Unilateral PKP is an effective and safe procedure for patients with OVCF. However, cement volume should be determined in terms of the vertebral body fraction to obtain a favorable outcome. The risk of AVF and cement leakage will increase obviously with the cement volume fraction increased. We recommend that a bone cement volume fraction of about one fourth is suitable for unilateral PKP.

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Autophagy, which is a mechanism for the turnover of intracellular molecules and organelles, protects cells during stress responses; however, the role of autophagy in the stages of bone fracture remains to be elucidated. The aim of the present study was to investigate the process of autophagy in bone tissue at different time-points after fracture. A femur fracture model was established in male adult Wistar rats via surgery. The protein expression of microtubule-associated protein II light chain 3 (LC3-II) was analyzed in a femur fracture (experimental) group and a sham-surgery group using immunofluorescence. The protein expression of proliferating cell nuclear antigen (PCNA) was used to investigate the cell proliferation in bone tissue following fracture via immunohistochemical analysis. The correlation between cell proliferation and autophagy was analyzed using linear regression. LC3-II protein was constitutively expressed in the sham-surgery group; however, compared with the expression in the sham-surgery group, the LC3-II expression in the experimental group was significantly increased at each time-point (P<0.05). Similarly, immunohistochemistry revealed that the number of PCNA-positive cells in each section was significantly increased following fracture injury (P<0.01). A comparison of the LC3-II- and PCNA-positive rates in the experimental group rats at each time-point revealed a linear correlation (R2=0.43, P<0.01). In conclusion, surgically induced fracture in rats is associated with an increase in LC3-II and PCNA protein expression during the initial stages of fracture injury, and a correlation exists between the expression of the two proteins. These results suggest that potential treatment aimed at improving fracture healing should target the process of autophagy.

Prospective cohort study. To evaluate whether failure of the fracture fragment at the anterior column reduction in thoracolumbar fracture has an influence on the final radiologic and clinical outcomes.Cervical teardrop fracture has caused wide concern in spinal surgery field. Although similar fracture fragment at the anterior column was also observed in thoracolumbar burst fractures, the conception of teardrop fracture in thoracolumbar fractures was rarely mentioned in the literature, let alone a study.Fifty patients who suffered from thoracolumbar burst fractures with a fracture fragment at the anterior column were prospectively analyzed. Twenty-seven patients in whom the fragments were reduced by posterior surgery, verified by postoperative X-ray or CT, were included in the reduced group, and 23 patients were included in the nonreduced group. Radiologic and clinical outcomes of both groups were compared after over 2 years follow-up.There was no significant difference regarding to Cobb angle, Oswestry Disability Index (ODI) score, and disc grade between the 2 groups preoperatively. At final follow-up, the mean angle of kyphosis was 13.91° ± 3.47° in the nonreduced group and 8.42° ± 2.07° in the reduced groups (P < 0.01). All fractures consolidated in the reduced group, but the nonreduced group revealed 3 cases with nonunion. Besides, the average Pfirrmann grade of degenerative disc adjacent to the fractured vertebral was 2.87 ± 1.18 in the nonreduced group, higher than 1.81 ± 0.62 in the reduced group (P < 0.01). The ODI score in the nonreduced group was 0.54 ± 0.13 and 0.36 ± 0.12 in the reduced group (P < 0.01).In the present study, failure reduction of the fracture fragment at the anterior column could result in poor radiologic and clinical outcomes of the thoracolumbar burst fractures treated with posterior surgery. Therefore, we recommend the surgeon should pay more attention to reducing the fracture fragment at the anterior column.