Hybrid Russe Procedure for Scaphoid Waist Fracture Nonunion With Deformity

Purpose To assess the results of a hybrid Russe procedure using a corticocancellous strut, cancellous autologous nonvascularized bone graft, and cannulated headless compression screw to reduce the deformity reliably from a collapsed scaphoid nonunion, provide osteoinductive stimulus, and stabilize the fracture for predictable union. Methods A hybrid Russe procedure was performed for scaphoid waist fracture nonunions with humpback deformity and no evidence of avascular necrosis. A volar distal radius autologous bone graft was harvested and a strut of cortical bone was fashioned and placed into the nonunion site to restore length and alignment. We packed cancellous bone graft in the remainder of the nonunion site and fixed the scaphoid was with a headless compression screw. Union was determined by radiographs or computed tomography, and intrascaphoid, scapholunate, and radiolunate angles were calculated on final radiographs. We recorded wrist range of motion, grip strength, pinch strength, pain, and complications. Results Fourteen male and 3 female patients (average age, 32 years; range, 16e78 years), with a mean follow-up of 32 months, were examined clinically and radiographically. All 17 scaphoids united with a mean time for union of 3.6 months. The mean postoperative intrascaphoid angle was significantly reduced from 65 preoperatively to 35 postoperatively. The mean radiolunate angle was significantly improved from 20 from neutral (lunate tilted dorsally) preoperatively to 0 postoperatively. The scapholunate angle also demonstrated significant improvement from 70 preoperatively to 56 postoperatively. Grip strength improved from 70% of the contralateral hand to 89% after the procedure. All patients were satisfied with the functional outcome and no donor site morbidity or hardware issues were identified. Conclusions This straightforward hybrid Russe technique predictably restored radiolunate, scapholunate, and intrascaphoid angles with a 100% union incidence. The technique provides excellent functional results in patients with a challenging clinical problem, and we recommend it for scaphoid fracture waist nonunions with dorsal intercalated segment instability deformity. (J Hand Surg Am. 2015;-(-):-e-

Antibodies for Assessing Circadian Clock Proteins in the Rodent Suprachiasmatic Nucleus

Research on the mechanisms underlying circadian rhythmicity and the response of brain and body clocks to environmental and physiological challenges requires assessing levels of circadian clock proteins. Too often, however, it is difficult to acquire antibodies that specifically and reliably label these proteins. Many of these antibodies also lack appropriate validation. The goal of this project was to generate and characterize antibodies against several circadian clock proteins. We examined mice and hamsters at peak and trough times of clock protein expression in the suprachiasmatic nucleus (SCN). In addition, we confirmed specificity by testing the antibodies on mice with targeted disruption of the relevant genes. Our results identify antibodies against PER1, PER2, BMAL1 and CLOCK that are useful for assessing circadian clock proteins in the SCN by immunocytochemistry

Summary of Immunostaining Results in Hamsters.

<p>Host #: R = rabbit; GP = guinea pig. Peak Time: Hamsters were perfused at the time of expected peak of immunostaining and a series of dilutions was examined. Nadir Time: Hamsters were perfused at the expected low point of immunostaining rhythms (ZT0 for PER1, PER2, and ZT12 for BMAL1). CLOCK immunostaining was comparable at ZT0 and ZT12; dilution studies were conducted at ZT12 and results from ZT0 are listed arbitrarily as Nadir Time. Studies at nadir time used the antibody concentration found to give optimal labeling at the peak time. N = number of animals tested. Results are scored as Described in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0035938#pone-0035938-t001" target="_blank">Table 1:</a> −(no SCN cells labeled), +(relatively poor staining), ++(good staining in SCN), and +++(best staining of SCN cells compared to background). NS indicates non-specific staining (cells inside and outside the SCN were labeled with the same intensity). “n.d." indicates not determined.</p

Photomicrographs of mouse SCN sections immunostained with BMAL1 and CLOCK antibodies.

<p>The left column shows sections from wild-type mice euthanized at ZT12. The center column shows sections from wild-type mice euthanized at ZT0. The right column shows sections from mice lacking the target antigen (“mutant") at ZT0 or 12, as indicated. The antigen, host number (R = rabbit; GP = guinea pig) and antibody concentration used for each antibody is indicated. Scale bar, 100 µm.</p

Assessment of Antibody Dilutions in Wild-Type Mice.

<p>Host #: R = rabbit; GP = guinea pig. Peak Time: Wild-type mice were perfused at the time of expected peak of immunostaining and a series of dilutions was examined. N = number of animals tested. Results are scored as: −(no SCN cells labeled), +(relatively poor staining), ++(good staining in SCN), and +++(best staining of SCN cells compared to background). NS indicates non-specific staining (cells inside and outside the SCN were labeled with the same intensity). “n.d." indicates not determined.</p