Objective To compare the smile incision combined with indirect reduction technique with traditional ORIF technique and systematically evaluate the advantages of this innovative surgical method in terms of functional recovery and postoperative cosmetic effects.Methods A total of 60 patients with midshaft clavicle fractures were enrolled between October 2022 and August 2024.The patients were randomly assigned to either ORIF group(open reduction and internal fixation,n=30)or MIPPO group(MIPPO combined with smile incision,n=30).Outcomes assessed included surgical trauma,functional recovery,and cosmetic outcomes.Results The MIPPO group exhibited significantly reduced intraoperative blood loss[(32.9±7.6)mL vs.(90.2±14.0)mL,P＜0.05],shorter incision length[(3.0±0.5)cm vs.(8.5±1.2)cm,P＜0.05],and reduced operative time compared to the ORIF group.Functional recovery indicators such as bone healing time[(10.1±1.7)weeks vs.(12.8±2.0)weeks,P＜0.05],initial and complete self-care time,and weight-bearing recovery were all significantly improved in the MIPPO group.The Constant-Murley score was higher in the MIPPO group(91.5±5.1 vs.82.4±6.0,P＜0.05).Cosmetic outcomes also favored the MIPPO group,with a superior SBSES score(9.2±0.4 vs.3.0±0.7,P＜0.05)and better results in scar visibility,pigmentation,thickness,and elasticity.Conclusion The smile incision combined with indirect reduction technique significantly reduces surgical trauma,accelerates postoperative recovery,and provides substantially better cosmetic outcomes compared to conventional methods,making it particularly suitable for patients with high aesthetic expectations.

Objective To compare the smile incision combined with indirect reduction technique with traditional ORIF technique and systematically evaluate the advantages of this innovative surgical method in terms of functional recovery and postoperative cosmetic effects.Methods A total of 60 patients with midshaft clavicle fractures were enrolled between October 2022 and August 2024.The patients were randomly assigned to either ORIF group(open reduction and internal fixation,n=30)or MIPPO group(MIPPO combined with smile incision,n=30).Outcomes assessed included surgical trauma,functional recovery,and cosmetic outcomes.Results The MIPPO group exhibited significantly reduced intraoperative blood loss[(32.9±7.6)mL vs.(90.2±14.0)mL,P＜0.05],shorter incision length[(3.0±0.5)cm vs.(8.5±1.2)cm,P＜0.05],and reduced operative time compared to the ORIF group.Functional recovery indicators such as bone healing time[(10.1±1.7)weeks vs.(12.8±2.0)weeks,P＜0.05],initial and complete self-care time,and weight-bearing recovery were all significantly improved in the MIPPO group.The Constant-Murley score was higher in the MIPPO group(91.5±5.1 vs.82.4±6.0,P＜0.05).Cosmetic outcomes also favored the MIPPO group,with a superior SBSES score(9.2±0.4 vs.3.0±0.7,P＜0.05)and better results in scar visibility,pigmentation,thickness,and elasticity.Conclusion The smile incision combined with indirect reduction technique significantly reduces surgical trauma,accelerates postoperative recovery,and provides substantially better cosmetic outcomes compared to conventional methods,making it particularly suitable for patients with high aesthetic expectations.

Objective To investigate the regulatory effects of glucocorticoids on the local renin-angiotensin system in osteoblasts by using MC3T3-E1 cells.Methods Cellular immune histochemistry was carried out to observe the renin-angiotensin system in osteoblasts.And then after 12-hour culture in serum-free solution,MC3T3-E1 cells were divided into four groups:control,dexamethasone (DXM),dexamethasone + mifepristone (DXM+MIF)and mifepristone (MIF).Components of the renin-angiotensin system including angiotensin type 1 receptor (AT1R),angiotensin type 2 receptor (AT2R)and angiotensin converting enzyme (ACE)in osteoblasts were detected at the mRNA and protein levels using Western blot and PCR.The activity of ACE was also measured after 36-hour intervention.Results The results of immunohistochemistry showed that AT1R,AT2R and ACE were all expressed in osteoblasts.The activity of ACE increased obviously after dexamethasone intervention compared with that in the control group,which was blocked by mifepristone.The mRNA levels of AT1R,AT2R and ACE were increased by dexamethasone compared with those in the control group,which was inhibited by mifepristone.The protein levels of AT1R,AT2R and ACE were enhanced by dexamethasone compared with those in the control group, which was blocked when the cells were co-intervened with mifepristone.However,ACE activity and the mRNA and protein levels of AT1R,AT2R and ACE did not change when the cells were intervened with mifepristone alone (P>0.05).Conclusion The local renin-angiotensin system in osteoblasts is activated by dexamethasone through glucocorticoid receptors on osteoblasts,which may be one of the pathogenesis of glucocorticoid-induced osteoporosis.