Osteonecrosis of the femoral head (ONFH) is a common disabling disease. Copper has positive effects on cells that regulate bone metabolism. However, the relationship between copper metabolism (CM) and steroid-induced ONFH (SONFH) remains unclear. The GSE123568 dataset was downloaded from the Gene Expression Omnibus. The differentially expressed CM-related SONFH genes (DE-CMR-SONFHGs) were identified via differential analysis and weighted gene coexpression network analysis (WGCNA). Receiver operating characteristic (ROC) analysis was performed for the predictive accuracy of key genes. Targeting drugs and the copper death-related genes (CDRGs) relevant to key genes were investigated. The bioinformatics results were confirmed via quantitative real-time polymerase chain reaction (qRT–PCR) and Western blot (WB) analysis. Two out of 106 DE-CMR-SONFHGs were identified as key genes (PNP and SLC2A1), which had diagnostic value in distinguishing SONFH from control samples and were related to various immune cell infiltrations. Eleven PMP-targeting drugs and five SLC2A1-targeting drugs were identified. The qRT–PCR, as well as WB, results confirmed the downregulation PNP and SLC2A1 and high expression of the CDRGs DLD, PDHB, and MTF1, which are closely related to these two key genes. In conclusion, PNP and SLC2A1 were identified as key genes related to SONFH and may provide insights for SONFH treatment.

Objective: To evaluate the treatment outcomes of a four‐corner arthrodesis concentrator of Ni‐Ti memory alloy for carpal collapse. Methods: From August 2006 to November 2009, 13 patients with carpal collapse underwent scaphoid excision and four‐corner (capitate, lunate, triquetrum and hamate) arthrodesis using a four‐corner arthrodesis concentrator of Ni‐Ti memory alloy. The mean follow‐up time was 26.5 months (range, 7–38 months). Various wrist parameters, including the grip strength, range of wrist movements and degree of pain (visual analogue scales) were recorded and compared before and after surgery. Results: The average fusion time was 2.3 months (range, 2–4 months). Neither non‐union nor wound infection was found in any of the patients. By the sixth month postoperatively, the grip strength had reached an average of 32.49 ± 6.21 kg with a range of 22.3–39.7 kg, this being 80.8% of that found on the healthy side. The range of motion reached over 53.0% of that of the healthy side. Preoperatively and at 6 months postoperatively, the mean pain scores were (4.46 ± 1.27) and 1.31 ± 0.95, respectively, when resting (P < 0.05), and 7.00 ± 1.41 and 2.62 ± 1.26, respectively, when weight‐bearing (P < 0.05). The mean value of the Krimmer wrist score was 79.2 (range, 64–84). The rate of excellent and fine results was 84.6% (11/13), being excellent in three cases, good in eight and fair in two. Conclusion: Four‐corner arthrodesis using a four‐corner arthrodesis concentrator of Ni‐Ti memory alloy is an effective method for treating carpal collapse and preserving most wrist function.

Objectives: The present work studied the mechanism of action of Wen-Dan decoction in treating steroid-induced necrosis of the femoral head (SINFH) via network pharmacology and in vivo experiments. Methods: The active compounds of Wen-Dan decoction and SINFH-related target genes were identified through public databases. Based on the results, further network pharmacological analysis was conducted to explore the potential key active compounds, core targets and biological processes of Wen-Dan decoction in SINFH. Subsequently, the potential mechanisms of action of Wen-Dan decoction in the treatment of SINFH obtained by network pharmacology analyses were validated through in vivo experiments. Results: A total of 608 DEGs (230 upregulated and 378 downregulated) in SINFH were identified. A GO functional enrichment analysis revealed that the SINFH-related genes were mainly involved in neutrophil activation and the immune response, and a KEGG pathway analysis showed that the SINFH-related genes were mainly associated with cytokine receptor interactions, lipids and atherosclerosis, and tuberculosis. In addition, a total of 147 active ingredients of Wen-Dan decoction were identified; of these, the core ingredient was quercetin, and licorice was an active ingredient. Moreover, 277 target genes in the treatment of SINFH with Wen-Dan decoction were identified, and NCF1, PTGS2, and RUNX2 were selected as core target genes. A quantitative real-time polymerase chain reaction (qRT–PCR) assay of peripheral blood from SINFH patients and control individuals showed that the patients exhibited highest levels of PGTS2 and NCF1 in blood. The qRT–PCR analysis of peripheral blood and femoral bone tissue from a mouse model of SINFH and control mice treated with quercetin showed that the PGTS2 and NCF1 levels revealed lower levels in the experimental animals compared with the controls, which was consistent with the bioinformatics analysis results. HE staining, immunohistochemistry and TUNEL staining confirmed significant improvement in hormone-induced femoral head necrosis in the mice treated with quercetin. Conclusions: This study provides new insights into the genes and related pathways involved in SINFH and shows that PTGS2 and NCF1 could be used as potential drug targets in SINFH. Quercetin could improve SINFH by promoting osteogenesis and inhibiting apoptosis.