The treatment of bone and soft-tissue defects after open fractures remains challenging. This study aimed to evaluate the clinical efficacy of the Masquelet technique combined with the free-flap technique (MFFT) versus the Ilizarov bone transport technique (IBTT) for the treatment of severe composite tibial and soft-tissue defects. We retrospectively analysed the data of 65 patients with tibial and soft-tissue defects and Gustilo type IIIB/C open fractures treated at our hospital between April 2015 and December 2021. The patients were divided into two groups based on the treatment method: group A (n = 35) was treated with the MFFT and internal fixation, and group B (n = 30) was treated with the IBTT. The mean follow-up period was 28 months (range 13-133 months). Complete union of both soft-tissue and bone defects was achieved in all cases. The mean bone-union times were 6 months (range 3-12 months) in group A and 11 months (range 6-23 month) in group B, with a significant difference between the two groups (Z = -4.11, P = 0.001). The mean hospital stay was 28 days (range 14-67 d) in group A which was significantly longer than the mean stay of 18 days (range 10-43 d) in group B (Z = -2.608, P = 0.009). There were no significant differences in the infection rate between group A (17.1 %) and group B (26.7%) (χ² = 0.867, P = 0.352). The Total Physical Health Scores were 81.51 ± 6.86 (range 67-90) in group A and 75.83±16.14 (range 44-98) in group B, with no significant difference between the two groups (t = 1.894, P = 0.063). The Total Mental Health Scores were significantly higher in group A (90.49 ± 6.37; range 78-98) than in group B (84.70 ± 13.72; range 60-98) (t = 2.232, P = 0.029). Compared with IBTT, MFFT is a better choice of treatment for open tibial and soft-tissue defects with Gustilo IIIB/C fractures. IBTT is the preferred option when the tibial bone defect is large or if the surgeon's expertise in microsurgery is limited.

Background: Research on open tibiofibular fractures is limited. We compared clinical outcomes of Gustilo – Anderson type IIIB/C open tibial fractures using orthopedic and orthoplastic approaches, and identified poor prognosis predictors. Materials and Methods: The clinical data of 746 patients with Gustilo – Anderson type IIIB/C open tibial fractures (420 and 326 treated using the orthopedic and orthoplastic approach, respectively) were retrospectively analyzed. We evaluated infection rates, nonunion incidence, arthritis incidence, number of surgeries, fracture healing time, amputation rate, wound closure duration, and Lower Extremity Functional Scale (LEFS) score, and identified risk factors affecting prognosis. Results: Significant differences in infection rates (deep infection, 8.0% vs. 29%; superficial infection, 8.0% vs. 41%; all P <0.001), nonunion incidence (11% vs. 2.5%, P <0.001), arthritis incidence (27% vs. 2.1%, P < 0.001), number of surgeries (4.6 ± 1.07 vs. 10.7 ± 3.33, P < 0.001), and wound coverage time (11.27 ± 5.14 vs. 3.98 ± 1.98, P < 0.001) were observed between the groups. LEFS scores from 3 to 24 months after injury were higher in the orthoplastic group. No difference in fracture healing time was observed (7.0 ± 1.99 vs. 7.0 ± 1.98, P = 0.987). The orthoplastic group required a lower amount of bone graft when using intramedullary nail fixation (6.8 ± 1.42 vs. 19.0 ± 2.88, P < 0.001). Smoking (odds ratio [OR], 0.24 for nonunion; 95% confidence interval [CI], 2.29–5.34; P = 0.008 and OR, 0.26 for deep infection; 95% CI, 0.10–0.71; P = 0.009), bone cement block formation (OR, 1.54; 95% CI, 2.06–4.73; P = 0.007), and local antibiotic use (OR, 4.89; 95% CI, 1.93–12.37; P < 0.001) were predictors of poor prognosis. Conclusion: The orthoplastic approach offers advantages in the treatment of Gustilo – Anderson type IIIB/C open tibial fractures. Smoking should be avoided, bone cement block molding should be actively adopted, and systemic and local antibiotics should be administered as early as possible. The Flap and Open Reduction Internal Fixation and Masquelet technique reduces the amount of bone graft without increasing deep infection risk.

Herein, we show a molecular pathway driven by an evolutionarily conserved microRNA (miRNA) in sensory neurons to control neuropathic pain. By employing high-throughput sequencing analysis, we find that miRNA-323-3p (miR-323-3p) exhibits the most significant upregulation in injured trigeminal ganglia (TGs). Local inhibition of miR-323-3p in injured TGs suppresses established trigeminal neuropathic pain but has no effect on inflammatory pain. Mechanistically, nerve injury upregulates the protein expression of protein arginine methyltransferase 2 (PRMT2), which promotes asymmetric dimethylation of H3R8, thereby facilitating the binding of the transcription factor forkhead box A2 (FOXA2) to the miR-323-3p promoter and resulting in the upregulation of miR-323-3p expression. Furthermore, the increased miR-323-3p expression induces significant reductions in Kv2.1 protein expression and channel currents, resulting in TG neuronal hyperexcitability. Conversely, the downregulation of miR-323-3p in injured TGs restores the decreased Kv2.1 expression and attenuates nerve-injury-induced mechanical hypersensitivity. The PRMT2/FOXA2/miR-323-3p/Kv2.1 signaling axis in sensory neurons may offer therapeutic targets in neuropathic pain management.