Morphological differences of proximal femoral medullary cavity in elderly patients and its effect on proximal femoral nail fixation / 中华创伤杂志

Objective To investigate the morphological differences of proximal femoral medullary cavity in elderly patients with intertrochanteric fracture and its effect on the treatment efficacy of proximal femoral nail antirotation (PFNA). Methods A retrospective case series study was conducted on the clinical data of 112 elderly patients with intertrochanteric fracture of the femur from December 2012 to January 2017, including the preoperative and postoperative hip joints orthotopic X ray (including the proximal femur), lateral X ray, and pelvic orthotopic X ray films. The proximal femoral canal flare index (CFI) and the metaphyseal canal flare index (MCFI) were measured. The proportion of patients with different types of medullary cavity and the gender difference were analyzed according to Dorr typing. The fractures were classified according to the modified Evans classification. Operation time, fracture reduction quality, tip apex distance (TAD), incidence of intraoperative split fracture around the rotors, postoperative fracture reduction loss rate, weight bearing time, and fracture healing time were recorded. Results The proximal femoral canal flare index (CFI) was significantly correlated with the intramedullary diameter above the lesser trochanter, the inner diameter of the affected side medullary cavity isthmus, and metaphyseal canal flare index (MCFI) (P ＜0.01). There was clear difference in gender in terms of the medullary cavity diameter 20 mm above the middle point of lesser trochanter, medullary isthmus internal diameter, the medullary cavity diameter 20 mm below the middle point of lesser trochanter, CFI, and MCFI. Thereinto, there was significant difference in the medullary cavity diameter 20 mm above the middle point of lesser trochanter [male (52.6 ± 6.4) mm, female: (49.9 ± 5.4) mm], the medullary cavity diameter 20 mm below the middle point of lesser trochanter [male: (26.5 ± 3.7) mm, female: (23.1 ±2.8)mm], and MCFI (male:2.0 ±0.3, female:2.2 ±0.2). No significant difference between the medullary isthmus internal diameter and CFI was found (P＞0.05). In this group, the medullary cavity of proximal femur was classified by Dorr: the proportion of funnel type, normal type, and chimney type was 5.4％ (6/112), 73.2％ (82/112), and 21.4％ (24/112), respectively. There was no significant difference in the modified Evans fracture stability among different morphological types of the proximal femoral medullary cavity. The difference of weight bearing time between normal group and chimney group was statistically significant [normal type: (21.4±16.9)d, chimney type: (45.5 ± 11.2)d] (P ＜ 0.05), but there were no significant differences in operation time, reduction quality, TAD, intraoperative incidence of cleavage fracture incidence, reduction loss rate, and healing time between the two groups (P＞0.05). Conclusions The occurrence and development of osteoporosis can cause significant changes in the morphology of proximal femoral medullary cavity, mainly manifesting as the gradual increase of the proportion of chimney type. The efficacy of PFNA in treatment of the intertrochanteric fracture is satisfactory. However, the risk of intraoperative cleavage fracture and postoperative reduction loss should be taken seriously.

Progress in treatment for ulnar styloid fractures / 中华创伤骨科杂志

Ulnar styloid fractures are commonly associated with distal radius fractures.It remains a surgical dilemma whether to fix the ulnar styloid or not.Some surgeons believe that management of the ulnar styloid fractures is imperative while others feel that they should be managed conservatively.Several clinical studies have concluded that the ulnar styloid fractures have no impact on the anatomic,radiographic,or functional results when accompanied with a distal radius fracture.Others have found they are associated with distal radioulnar joint (DRUJ) instability,concomitant triangular fibrocartilage complex (TFCC) tear,decreased range of motion,or decreased grip strength in the affected wrist.The purpose of this review was to evaluate the effect of associated ulnar styloid fractures on the distal radius fractures and to discuss the treatment of ulnar styloid fractures.

