Different fixation methods for artificial femoral head replacement: A biomechanical comparison of joint stability / 中国组织工程研究

BACKGROUND: Artificial humeral head replacement is an effective method for the treatment of complex proximal humeral fractures, which has received good results in relieving pain. However, the final functional recovery is unpredictable. OBJECTIVE: To compare biomeshanical stability between anatomical and overlapping reconstruction of the greater tuberosity in cadaveric humeral head replacement models.METHODS: Eight pairs of fresh-frozen shoulder cadavers (16 shoulder joints) were match-paired into two groups. Standardized humeral head replacement procedure was performed in all specimens, and anatomical and overlapping reconstruction of thegreater tuberosity was adopted in each group respectively. For overlapping group, the greater tuberosity was reattached to the proximal humeral shaft in an overlapping style, which was achieved by an additional 5 mm bone osteotomized from the medial cortex of the humeral diaphysis. Custom mounting apparatus and fixation jigs were designed for designated shoulder motion.RESULTS AND CONCLUSION: When the shoulder was external rotated to neutral position, the mean displacement of greater tuberosity in the anatomical reconstruction group was smaller than that of the overlapping reconstruction group (P < 0.05). When the gleno-humeral joint was elevated to 30～ and 60～ forward flexion (accounting for 45° and 90° shoulder forward flexion), there was no significant difference of greater tuberosity displacement between the anatomical group and overlapping group. The findings demonstrated that, although overlapping reconstruction can increase the bone healing area between the greater tuberosity and the humeral diaphysis, there may be some loss in mechanical stability as the trade-off. Even though we strictly follow the standardized postoperative rehabilitation protocol after humeral head replacement, prominent displacement between the greater tuberosity relative to the humeral diaphysis was detected. Accordingly, postponing of the postoperative rehabilitation program after humeral head replacement for a decent period may improve tuberosity healing.

Monteggia fracture-dislocation in adults / 中华创伤骨科杂志

Monteggia fracture dislocation refers to the fracture of the ulna with associated dislocation of the radial head. This rare injury only accounts for less than 5%of all the forearm fractures. By literature review of the history of Monteggia fracture dislocation, the authors further clarify the definition, classification, injury mechanism and treatment protocol of this special type of fracture. The key to a good result of the treatment for a Monteggia fracture dislocation is timely diagnosis and management so that anatomic reduction and stable fixation of the ulna can be achieved. In addition, enough attention must be paid to the associated injuries at the level of the elbow, including fractures of the coronoid process and the radial head as well as posterolateral rotatory instability of the ulnohumeral articulation. The factors strongly affecting prognosis include comminuted fractures of the ulna combined with fractures of the radial head and coronoid process.

Proximally based conjoined tendon transfer for coracoclavicular ligament recon struction in treatment of acromioclavicular separation / 中华创伤骨科杂志

Objective To introduce a procedure, proximally based conjoined t en don transfer, which is to be used for coracoclavicular ligment reconstruction in the treatment of acromioclavicular separation. Methods From 2001 to 2003, 26 pa tients with acromioclavicular dislocation of Rockwood Grades Ⅲ-Ⅴwere treated with transfer of the lateral half of the conjoined tendon to the distal clavicle in a proximally based fashion with additional coracoclavicular fixation. Radiol ogy was used to evaluate the acromioclavicular correspondence. ASES (American Sh oulder &Elbow Surgeon) score, SST (Simple Shoulder Test) form and Constant-Mur ley score were adopted to evaluate the shoulder functions. Results Follow-ups o f 22.6 months on average revealed that the height of distal clavicle reached ana tomic reduction in all the cases during operation. At the latest follow-up, the mean ASES score was 94.2, the mean VAS(Visual Analog Scale) score for pain was 1.2,the mean forward flexion was 150?,and the mean external rotation was 35? . The mean Constant-Murley score was 92.8. The number of positive answers to th e SST was 11. The overall satisfaction rate was 88.5%(23/26) and all patients r eplied with “Yes”when questioned with “Do you want to accept the same operati on if the same condition happens to your contralateral shoulder?”Conclusions Th is surgical procedure proves reliable without sacrificing the coracoacromial lig ament during coracoclavicular reconstruction. When the patients are complicated with fresh or old rotator cuff injury, or the coracoclavicular ligament is thin, or long ligament is needed in the reconstruction, the proximally based conjoine d tendon can be served as a good source of autograft ligament.

