Purpose The aim of this study was to compare the results of a new technique for low, multidirectional locked nailing with closed reduction and minimally invasive plating in the treatment of distal tibial metadiaphyseal fractures. Methods Forty-six matched patients were divided according to age, gender, Injury Severity Score, and fracture pattern into group A (expert tibial nailing) and group B (minimally invasive plating). Then, the patients were followed up, and the clinical and radiographic results were retrospectively analysed.

BackgroundThis study was to compare clinical and radiographic outcomes with three different implants and evaluate the effectiveness of minimally invasive plate osteosynthesis (MIPO) technique for the distal fibular fractures.MethodsWe performed a retrospective cohort single-surgical team single-facility study between 2000 and 2011. 147 patients receiving surgical interventions for closed, displaced distal fibular fractures were included. Based on the different implants, patients were divided into three groups: Group A: one-third tubular plate; Group B: locking compression (LCP) metaphyseal plate; Group C: LCP distal fibula plate. Clinical and radiographic outcomes were compared among the three groups.ResultsTotally, we found that patients in Group C had significant higher functional scores than those in Group A (p1 = 0.004; p2 = 0.002) (p1 stands for the p value for Olerud & Molandar Score, p2 stands for the p value for American Orthopaedic Foot & Ankle Society score). The healing time was significant less in Group C than that in Group A (p < 0.0001) and Group B (p < 0.0001). Subgroup analysis showed that: (1) For Weber A fracture, the functional scores of the Group C were higher than those in Group A (p1 = 0.020; p2 = 0.029) and B (p1 = 0.020; p2 = 0.034). (2) For Weber B fracture, the functional scores of the Group B (p1 = 0.033; p2 = 0.030) and C (p1 = 0.027; p2 = 0.017) were higher than those in Group A. No significant differences were observed in terms of the ankle range of motion, reduction accuracy and complication rate.ConclusionsOur study demonstrated using LCP metaphyseal plate in patients associated with lateral malleolar fracture could achieve significantly better OMS & AOFAS scores and less healing time than using one-third tubular plate. Specifically, For Weber A fracture, LCP distal fibula plate is much better than one-third tubular plate and LCP metaphyseal plate. While for Weber B fracture, LCP distal fibula plate and LCP metaphyseal plate are better than one-third tubular plate. As to the complications, using MIPO technique in patients with distal fibular fractures is at least comparable to the traditional one.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-360) contains supplementary material, which is available to authorized users.

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Background: Closed reduction and percutaneous pinning (CRPP) is a promising treatment for pediatric lateral condyle humerus fractures (LCHFs) displaced > 4 mm. However, few studies discussed roles of fracture types on success of CRPP in LCHFs. This study aimed to analyze the impacts of types of LCHFs displaced > 4 mm on the success rate of CRPP. Methods: We retrospectively reviewed 66 consecutive pediatric LCHFs attempted CRPP at our center. Song, Milch, Jakob, and Weiss classification were used to classify LCHFs. The fracture gap ≤ 2 mm and step of articular surface ≤ 2 mm were deemed as a successful CRPP. Otherwise, open reduction and internal fixation (ORIF) would be performed. Different fracture types and preoperative displacement were analyzed for their roles on success rate of CRPP in treating LCHFs displaced > 4 mm. Results: Fifty patients met the inclusion criteria were finally included in this study. Results showed that Milch type II LCHFs had a higher success rate of CRPP than type I LCHFs (P = 0.03, <0.05). Correlation was found between Milch types and success rate of CRPP displaced > 4 mm. No difference was found between Song stage 4 and 5 LCHFs displaced > 4 mm in success rate of CRPP (P = 0.90, > 0.05), also no difference was found in preoperative displacement between CRPP group and ORIF group. Conclusions: Milch classification is more important than Song classification in the success rate of CRPP when treating LCHFs displaced > 4 mm. Milch type II LCHFs are recommended to be treated with CRPP, while Milch type I LCHFs are recommended to be treated with ORIF. The current study confirm Song's initial report that closed reduction can be successful and should be attempted for fractures with such displacement rather than going directly to ORIF. Level of Evidence: Level III.

Aim. Antibiotic abuse contributes to the emergence of methicillin-resistant Staphylococcus aureus (MRSA). It is increasingly important to screen new antimicrobial agents for the management of MRSA infections. G. chinensis, a nontoxic Chinese herbal medicine, is considered a potential antibacterial agent. The aim of this study was to investigate the bactericidal effects of the aqueous extracts of G. chinensis on MRSA. The potential mechanisms of G. chinensis aqueous extract inhibition of the pathogenicity of MRSA in vivo are also discussed. Methods. G. chinensis aqueous extract was prepared and its antimicrobial activities were examined by determining its minimum inhibitory concentration (MIC). Biofilm biomass was determined by scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). RNA sequencing (RNA-seq) was used to evaluate differentially expressed functional pathways in MRSA treated with G. chinensis aqueous extract. We validated the role of G. chinensis aqueous extract in the invasive ability and pathogenicity of MRSA in vivo using a rat infectious model. Results. The results indicated that MRSA was sensitive to the G. chinensis aqueous extracts at concentration of 31.25μg/mL. G. chinensis extract led to a reduction in dextran-dependent aggregation and biofilm formation in MRSA. Based on the transcriptome analysis, G. chinensis aqueous extracts significantly downregulated the gene expression related to biofilm formation and carbohydrate metabolism. G. chinensis aqueous extract inhibited the invasive ability and the pathogenicity of MRSA in vivo. Conclusion. The antimicrobial properties of G. chinensis aqueous extract are likely related to its modulation of MRSA biofilm formation and carbohydrate metabolism. G. chinensis aqueous extract is a promising supplementary therapy to lessen or eliminate the use of antibiotics and is a potential tool for the management of MRSA infections.