Zitao Zhang

Bone nonunion is a major complication in fracture treatment. Despite considerable advancements in fracture care, 5-10% of fractures result in nonunion; This demonstrates the requirement for novel molecules to enhance fracture healing. Brain-derived neurotrophic factor (BDNF) has been increasingly recognized for its role in fracture healing; however, the underlying molecular mechanisms remain unclear. Osteoblast proliferation and migration are critical to this process. The nuclear casein kinase and cyclin-dependent kinase substrate 1 gene (NUCKS1), located on human chromosome 1 at 1q32.1, encodes a 27-kDa nuclear DNA-binding protein, which influences cell proliferation, migration, and apoptosis strongly. Although NUCKS1 is implicated in various diseases, its specific role in fracture healing remains unclear. Here, we explored whether NUCKS1 participates in the BDNF-mediated fracture-healing process. We assessed NUCKS1 expression in MC3T3-E1 cells and callus from closed femoral fracture mice through quantitative reverse transcription polymerase chain reaction and Western blotting. NUCKS1 inhibition in MC3T3-E1 cells in terms of migration and proliferation changes was evaluated through transwell cell migration and Cell Counting Kit-8 assays. Fracture-healing status in mice was assessed through x-ray and micro-CT imaging 2 weeks after fracture. BDNF promoted NUCKS1 expression in both MC3T3-E1 cells and mouse callus tissues. NUCKS1 inhibition reduced MC3T3-E1 cell proliferation and migration and impaired fracture healing in mice. Finally, suppression of TrkB expression reduces both Akt phosphorylation and NUCKS1 expression, and inhibition of Akt phosphorylation reduces NUCKS1 expression. BDNF may enhance NUCKS1 expression through the TrkB-mediated Akt pathway, promoting osteoblast proliferation and migration and facilitating fracture healing.

To explore the effect of intravenous tranexamic acid on postoperative drainage and elbow joint function after traumatic elbow stiffness release. The clinical data of 44 patients with elbow joint stiffness who were treated with release surgery between March 2022 and December 2023 and met the selection criteria were retrospectively analyzed. Among them, 20 patients were given intravenous infusion of 100 mL (1 g/100 mL, once a day) of tranexamic acid solution for 3 consecutive days after surgery (group A), and 24 patients were not treated with tranexamic acid after surgery (group B). There was no significant difference in baseline data such as gender, age, side, body mass index, initial injury, and preoperative hemoglobin, visual analogue scale (VAS) score, and Mayo elbow function score (MEPS), elbow flexion and extension activity between the two groups ( P>0.05). The drainage volume at 1 day and 3 days after operation, total drainage volume, drainage tube indwelling time, postoperative hospital stay, VAS score before operation and at 1, 2, and 3 days after operation, MEPS score before operation, at 3 months after operation, and at last follow-up, and elbow flexion and extension activity before operation and at last follow-up were recorded and compared between the two groups. Both groups of patients successfully completed the operation, and there was no significant difference in operation time ( P>0.05). The drainage volume at 1 day and 3 days after operation, total drainage volume, drainage tube indwelling time, and postoperative hospital stay in group A were significantly less than those in group B ( PPP0.05). At 3 months after operation and at last follow-up, the MEPS scores of both groups significantly improved when compared with those before operation ( P0.05). At last follow-up, the postoperative elbow flexion and extension activity of the two groups significantly increased when compared with that before operation ( P0.05). Intravenous tranexamic acid for 3 consecutive days after release of traumatic elbow stiffness can significantly reduce postoperative drainage volume, shorten drainage tube indwelling time and hospital stay, and relieve early postoperative pain, but it has no effect on the risk of thrombotic and embolic events and postoperative elbow function.

Background: The choice of treatment for scapular fractures is a topic worth discussing. The type of scapular fracture is often complex, and more and more scholars prefer surgical treatment to obtain better shoulder joint function. In addition, because of the rich blood supply and muscles of the scapula, some scholars believe that simple suspension can also achieve satisfactory clinical effects. The aim of this study was to investigate the curative effect and prognostic factors of patients with scapular fracture with indications for surgery after receiving conservative treatment. Methods: Patients with scapular fracture who did not receive surgical treatment from July 2016 to May 2021 were recruited from the orthopedic trauma database of Nanjing Gulou Hospital, and the data from patients with indications for surgery were screened out for a retrospective analysis. The data were obtained from the database of orthopaedic trauma patients in Nanjing Drum Tower Hospital. The relevant data were recorded during telephone and video follow-up visits. Linear regression was used to analyze the factors associated with disabilities of the arm, shoulder and hand (DASH) score after receiving conservative treatment. Results: A total of 21 patients were included in the final statistical analysis. All patients were followed up for 31.0±20.3 (range, 6–63) months, aged 52.9±12.7 (range, 27–71) years. All fractures had clinical healing with a 100% recovery satisfaction rate. Outcome measures of efficacy [both DASH scores and visual analogue scale (VAS) scores], were correlated with whether the fracture involved the superior border of the scapular, were not associated with the following variables: age (P=0.18), Injury Severity Score (ISS) score (P=0.10), the glenopolar angle (GPA) value (P=0.76), superior shoulder suspensory complex (SSSC) injury (P=0.82), and glenoid fracture (P=0.84). The range of motion of the affected shoulder was significantly reduced compared to the healthy shoulder (P0.05). Patients with fractures not involving the superior border of the scapula had a much lower range of motion in the affected shoulder than in the healthy shoulder during abduction (PConclusions: The range of surgical indications for scapular fractures with scapular fractures involving the lower margin of the scapular can be appropriately narrowed. Some patients with scapular fracture who have surgical indications can regain satisfactory shoulder function after receiving conservative treatment.