The study of 60 cases of adult fresh Monteggia fractures / 中华创伤骨科杂志

Objective To explore a better treatment of fresh Monteggia fracture and factors which lead to unsatisfactory results. Methods A retrospective study was done on 60 of the 114 patients with Monteggia fractures who had been treated from 1994 to 2004 in our hospital. According to Bado classification, 26 patients were type Ⅰ, 14 type Ⅱ, 19 type Ⅲ, and 1 type Ⅳ. All the cases received operation. Fixation included plates and screws, plates with tension band, with or without plaster to immobilize the limb after operation. For the fracture of the radial head, the radial head was totally or partially removed and fixated with screw or k-wire. Results 60 patients were followed up for an average of 2 years(1 to 6 years). The average score according to the system of Broberg and Morrey was 95 points (53 to 100 points). The result was excellent for 48 patients, good for 6, fair for 4 and poor for 2. Complications included heterotopic ossification, ulnohumeral osteoarthrosis, cross-union, nonunion, radial nerve injury and dysfunction of elbow joint and forearm. Conclusions Yong adults, especial males, tend to suffer this kind of low-energy injury. Anatomic reduction and rigid fixation is the key to satisfactory results. Heterotopic ossification, ulnohumeral osteoarthrosis are the major factors leading to unsatisfactory results.

Patella ligament and femoral quadriceps tendon rupture / 中华外科杂志

<p><b>OBJECTIVE</b>To study the diagnosis and treatment of rupture of patella ligament and Femoral quadriceps tendon.</p><p><b>METHODS</b>Twenty-three patients with rupture of the patella ligament and femoral quadriceps tendon were treated from March 1990 to August 2000. They were retrospectively evaluated with regard to patient's age, cause of injuries, characteristics of injuries, symptoms and signs, supplemental checkup, patella position, operative method and time interval from injury to treatment, immobilization, motion of knee, functional recovery etc.</p><p><b>RESULTS</b>They were followed up for 6 years (4 months-11 years) on average. Thirteen of 15 acute injuries after treatment showed excellent results and good results in 2. In 5 old injuries of the extensor mechanism after treatment 2 got excellent results (3 lost to follow-up).</p><p><b>CONCLUSION</b>Excellent or good results could obtain in patients with acute injuries after operation. The results of old injuries are not as good as acute injures, but better results could also achieve after repair.</p>

Using unstable fractures of the distal end of the radius: open reduction and internal fixation with T - type plate / 中华外科杂志

<p><b>OBJECTIVE</b>To treat unstable fractures of the distal end of the radius with open reduction and internal fixation with T-type plate.</p><p><b>METHODS</b>45 patients were treated with T-type plate. Bone graft was used in fifteen patients with severe bone defect. Clinical findings of 45 patients with fractures of the distal end of the radius (one is bilateral fractures) showed fairly good results.</p><p><b>RESULTS</b>The patients were followed up for an average period of 25.36 months. 41 patients showed excellent or good results with a rate of 91.11%.</p><p><b>CONCLUSION</b>It is difficult to reduce unstable fracture of the distal end of the radius in the way of close reduction. Re-displacement is frequent for external fixation and is not reliable in maintaining reduction. These fractures should be treated with early open reduction and internal fixation, and reasonable exercise should be taken after the operation. Good results can be predicted. The most important factors affecting final outcome include radial shortening and reduction of articular surface.</p>

Measurement of fracture malrotation after interlocking intramedullary nailing of femoral shaft fracture / 中华外科杂志