Progress in treatment for distal radius fractures / 中华骨科杂志

Distal radius fractures (DRFs) are one of the most common injuries in orthopaedics,accounting for up to 20％ of all fractures seen in the emergency room.At present,the optimal treatment of these fractures remains controversial.Although most DRFs can be treated non-operatively,such as immobilized by plaster,splint or brace,surgical management has become more and more popular with people's living standards improved and expecting better functional outcome.Surgical treatments for DRFs include percutaneous fixation with Kirschner wires,skeletal external fixation,open reduction and internal fixation,intramedullary nails,fixation using the mini-invasive approach,arthroscopy,and total wrist arthroplasty.Currently,open reduction with volar plate fixation is the most popular and widely way for DRFs,while a mini-invasive approach is a new reliable and reproducible procedure with few complications.Despite recently surgical treatment has become more and more popular,it is also unclear whether surgical intervention will produce better long-term outcomes.The aim of this paper is to present the studies in the literatures about the treatment for DRFs and an update of existing techniques.

A study on the diagnostic reliability of classification of intertochanteric fractures / 天津医药

Objective To compare the diagnostic reliability of AO classification and Evans-Jensen classifications in X ray film and three-dimensional CT reconstruction images intertochanteric fractures, and explore advantage of the three-di?mensional CT. Methods A retrospective study was performed to evaluate 54 patients with intertochanteric fractures. Three orthopaedic surgeons were asked to make assessment of fracture classifications using X ray film and the three-dimen?sional CT images. Agreement test was performed to evaluate interobserver and intraobserver reliability for fracture classifica?tion. Results When X ray film was used, mean Kappa values of interobserver reliability for AO and Evans-Jensen classifi?cations between three surgeons were 0.597 and 0.571, that was medium consistency. While using three-dimensional CT to AO classification, lower Kappa value was 0.411, medium consistency. Evans-Jensen classification, Kappa value was 0.704, highly consistency. Each surgeon respectively using X ray film and three-dimensional CT, the mean Kappa values of AO and Evans-Jensen classification were 0.464, medium consistency and 0.191 (0.160-0.233), weak consistency. Conclusion Both classifications based on X ray film show moderate consistency, using three-dimensional CT does not improve the consis?tency of AO classification. The three-dimensional CT is not applicable in Evans-Jensen classification.

Metal implant fixation and repair for fresh unstable distal radial fractures with scaphoid fracture：half-year follow-up / 中国组织工程研究

BACKGROUND:Healing time and plaster used in fixed position and fixed time are different between distal radius fractures and scaphoid fracture. When both fractures occur simultaneously, you cannot choose a fixed position and determine a fixed time. One-stage internal fixation for the distal radial fractures and scaphoid fractures simultaneously can obtain a good function. OBJECTIVE:To retrospectively analyze the effects of titanium locking compression plate and Herbert screw fixation for fresh unstable distal radial fractures with scaphoid fracture. METHODS:A total of 12 patients with fresh unstable distal radial fractures combined with scaphoid fracture were treated in the Shanxi Dayi Hospital from November 2011 to June 2014. Al cases received open reduction and locking compression plate fixation of the distal radius, open reduction of scaphoid fracture or percutaneous Herbert screw fixation. Fracture healing was observed during folow-up. At 6 months after treatment, wrist joint function was evaluated with modified McBride score. Range of motion of palmar flexion, dorsiflexion, ulnar deviation, radial deviation, pronation and supination and grip strength were measured. The distal radial shortening (difference in height of styloid process of radius and ulna), and angles of ulnar deviation and palmar tilt were measured with X-ray films. The data of healthy side and affected side were compared. RESULTS AND CONCLUSION:(1) 12 cases were folowed up for 6-24 months. (2) The distal radius and scaphoid fractures healed. The healing time of distal radius was 6-12 weeks, with an average of seven weeks. Healing time of scaphoid fracture was 3-6 months, with an average of 4.2 months. (3) Wrist score was evaluated using modified McBride scoring criteria at 6 months after treatment. There were excelent in 5 cases, good in 6 cases, and average in 1 case, with the excelent and good rate of 92%. (4) No significant difference in range of motion of palmar flexion, dorsiflexion, ulnar deviation, radial deviation, pronation and supination and grip strength, angles of ulnar deviation and palmar tilt, difference in height of styloid process of radius and ulna and modified McBride score was detected between healthy side and affected side (P > 0.05). (5) The median nerve injury in two patients was recovered within 6 months after postoperative exploration decompression. No complications appeared, such as infection, dorsal muscle tendon irritation symptoms, carpal tunnel syndrome, and internal fixation failure. (6) These findings confirm that fresh unstable distal radial fractures with scaphoid fractures can be treated with open reduction of the distal radius and locking plate fixation, open reduction of scaphoid bone or percutaneous Herbert screw fixation, with reliable fixation, high fracture healing rate, and good wrist function recovery rate; the repair effect is satisfactory.

