RESUMEN
Pronation external rotation (PER) fractures are unstable ankle fractures that require anatomically stable fixation. However, due to the long distance between the fibula and the posterior malleolus in PER IV, existing approaches may make it difficult for the fixation of the associated posterior joint and the lateral malleolus. We describe an S-type posterolateral approach for the open reduction and internal fixation of posterior malleolar fractures with an associated lateral malleolar fracture in PER IV.
Asunto(s)
Fracturas de Tobillo , Fracturas de Tobillo/diagnóstico por imagen , Fracturas de Tobillo/cirugía , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/cirugía , Peroné/diagnóstico por imagen , Peroné/cirugía , Fijación Interna de Fracturas , Humanos , Pronación , Rotación , Resultado del TratamientoRESUMEN
The hypoxia-inducible factors (HIFs), HIF-1α and HIF-2α, are the central mediators of the homeostatic response that enables cells to survive and differentiate in low-oxygen conditions. Previous studies indicated that disruption of the von Hippel-Lindau gene (Vhl) coincides with the activation of HIFα signaling. Here we show that inactivation of Vhl in mature osteoblasts/osteocytes induces their apoptosis and disrupts the cell/canalicular network. VHL-deficient (ΔVHL) mice exhibited a significantly increased cortical bone area resulting from enhanced proliferation and osteogenic differentiation of the bone marrow stromal cells (BMSCs) by inducing the expression of ß-catenin in the BMSC. Our data suggest that the VHL/HIFα pathway in mature osteoblasts/osteocytes plays a critical role in the bone cell/canalicular network and that the changes of osteocyte morphology/function and cell/canalicular network may unleash the bone formation, The underlying mechanism of which was the accumulation of ß-catenin in the osteoblasts/osteoprogenitors of the bone marrow.