<p><b>OBJECTIVE</b>To study the quantitative measurement of the extent of malrotation after interlocking intramedullary nailing of femoral shaft fracture.</p><p><b>METHOD</b>CT scan ("routine method") applied in 36 femoral shaft fractures that had been treated with close reduction and interlocking intramedullary nailing. For the judgement of the extent of malrotation, the anteversion of both fracture side and contralateral side were measured and the difference between the 2 sides was evaluated. The increase of anteversion represented internal rotation of the distal fragment, whereas the decrease of anteversion represented external rotation.</p><p><b>RESULTS</b>The maximum anteversion of the fracture sides, whereas 48 degrees, the minimum anteversion -10 degrees, the mean value, 15.04 degrees, and the standard error is 11.34 degrees. The maximum anteversion of the contralateral side, whereas 31.3 degrees, minimum -4.8 degrees, the mean value was 13.96 degrees and the standard error was 10.20 degrees (P < 0.001). Compared with the contralateral side, half of the 36 cases showed increased anteversion and the other half decreased anteversion. The mean value of internal rotation is 11.56 degrees, and external rotation 9.39 degrees. The maximum internal rotation was 37 degrees, the minimum 0.9 degrees. Eight cases had internal rotation less than 8 degrees, 6 between 10 degrees - 15 degrees, and 4 over 15 degrees. The maximum external rotation was 24.3 degrees, and the minimum 1.8 degrees. Eleven cases had external rotation less than 10 degrees, 4 between 10 degrees - 15 degrees and 3 over 15 degrees. The incidence of malrotation more than 10 degrees was 47% (17/36), and more than 15 degrees 19.4% (7/36).</p><p><b>CONCLUSION</b>The incidence of malrotation after femoral shaft fracture treated with close reduction and interlocking intramedullary nailing is high. Attention should be paid to clinical management and strict control for rotational reduction intra-operatively.</p>

Internal fixation of the radius head fractures / 中华创伤骨科杂志

Objective To investigate the treatment of radi us head fracture through internal fi xation.Methods 42cases of radius head fracture trea ted with internal fixation were foll owed up.Mason classification and Broberg and Morrey criteria were use d to analyze the correlation between the results and the factors of fractu re type and method of fixation.Results42cases were followed up for a mean time of 25months.Evaluation was done according to Broberg and Morrey score systems.The function recovered we ll in 76%of the cases.The results of minor plate group were better than th ose of the screw(P=0.01)or K wire group(P=0.04).The results of Mason typeⅡwere better than those of the typeⅣ(P=0.03).Conclusion Treatment of radius head fracture with internal fixation will improve the elbow function and has better result for Mason typeⅡ.Fixation with minor plate is better than with screw or K wi re.[

Unstable fractures of the distal end of the radius: management with external fixator / 中华创伤骨科杂志

Objective To evaluate the treatment of unstable fractures of the distal end of the radius with external fixator.Methods 28 patients with unstable fractures of the distal end of the radius were treated with external fixators. 19 cases of them were fixed with K wires and bone graft was used in 4 patients with severe bone defect.Results The patients were followed up for an average period of 10.11 months. According to modified Mcbride grading, 25 patients showed excellent or good results with the excellent and good rate being 89.28% . Conclusion It is difficult to reduce unstable fracture of the distal end of the radius with close reduction. Redisplacement is frequent for plaster cast and is not reliable in maintaining reduction. These fractures should be treated with early open reduction. External fixation plus reasonable exercises taken after the operation is one of the good treatments and good results can be predicted. The most important factors affecting final outcome include radial shortening and reduction of articular surface.

Distal tibiofibular synostosis after ankle fracture / 中华创伤骨科杂志

Objective To report a group of uncommon cases, and discuss t he impact of distal tibiofibular synostosis on the patients and its clinical sig nificance. Methods At a mean follow-up of 22.8 months(11 to 54 months), 14 pati ents with distal tibiofibular synostosis after ankle fracture were evaluated wit h Philips and Schwartz clinical scoring system of ankle. Results 3 patients comp lained of transient pain after strenuous activities. The others complained of no discomfort. All of them had no trouble in normal working and daily activities. The mean degree of plantar flexion was 47.9?, with 3.5?(0 to 10?)less than the normal side. The mean degree of dorsiflexion was 20?, with 8.6?(0 to 20? )less than the normal side. There were no degenerative changes in all ankles. T he mean Philips and Schwartz score was 90.8(82 to 98). The excellent rate was 71 .4%, and the excellent and good rates were 100%. Conclusion Distal tibiofibul ar synostosis after an ankle fracture usually gives rise to few symptoms and nee ds no specific treatment.