Efficacy of proximal femoral nail antirotation fixation combined with zoledronic acid in treatment of osteoporotic intertrochanteric fracture / 中华创伤杂志

Objective To compare the clinical outcomes between proximal femoral nail antirotation (PFNA) combined with zoledronic acid and PFNA only in the treatment of osteoporotic intertrochanteric fracture in the elderly patients.Methods A retrospective analysis was made on 72 patients that completed the follow-up after PFNA for osteoporotic intertrochanteric fracture from November 2011 to May 2014.According to the application of zoledronic acid (5 mg,once a year) after PFNA,the patients were divided into study group (n =30) and control group (n =42).Bone healing and subsequent refracture were assessed with X-ray postoperatively.Harris hip score was recorded.Bone mineral density before operation and one year after operation were compared between the two groups.Adverse effect of zoledronic acid was recorded during hospitalization.Results Mean period of follow-up was 15 months (range,12-26 months).One year after operation,Harris score,new fracture incidence,mean fracture union time were (82.65 ± 6.24) points,3％ (1/30) and (14.26-± 2.24) weeks in study group,while (81.85 ± 5.38) points,14％ (6/42) and (15.26 ± 3.05) weeks in control group.There were no statistical differences between the two groups (P ＞ 0.05),but the subsequent fracture was higher in control group.One year after operation,lumbar and contralateral non-injury hip bone marrow density were (0.78 ± 0.16)g/cm2 and (0.71 ± 0.14)g/cm2 in study group,higher than (0.75 ± 0.13)g/cm2 and (0.69 ±0.13)g/cm2 in control group (P ＜0.05).But there were no significant differences between the two groups before operation.All fractures were healed at postoperative 1 year.No intolerable adverse events occurred in study group.Conclusions PFNA is effective in the treatment of osteoporotic intertrochanteric fracture.In the meantime,the combination with zoledronic acid has no influence on bone healing while increasing bone mineral density,and may decrease the occurrence of subsequent fragile fractures.

Protective effect of glial cell line-derived neurotrophic factor infused into the tube setted into cavitas subarachnoidealis on spinal front corner motor neurons / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effect of exogenous glial cell line-derived neurotrophic factor (GDNF) infused into the cavitas subarachnoidealis on cornu anterius medullae spinalis motor neurons after sciatic nerve axotomy.</p><p><b>METHODS</b>Forty-eight healthy SD rats were divided into 2 groups randomly: GDNF group and NS group. The left sciatic nerve in rats were cut off. And then 0.9% saline (6 microl) and GDNF solution (6 microl) were injected into cavitas subarachnoidealis at L4-L6 in NS group and GDNF group,respectively. The rats were sacrificed on postoperative 1, 2, 4 and 8 weeks respectively. Their specimen of L4-L6 spinal cord were taken at different time and sectioned. The HE staining, Nissl staining and cholinesterase (ChE) staining in motor neurons were used for counting of motor neurons.</p><p><b>RESULTS</b>In GDNF group the number of motor neurons in cornu anterius medullae spinalis and the ChE activity were higher than that of NS group.</p><p><b>CONCLUSION</b>The exogenous GDNF infused into the cavitas subarachnoidealis are supposed to protect the degenerated spinal motor neuron from death after sciatic nerve injury.</p>

Treatment for necrosis of the femoral bead by vascular bundle grafting / 中华显微外科杂志

entrate graft can block pathologic process and improve the inclusion of femoral head and increase blood circulation of femoral head, which is beneficial to its recovery.

