Introduction: The role of open cerclage wiring in comminuted femoral shaft fracture treatment with intramedullary nails remains unclear. Here, we analyzed the effect of open cerclage wiring and the risk factors for nonunion after interlocking nailing in comminuted femoral shaft fracture treatment. We hypothesized that open cerclage wiring can be applied in patients with severe comminuted femoral shaft fractures without affecting bone healing.Patients and methods: This retrospective cohort study used data from consecutive patients who underwent interlocking nail fixation of a comminuted femoral shaft fracture between January 1, 2009, and December 31, 2016. First, eligible patients were divided into the wire and no wire groups according to the surgical technique used, and their union rate was recorded. The patients were then divided into the union and nonunion groups, and their perioperative data were analyzed.Results: In total, 71 comminuted femoral shaft fractures treated with interlocking nail fixation were included: 38 fractures (53.5%) augmented with the open wiring technique and 33 reduced with closed or mini-open techniques without wiring. The wire group demonstrated significant improvements in fracture reduction compared with the no wire group, whereas no significant difference was observed in the union rate between the wire and no wire groups (p= 0.180). Moreover, 46 (65%) of 71 fractures achieved union smoothly, and no significant difference was observed in any perioperative data between the union and nonunion groups.Discussion: Augmentation with open cerclage wiring is indicated for comminuted femoral shaft fractures treated with intramedullary nails, even when the fragments are large or greatly displaced. Thus, open cerclage wiring can be used for fracture treatment without decreasing the union rate.

Ligamentum flavum hypertrophy (LFH) is a major cause of lumbar spinal stenosis (LSS). In hypertrophic ligamentum flavum (LF) cells, oxidative stress activates intracellular signaling and induces the expression of inflammatory and fibrotic markers. This study explored whether healthy and hypertrophic LF cells respond differently to oxidative stress, via examining the levels of phosphorylated p38 (p‐p38), inducible nitric oxide synthase (iNOS), and α‐smooth muscle actin (α‐SMA). Furthermore, the efficacy of N‐acetylcysteine (NAC), an antioxidant, in reversing the fibrogenic and proinflammatory effects of oxidative stress in hypertrophic LF cells was investigated by assessing the expression levels of p‐p38, p‐p65, iNOS, TGF‐β, α‐SMA, vimentin, and collagen I under H₂O₂ treatment with or without NAC. Under oxidative stress, p‐p38 increased significantly in both hypertrophic and healthy LF cells, and iNOS was elevated in only the hypertrophic LF cells. This revealed that oxidative stress negatively affected both hypertrophic and healthy LF cells, with the hypertrophic LF cells exhibiting more active inflammation than did the healthy cells. After H₂O₂ treatment, p‐p38, p‐p65, iNOS, TGF‐β, vimentin, and collagen I increased significantly, and NAC administration reversed the effects of oxidative stress. These results can form the basis of a novel therapeutic treatment for LFH using antioxidants.

Introduction: Geriatric fractures including distal femur and hip fractures are associated with high mortality rates. Currently, prognostic factors for in-hospital postoperative mortality are not identified. We aimed to evaluate overall in-hospital mortality and related potential risk factors in elderly patients who underwent distal femur fracture surgery. Materials and methods: A retrospective cohort study of patients older than 60 years, who underwent distal femur fracture surgery between January 01, 2003, and December 31, 2021, was conducted. A case-control study was conducted to compare two age-matched groups of elderly patients of equivalent ages at a 1:4 ratio. The in-hospital mortality rate was calculated and potential confounders were compared between groups. Results: A total of 170 patients were enrolled; five died during hospital stay after undergoing surgery, yielding a 2.94% in-hospital mortality rate. Twenty patients who did not die were included in the control group. Patients’ demographics were similar. The case-control comparison showed that the time from injury to surgery, preoperative hemoglobin level, estimated glomerular filtration rate (eGFR), and white blood cell count were significant factors correlated with in-hospital mortality. Discussion: The overall in-hospital mortality rate was 2.94%. Significant risk factors for in-hospital mortality included a longer time from injury to surgery, lower preoperative hemoglobin level and eGFR, and higher preoperative white blood cell count. In conclusion, preoperative comprehensive geriatric assessment, including cognitive, nutritional, and frailty status, should also be considered in the elderly fracture care model.

The shoulder is the most mobile joint in the human body, thus requiring intricate coordination of adjacent muscles. Patients suffered from rotator cuff muscle Injuries have several typical symptoms include shoulder pain and difficulty raising the arm, thus reducing work efficiency, and compromising the quality of life. Ultrasound has been used widely for shoulder soft tissue imaging as well as ultrasound elastography was introduced in shoulder examination for the dilemma of treating degenerative rotator cuff tears. However, most of ultrasound examination was performed under a static condition. Providing dynamic information from shoulder muscle are important in clinical applications because the pains sometime come from various positions of shoulder during moving. In this study, a customized wearable T-shaped ultrasound transducer (128+128 elements) was proposed for shoulder dual-direction shear wave elastography (DDSWE) which provides the SWE for both longitudinal (SW along the muscle fiber) and transverse (SW cross the muscle fiber) directions dynamically. An optical tracking system was synchronized with ultrasound imaging system to capture shoulder movements in 3-D space with their corresponding ultrasound images. The performance of DDSWE and the accuracy of optical tracking were verified by phantom experiments. Human studies were carried out from volunteers as they are moving their arms. Experimental results shows that the bias and precision for the proposed DDSWE in elastic phantom were about 6% and 1.2 % for both directions, respectively. A high accuracy of optical tracking was observed using 3-D motor stage experimental setup. Human experiments shows that the shear wave velocities (SWVs) were increased with the angles of shoulder abduction, the average transverse and longitudinal SWVs were increase from 2.24 m/s to 3.35 m/s and 2.95 m/s to 5.95 m/s with abduction angle from 0° to 60°, respectively, which they are anisotropic-dependent. All the experimental results indicates that the proposed wearable ultrasound DDSWE can quantify the mechanical properties of shoulder muscles dynamically, thereby may help surgeons and physical therapists determine whether the intensity of rehabilitation shoulder be tuned down or escalated in the future.