ABSTRACT
Objective To study the characteristics and classifications of the fractures of the talar neck as well as to define the appropriate treatments and its complications. Methods 47 patients of the fractures of the talar neck were referred to our department of orthopaedics from July 1996 to November 2001. There were 32 males and 15 females with an average age of 31.6 years. The injuries were caused by fall in 13, traffic accident in 28, and others in 6. According to Hawkins classification, there were type Ⅰwith nondisplaced vertical fracture in 6 patients, which were treated non-operatively, and immobilized with a non weight bearing short leg cast; type Ⅱ in 26 patients, and type Ⅲ in 15 patients, all of which were treated in emergency with anatomic reduction and fixation with 4.0 mm lag screws through anteromedial or anterolateral approaches of the ankle. Otherwise, the arthrodesis of subtalar joint in type Ⅲ fracture were primarily performed as well. The ankles were immobilized until the fracture healed. Results The patients were followed up 2 to 5 years (average, 3.6 years). By the assessment of clinical effects depending on the complaints, functions and radiological results of the ankle and subtalar joint, 17 patients were rated as excellent, 22 patients good, 5 fair, and 1 poor, the total rate of excellent and good was 83.0%. Osteonecrosis occurred in 8 patients with 3 of type Ⅱ and 5 of type Ⅲ fractures. 3 of 4 patients with talar displacement were found with osteonecrosis or painful arthritis. The subtalar arthrosis occurred in 6 patients, 4 of which were associated with ankle arthrosis. 3 patients underwent arthrodesis because of painful arthritis of the subtalar joint or osteonecrosis of the talar body. Anteromedial skin necrosis of the ankle developed in 1 patient. Conclusion If the fracture of talar neck is not managed appropriately as early as possible, its complications are common, the fractures should be treated in emergency to reduce the incidence of posttraumatic osteonecrosis, arthrosis and malunion of the fractures.
ABSTRACT
Objective To study the method of surgical correction for pelvic obliquity secondary to leg length inequality. Methods Pelvic equilibrium operation is designed to correct the fixed pelvic obliquity, equilibrate the two lower limbs by bilateral iliac osteotomies with transfer of a block of iliac bone from the normal ilium into the abnormal ilium of the contralateral side. This procedure also corrects the associated acetabular dysplasia. Results In this series of 32 patients, none was lost to follow-up. Thirty-two patients, 19 males and 13 females, whose ages ranged from 14 to 34 years with a mean of 22 years, underwent surgery; twenty-four cases had fixed pelvic obliquity and acetabular dysplasia secondary to a short limb following anterior poliomyelitis. The deformities in seven cases were due to severe tuberculous infection in childhood which had resulted in a fixed adducted ankylosed hip. The pelvic equilibrium was caused by trauma in one case. During the review, the minimum time from surgery was 2 years and 6 months, and the maximum 13 years and 6 months with a mean of 6 years and 8 months. The results were excellent. Preoperatively, 29 patients walked on crutches, and postoperatively, 25 patients could walk unaided, one with a stick and three on single crutch. In this paper, we also presented the associated experiment research of pelvic equilibrium operation. Conclusion Pelvic equilibrium operation has been proved to be a new effective surgical correction method of pelvic obliquity secondary to leg length inequality.
ABSTRACT
Objective To study the forearm angulation deformities and observe its influence on the rotation function of the forearm.The importance of the interosseous to forearm rotation function was also analyzed. Methods Eight human cadaver specimens, with the forearm superfical and deep fascia, antebranchial extensor and flexor groups dissected off were used to study the origin and insertion of the pronator teres and supinator, and the movements of the fibers of the interosseous membrane and oblique cord during forearm rotation. Single and double fracutures of the radius and the ulna were produced in ten other human cadaver upper limb specimens with the pronator teres， supinator， interosseous membrane， oblique cord， proximal and distal radio-ulnar joint preserved. The fractures were fixed with plates and screws, and were made into models with different directions and degrees of angulation deformity. The upper limb were fixed with elbow at 90? of flexion in order to observe the effects of angulation deformities upon the forearm rotation function. Results The oblique cord and the upper third interosseous membrane fibres control the excessive pronation of the forearm while the middle and lower third interosseous membrane fibres control the excessive supination; so the oblique cord and interosseous membrane limited the rotation range of the forearm. The forearm angulate deformity resulted from single or double fractures are both be able to cause the forearm rotational disturbance; when the angular deformity exceeds 5? , disturbance of rotational function of the forearm will occur. The disorder of interosseous membrane and the oblique cord, the slope of the articulus radio-ulnaris distalis and proximalis and the osseous obstruction are the main causes of the disturbance of rotation function. Conclusion The interosseous membrane limits the scope of forearm rotation and the deformity of angulation can cause the hindrance of the forearm rotation.