Shenghe Liu

Purpose: Segmental tibial diaphyseal bone defects after open fracture are difficult to treat and require timely, coordinated reconstruction. We aimed to develop evidence-based surgical guidelines based on meta-analysis and consensus recommendations from an expert committee of orthopedic surgeons. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, we searched 5 databases (1989 to 2024) for studies evaluating surgical treatment of post-traumatic tibial diaphyseal segmental defects. Random-effects models pooled union rate, union time, and complication rate across 4 techniques (Ilizarov bone transport [IBT], free vascularized bone grafting [FVBG], nonvascularized autografting [AG], and the Masquelet technique [MT]). Consensus recommendations were developed using a Delphi process. Results: Twenty-eight studies, including 824 patients (824 tibias) were analyzed: IBT (11 studies; n=361), FVBG (4; n=68), AG (10; n=164), and MT (6; n=67). Pooled union rates were 96% (IBT), 95% (FVBG), 95% (AG), and 81% (MT). Mean pooled union times were 33.04 weeks (IBT), 37.81 (FVBG), 29.73 (AG), and 29.74 (MT). Pooled complication rates were 82% (IBT), 94% (FVBG), 44% (AG), and 53% (MT). Conclusion: On the basis of the evidence and expert consensus, early operative management with prompt stabilization and antimicrobial therapy, supported by multidisciplinary care, is recommended. For large or complex defects, IBT and FVBG are generally preferred, while AG and MT remain options in selected scenarios. Outcomes depend on early intervention, appropriate technique selection, and structured rehabilitation; further high-quality studies are needed to validate these recommendations.

Introduction: Tendon injuries are prevalent musculoskeletal conditions in clinical settings, affecting various regions such as the rotator cuff tendons, forearm flexor/extensor tendons, finger flexor tendons, and Achilles tendon. While surgery is an effective treatment, it often fails to balance intrinsic and extrinsic healing processes, leading to abnormal cell activation, proliferation, and migration, resulting in collagen deposition at the injury site. This pathological fibrosis causes severe peritendinous adhesions, posing a therapeutic challenge. Traditional nonsteroidal anti-inflammatory drugs (NSAIDs) and implantable membranes have limited long-term efficacy and come with various side effects. Literature indicates that Aloe emodin(AE) can potentially inhibit multiple known pro-inflammatory pathways, including NF-κB, MAPK, p38, and ERK, directly or indirectly reducing oxidative stress. In the field of fibrosis, Aloe emodin regulates the TGFβ/Smad signaling pathway, downregulates extracellular matrix gene transcription, inhibits collagen deposition, improves cardiac function and myocardial fibrosis. Based on these findings, we hypothesize that Aloe emodin may serve as an effective therapeutic agent for improving peritendinous adhesions. Methods: This study involved grafting Aloe emodin onto polylactic acid via esterification to create a polylactic acid ‐ Aloe emodin conjugate compound. Using electrospinning technology, a novel polylactic acid-Aloe emodin conjugate electrospun nanofiber membrane (PCA) was developed and characterized, and its role in preventing peritendinous adhesions was thoroughly validated. We validated and systematically evaluated the anti-adhesive capability of the new electrospun membrane through in vitro and in vivo experiments in rats. Results: Experimental results demonstrate that the electrospun membrane of polylactic acid-Aloe emodin grafted material exhibits excellent mechanical properties and hydrophilicity, and can achieve localized targeted release of damaged tissues after treatment with lipase. Compared with polylactic acid-Aloe emodin hybrid electrospun membrane (PBA), PCA exhibits superior anti-adhesion properties and maintains longer-lasting therapeutic effects. In vitro studies showed that PCA effectively reduced fibroblast activity, inhibiting their proliferation, adhesion, and PA formation. In vivo experiments confirmed that PCA could effectively wrap around surgically treated tendons and inhibit the TGFβ1/COLIII signaling pathway, significantly reducing peritendinous adhesions in rats, offering a new approach for PA treatment. Discussion: In this study, we designed and manufactured a novel polylactic acid - Aloe emodin conjugate electrospun nanofiber membrane. We validated and systematically evaluated the anti-adhesive capability of the new electrospun membrane through in vitro and in vivo experiments in rats. In summary, our research proposed a new approach for the treatment of tendon adhesions.

Background/Objectives: Pain-induced vasoconstriction and thrombosis cause vascular insufficiency, a major etiology of early necrosis in replanted digits. While systemic intravenous analgesia (SIVA) carries significant side effects, continuous brachial plexus block (CBPB) provides analgesia with vasodilation. Amidst uncertainties regarding distal vascular recanalization and sympathetic denervation, whether CBPB’s hemodynamic effects translate into improved perfusion and outcomes in replanted digits remains unknown. This randomized controlled trial compared the effects of CBPB versus SIVA on digit perfusion, vascular insufficiency, and survival rates post-replantation. Methods: After screening 113 patients, 55 patients (71 digits) were ultimately randomized and analyzed: the CBPB group (n = 27, 36 digits) received 0.2% ropivacaine infusion at 5 mL/h; the SIVA group (n = 28, 35 digits) received intravenous parecoxib 20 mg twice daily with supplemental tramadol for visual analog scale (VAS) scores > 3. The primary outcome was digital skin temperature trajectory measured at 0, 12, 24, 36, and 48 h postoperatively. Secondary outcomes included Doppler-quantified combined volumetric flow rate of the radial and ulnar arteries (RA-UA VFR) at identical timepoints, VAS scores, vascular insufficiency incidence, and 7-day digit survival. Results: CBPB significantly enhanced perfusion in replanted digits at all postoperative timepoints, with digital skin temperature peaking at 48 h (32 ± 1.6 °C vs. 31 ± 1.1 °C; p < 0.001) and RA-UA VFR peaking at 24 h (4.0 ± 0.83 vs. 1.8 ± 0.51 mL/s; p < 0.001) versus SIVA. Concurrently, CBPB provided superior analgesia (VAS 0.52 ± 0.51 vs. 1.9 ± 1.0; p < 0.001) and significantly reduced 48-h vascular insufficiency incidence (8.3% vs. 29%; p = 0.028). No significant difference was observed in seven-day survival rates between groups (97% vs. 91%; p = 0.329). Conclusions: CBPB significantly enhanced perfusion in replanted digits and reduced the incidence of vascular insufficiency, despite not conferring additional survival benefits.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Celecoxib-Loaded Electrospun Fibrous Antiadhesion Membranes Reduce COX-2/PGE₂ Induced Inflammation and Epidural Fibrosis in a Rat Failed Back Surgery Syndrome Model: To date, failed back surgery syndrome (FBSS) remains a therapy-refractory clinical condition after spinal surgery. The antiadhesion membrane is applied to prevent FBSS by isolating fibrosis; however, the inflammation stimulated by the foreign body and surgical trauma needs to be further resolved simultaneously. Therefore, we developed new electrospun polycaprolactone (PCL) fibrous membranes loaded with celecoxib (CEL) to prevent fibrosis and inflammation associated with FBSS. The CEL-loaded PCL fibers were randomly distributed, and the drug was released over two weeks. Fluorescence micrographs revealed that the fibroblasts proliferated less on the PCL-CEL fibrous membranes than in the PCL group and the blank control. In the rat laminectomy model after 4 weeks, magnetic resonance imaging of epidural fibrosis was least in the PCL-CEL group. Expression of COX-2 and PGE₂ was lower in the PCL-CEL group. It concluded that the CEL-loaded PCL membrane could reduce fibrosis and inflammation in a rat model of FBSS via COX-2/PGE₂ signaling pathways.