[Research progress of augmentation plate for femoral shaft nonunion after intramedullary nail fixation]

Efficacies and complications of internal fixations with PHILOS plate and intramedullary Multiloc® nails in the surgical treatment of proximal humerus fractures

OBJECTIVE

To compare the efficacies of internal fixations with proximal humeral internal locking system (PHILOS) plate and intramedullary MultiLoc^® nails in the surgical treatment of proximal humerus fractures (PHF).

METHODS

A total of 115 patients with PHF admitted to our hospital were selected as the research subjects, and were randomly divided into PHILOS group (n=57) and MultiLoc group (n=58). PHILOS group was treated with internal fixation with PHILOS plate, while MultiLoc group was treated with internal fixation with intramedullary MultiLoc^® nails.

RESULTS

MultiLoc group was superior to PHILOS group in the surgical duration and amount of intraoperative hemorrhage (P < 0.05). At 1 week after surgery, the visual analogue scale (VAS) scores in MultiLoc group were lower than those in PHILOS group (P < 0.05). After surgery, MultiLoc group had a shorter time of occurrence of bony callus and disappearance of fracture line (P < 0.05) and a lower incidence of complications (0.00% vs. 3.51%) (P > 0.05) compared with PHILOS group. At 6 months after surgery, MultiLoc group had higher abduction and external rotation angles and higher scores of Constant-Murley and American Shoulder and Elbow Surgeons (ASES) than PHILOS group (P < 0.05).

CONCLUSION

The internal fixations with PHILOS plate and intramedullary MultiLoc^® nails are effective in the treatment of PHF. However, the internal fixation with intramedullary MultiLoc^® nails is superior to the internal fixation with PHILOS plate in alleviating pain and expediting the postoperative restoration of joint function.

miRNA-92a-3p regulates osteoblast differentiation in patients with concomitant limb fractures and TBI via IBSP/PI3K-AKT inhibition

Patients who sustain concomitant fractures and traumatic brain injury (TBI) are known to have significantly quicker fracture-healing rates than patients with isolated fractures. The mechanisms underlying this phenomenon have yet to be identified. In the present study, we found that the upregulation of microRNA-92a-3p (miRNA-92a-3p) induced by TBI correlated with a decrease in integrin binding sialoprotein (IBSP) expression in callus formation. In vitro, overexpressing miRNA-92a-3p inhibited IBSP expression and accelerated osteoblast differentiation, whereas silencing of miRNA-92a-3p inhibited osteoblast activity. A decrease in IBSP facilitated osteoblast differentiation via the Phosphatidylinositol 3-kinase/threonine kinase 1 (PI3K/AKT) signaling pathway. Through luciferase assays, we found evidence that IBSP is a miRNA-92a-3p target gene that negatively regulates osteoblast differentiation. Moreover, the present study confirmed that pre-injection of agomiR-92a-3p leads to increased bone formation. Collectively, these results indicate that miRNA-92a-3p overexpression may be a key factor underlying the improved fracture healing observed in TBI patients. Upregulation of miRNA-92a-3p may therefore be a promising therapeutic strategy for promoting fracture healing and preventing nonunion.