion,shoulder dislocation or humeral head necrosis.However,screw cut-out was observed in one case.According to the Neer's scoring system,shoulder function was evaluated at the last follow-up as excellent in 3cases,as good in 15 and as fair in 3,giving a good to excellent rate of 85.7％.The humeral neck angle after operation was 136.4° ± 5.8°,significantly larger than the preoperative one (106.0° ± 7.3°) (P ＜0.05) but insignificantly different from the value at the last follow-up (135.4° ±6.5°) (P ＞ 0.05).The postoperative distance between the plate top and the humeral head top was 1.6± 0.2 mm,insignificantly different from that at the last follow-up (1.5 ± 0.2 mm) (P ＞ 0.05).Conclusion Locking plate combined with allogenic fibular intramedullary support can effectively reconstruct the medial proximal column of the humerus,restore the humeral neck angle,facilitate intraoperative fracture reposition and reduce operation time,leading to good functional recovery of the shoulder and prevention of related complications.

Posterior tibial slope (PTS) is used to describe the sagittal alignment of the tibial plateau of the knee. As its values indicate the steepness or gentleness of the tibial platform, it is an important basis for knee surgery, such as total knee replacement (TKA), anterior cruciate ligament/posterior cruciate ligament reconstruction (RACL/RPCL) and tibia high-level osteotomy (HTO), and affects the indication and efficacy of knee surgery. Since there has been no consensus description of PTS at present in clinical practice in China, this paper intends to discuss PTS from perspectives of epidemiology, measurement, its influence on knee joint activity, relationship between subchondral bone and knee ligament, and its significance in various knee joint operations. This review hopes to contribute to the knee surgery after the surgeons have a comprehensive understanding of the clinical significance and applications of PTS.

As an important enzyme for gluconeogenesis, mitochondrial phosphoenolpyruvate carboxykinase (PCK2) has further complex functions beyond regulation of glucose metabolism. Here, we report that conditional knockout of Pck2 in osteoblasts results in a pathological phenotype manifested as craniofacial malformation, long bone loss, and marrow adipocyte accumulation. Ablation of Pck2 alters the metabolic pathways of developing bone, particularly fatty acid metabolism. However, metformin treatment can mitigate skeletal dysplasia of embryonic and postnatal heterozygous knockout mice, at least partly via the AMPK signaling pathway. Collectively, these data illustrate that PCK2 is pivotal for bone development and metabolic homeostasis, and suggest that regulation of metformin-mediated signaling could provide a novel and practical strategy for treating metabolic skeletal dysfunction.
Mice ; Animals ; Metformin/pharmacology* ; Phosphoenolpyruvate Carboxykinase (ATP)/metabolism* ; Gluconeogenesis/genetics* ; Mice, Knockout