The forearm traction instrument —a new traction device / 中华创伤骨科杂志

Traction during reduction is essent ial for internal or external fixatio n of unstable distal radial fractures.Adequate and effective t raction is the key to the restoration of articular congruence,normal joint relation and the length of distal radius.The f orearm traction instrument develop ed by the authors is a simple,versatile and reliable device,from which stable,continuous and effective traction c an be expected during the surgery.The traction instrument is connected wi th the surgery-table before the operation.According to the needs of diff erent operations,many kinds of traction could be perfo rmed to support the operation.With t he help of the device,frac-ture reduction and fixation is signi ficantly improved during the surgery without excessively violent traction.The X-ray exposure and the operation hou rs can also be decreased as well.Over-traction or long-time violent traction could be avoided during the surgery.According to the author' s experience,the forearm traction i nstrument is an effective implemental device in the treatment of the unstable fractures of distal radius.[

Enhance the clinical research on orthopaedic trauma / 中华创伤骨科杂志

About 20papers presented at the 2002Annual Meeting of Chinese Orthopaed ic Trauma As-sociation have been selected for thi s special issue.They demonstrate th e state of art of orthopaedic trauma i n China.The articles about managemen t of pelvic fractures discuss gross h emorrhage and lumbar sacral plexus i n-jury in pelvic fractures .To treat pelvic hemorrhage,general support co mbined with fixation of the fracture and homeostasis are the key.5of them dea l with the choice of implant for proximal femoral fractures.The DHS is more suitable for stable intertrochante ric fractures,while the intramedul lary fixation system is favored for u nstable in-tertrochanteric fractures.Many wa ys of fixation can be applied in the tr eatment of distal femoral fractures.Pre-operative planning and decent techniques should be emphasized.The diagnosis of calcaneal fractures should be based on the combination of X-ray and CT scan.The restoration of height,l ength,width and the congruency of th e articular surface of the calcaneus a re the goals of treatment.From now on,we should enhance the clinical rese arch on orthopaedic trauma and specify th e diagnosis criteria.[

The clinical study for the treatment of unstable distal radius fractures via volar approach / 中华骨科杂志

Objective To summarize the outcome of volar approach for unstable distal radius fractures, as well as to explore and discuss the more prompt and efficient way with less complications. Methods Volar approach was used for unstable distal radius fractures in 129 cases (140 sides). This study involved 77 males and 52 females with an average age of 43.7 years (range, 15-76 years). According to the Coony universal classification, 36 sides were of type Ⅱ, 7 of type Ⅲ and 97 of type Ⅳ, which included 105 sides of fresh fracture and 35 old ones. Extra-articular reduction was performed under C-arm to restore the palm tilted angle and ulna deviated angle. For those with severe bone defect, artificial bone graft or auto-graft was applied. T-plates were fixed in 32 sides, T-plates with K-wires in 57, external fixators in 13, external fixators with K-wires in 38 respectively. Results The functional recovery was achieved at 3.8 months averagely after operation with a range of 2 to 6 months. The mean follow-up period was 23.6 months ( range, 12-40 months). 91 sides were rated as excellent, 38 as good, 10 fair and 1 poor. The long-term excellent-good rate was 92.1%. Conclusion The volar approach for unstable distal radius fractures has the following advantages: 1)less invasive without compromise to the bone and tendon sheath of distal radius; 2)The volar surface of radius is smooth , easier for plating; 3)no injury to the palmer ligaments and better for recovery; 4)better reduction; 5)avoidance of bone graft displacement; 6) shorten the operation time, less post-operative complication, earlier rehabilitation and faster functional recovery. The volar approach for unstable distal radius fractures is suitable either for internal or external fixation.