Review of traumatic diaphragmatic hernia associated with pelvis fractures / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To review the epidemiological feature, clinical and diagnostic data of post-traumatic diaphragmatic hernia (TDH) associated with pelvis fracture reported in recent 10 years.</p><p><b>METHODS</b>A 10-year retrospective study was undertaken to analyze the incidence, diagnosis, management, morbidity and mortality of patients with traumatic diaphragmatic hernia associated with pelvis fractures. A total of 46 cases in our country were reviewed.</p><p><b>RESULTS</b>The incidence of TDH associated with pelvis fractures was relatively rare and the diagnosis was often delayed or missed. A total of 72.34% of these patients were diagnosed as TDH associated with pelvis fractures after injury for 36 hours to 1 week. Although the trans-thorax approach was preferred for surgical closure in the acute phase, its mortality still reached 8.51%.</p><p><b>CONCLUSIONS</b>TDH associated with pelvis fractures is difficult to be diagnosed because of its varied clinical and radiological signs and the patients may not present with symptoms for a long time after injury. In clinical, a high index of suspicion with appropriate examination is the mainstay of management, which can be helpful in prognosis.</p>

Surgical treatment for complex acetabular fractures / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To explore the effect of surgical treatment on complex acetabular fractures.</p><p><b>METHODS</b>The data of 46 patients (38 males and 8 females, aged 16-75 years, mean equal to 38.5 years) with complex acetabular fractures, who were admitted to our hospital from January 1998 to December 2005, were analyzed retrospectively in this study. According to Letournel rules, posterior wall and posterior column fractures were found in 11 patients, transverse and posterior wall fractures in 13, T-type fracture in 4, both columns fracture in 10, and anterior column and posterior transverse fracture in 8. The choice of surgical approach was based on the individual fractures, which included ilioinguinal approach in 5 patients, Kocher-Langenbech approach in 7, combined approach in 26, and extended iliofemoral approach in 8.</p><p><b>RESULTS</b>All the patients were followed up for 3.5 years averagely. The clinical outcomes were analyzed with Harris hip score and radiography. In 36 patients (78.3%), the surgical procedure was successful (Harris hip score more than 80 points). The rate of excellent and good was about 86%.</p><p><b>CONCLUSIONS</b>The keys to increase the effectiveness of surgical treatment on acetabular fractures are correct preoperative classification of fractures and choices of appropriate surgical approach and time.</p>

Management of the femoral neck fractures in younger patients and prevent the necrosis of femoral head by microsurgical techniques / 中华显微外科杂志

Objective To explore the clinical application of microsurgical techniques to therapy the femoral neck fracture in younger patients and prevent the necrosis of femoral head.Methods Seventy-four younger adults,age from 23 to 50,with femoral neck fractures were treated by open veducition,internal fixa- tion and pedicled bone transplantation from Jan.1995 to Dec.2004.All of the 74 patients were reviewed clin- ically and radiologically after an average of 3.2 years.Results In this group,19/74 cases(25.68%)had avaseular necrosis of the femoral head,which were diagnosised after an average of 28.5 months following inju- ry.Despite these results,these patients assessment with Harris system had been very good or good in 55/74 patients(74.32%).Conclusion It's an effective method to decrease the incidence of necrosis of femoral head after management the femoral neck fracture in younger patients by microsurgical techniques.