Operative treatment of the complex proximal humeral fractures / 中华骨科杂志

Objective To summarize the methods of operative treatment for complex proximal humeral fractures and its clinical results. Methods 40 cases with complex proximal humeral fractures underwent operation from December 1999 to February 2002. Of 40 cases, 29 were followed up with a mean of 25 months (11 to 40 months). Using Neer system, Constant-Murley rating system and questionnaire were adopted to classify the fractures and evaluated postoperative functions of the daily life and work. A deltoid-pectoral approach was used in all patients. The surgical neck fractures were fixed with the terminal threaded pin or modified Ender's nail. The tubercle fragments were sutured with non-absorbable Ethibond No.5 or "8" figure tension band wire. Results The average absolute Constant-Murley score was 81.7(54 to 96), the excellent and good rate was 65%(19/29), fair 24%(7/29), and poor 11%(3/29). The average forward elevation was 142.5?(60? to 180?). The average pain VAH score was 12(9 to 15). The humeral head avascular necrosis, detected by the follow-up X-ray film, was diagnosed if the humeral head was completely or partially absorbed or reduced. In three-part fractures, 71% cases were excellent or good results, no poor result, and 17% had humeral head necrosis; in four-part fractures, 58% cases were excellent or good results, 25% poor, and 67% were found with humeral head necrosis. The extent of the humeral head necrosis was one of main causes to the poor function for complex proximal humeral fractures. All of the fractures healed at 6 to 8 weeks postoperatively without delayed union and nonunion. Conclusion For complex proximal humeral fractures, a good clinical result can be obtained on condition of the anatomical reduction of the tubercle fragments, as well as the stable fixation of the surgical neck fracture with appropriate suture materials and proper post-operative rehabilitation. Satisfactory result is possible even while the humeral head avascular necrosis happened.

Giant cell tumor of tendon sheath in the hand:a clinicopathological,immunohistochemical and flow cytometric DNA analysis / 中华骨科杂志

Objective A retrospective study of GCTTS in the hand was undertaken to determine whether specific clinic or pathologic factors were associated with an increased risk of recurrence, and to investigate the relationship between the recurrence of GCTTS and its biological indices. Methods 83 patients with histologically proven GCTTS were treated and followed up. The clinical materials were reviewed. Comparison was made between certain factors to determine which were associated with increased recurrence rates. Results The patients were followed for an average of 55 months. 22 patients (26.5%) recurred. Age, gender, site, the origin of tumors, size, bone erosion or destruction, cellularity and the mitoses were not risk factors for recurrence. Tumors without capsule had higher recurrence rate than that with capsule, and the difference was highly significant. The local recurrence rate of Nm23 positive group was 28.3%, and Nm23 negative group was 19.2%, there was no remarkable difference between the groups. The PCNA-LI was 0.448?0.130 in recurrent group and 0.358?0.147 in nonrecurrent group, the difference was statistically significant. The aneuploidy DNA content was presented in 50% of the recurrent tumors, and in 23.2% of nonrecurrent ones. The SPF was 6.98?4.64 in recurrent group and 4.70?2.49 in nonrecurrent group. These values were also significantly different. PCNA-LI, the aneuploidy DNA content and SPF were significantly higher in group without capsule than those in group with capsule. These values were not different between tumors with and without bone destruction, large and small diameter, high and low cellular tumors, as well as high and low mitoses tumors. Conclusion The high proliferative indices of recurrent GCTTS may explain its aggressive biologic behavior. Tumors without capsule possess higher proliferative indices than the ones with capsule, and they have higher recurrent rate. The proliferative indices of the tumors with and without bone distruction are comparable, and the difference of the recurrence rate among groups is not significant.

The analysis of related factors leading to hip fracture in the elderly / 中华老年医学杂志

Objective To observe the BMD threshold of hip fracture in the elderly, analyze the pre-imposing factors leading to femoral neck fracture or intertrochanteric fracture, and provide some evidences for fracture prevention. Methods The BMD examination were performed on 496 fractured patients over 60 years old which were grouped after admission according to their age, gender and fracture types, and then the results were statistically analyzed. Results The BMD of fracture cases in the elderly over 60 years old was 2.5 s less than peak bone volume. There is no obvious difference in BMD between femoral neck fracture and intertrochanteric fracture among various age groups. According to our study, most hip fractures happened at the age of 60-79 years, accounting for 73%of all hip fractures. Conclusions Decreased bone mass or osteoporosis is an important factor leading to hip fracture in the elderly. The fracture types (femoral neck fracture or intertrochanteric fracture) depend mainly on the impaction force to the hip, not only on the BMD change.