ABSTRACT
[Objective]To investigate the injury characteristics and treatment of the Hoffa facture associated with extensor mechanism injury.[Method]Four patients with Hoffa facture associated with extensor mechanism injury treated in author's hospital in recent 6 years were enrolled in this study.All the patients were multiple-injured,and associated with the ipsilateral limb fracture and retinacular and capsule laceration.The site of the extensor mechanism injury included 1 distal patellar tendon disruption,2 proximal patellar tendon disruption,and 1 distal quadriceps tendon disruption.No cruciate ligament injury was found in 3 ipsilateral bicondylar fractures.One unicondylar fracture was associated with anterior and posterior cruciate ligament and medial collateral ligament injury simultaneously.Emergency operation was performed along with the debridement in the three open fractures.In another patient with closed fracture,operation was performed one week after injury.Fractures were reduced and fixed with lag screws.Extensor apparatus were repaired and strengthened with a tension band wire through both patella and tibia.Ipsilateral limb fractures were reduced and internal fixed with hardware simultaneously. The knees were immobilized in extension with cast after operation,and flexion exercise was commenced four to six weeks later.[Result]Four patients wounds reached the first rate healing.There was no infection and necrosis of skin.All patients were followed-up for six months to three years.All 7 condyles of the 4 patients reached bone union.Healing time was about six to twelve weeks.According to Letenneur’s functional assessment system,excellent and good results were in 1 cases,fine in 3 cases.[Conclusion]Hoffa facture associated with extensor mechanism injury are usually accompanied with injuries in other part of the body.In open fracture,emergency operation is mandatory,and fracture reduction and internal fixation and extensor apparatus repair should be performed along with debridement.Tension band wire may strengthen the stability of the extensor mechanism and facilitated early mobilization.
ABSTRACT
BACKGROUND: Repair of segmental bone defects is one of the difficult problems in orthopaedics. Although the therapeutic effect on bone autograft is the best, the source is limited and there is lack of suitable substitutive materials for autologous bone.OBJECTIVE: To probe into the therapeutic effects of surface-decalcified bone matrix gelation(SDBMG) and the substitutive possibility of autologous bone on repair of segmental bone defects.DESIGN: The research was designed as completely randomized controlled experiment. The clinical research was designed as pre- and post-controlled study on the basis of diagnosis.SEETING: Department of Orthopaedics, Wuhan General Hospital of Guangzhou Military Area Command.MATERLALS and PARTICIPANTS: The experiment was accomplished in Laboratory of Wuhan General Hospital of Guangzhou Military Area Command, and Testing Center of Wuhan University of Technology. Thirty-two local healthy adult male rabbits were employed as the materials in the experiment, 2.5 kg in body mass, bought from Hubei Academy of Medical Sciences. The clinical subjects were 31 patients(male 25 and female 6, a meanage of 9 years old) with segmental bone defects hospitalized in the Department of Orthopaedics, Wuhan General Hospital of Guangzhou Military Area Command during January 1991 to May 2001.METHODS: The 32 rabbits were randomized into group A and group B. The bilateral radial bones were prepared into 1-cm bone defect in both groups. In both groups, SDBMG was grafted on the left side; in Group A, wholly-decalcffied bone matrix gelatin(WDBMG) was grafted on the right side;and in Group B, the autologous bone was grafted on the right side. Human SDBMG was provided to treat 31 cases of segmental bone defects.MAIN OUTCOME MEASURES: ① Regular X-ray and histological examinations after operation in animals(Group A) and biomechanical deterruination (Group B ). ② Regular X-ray examinations after operation.RESULTS: SDBMG induced osteogenesis process "gradually" from exterior to interior. The bone repair with SDBMG was similar to that with autologous bone, and there was no significant difference in compressive strength compared with autologous bone. After clinical follow-up, except failure in 1 case due to improper selection of indication, the other 30 cases were all cured.CONCLUSION: SDBMG provides satisfactory osteogenesis and reliable mechanical property. It can be taken as the suitable substitutive material for autologons bone in the repair of segmental bone defects. But it is cautious for the application of SDBMG to infective bone defect in the active phase.
ABSTRACT
Objective To describe postmedial approach to the knee and discuss the main technique using it to repair and reconstruct posterior cruciate ligament (PCL). Methods 24 patients with PCL injury were operated on with the postmedial approach. 13 cases were repaired directly using the technique of pulling out steel wire and 11 cases were reconstructed by semitendinosus. Prone position was adopted in 16 cases and supine position in 8 cases (21 cases had been followed up over six months). Applied anatomy, main techniques and clinical results were evaluated. Results The postmedial approach saved 30～60 minutes compared with the posteior approach, and was not restricted by body posture. Neurovascular structure did not need to be dissected, PCL repair and reconstruction could be finished in one incision.By a six month follow up evaluation, no symptoms of instability occured and they were completely stable on physical examination. Conclusion The postmedial approach is simple, safe, and yields excellent exposure. It's an ideal approach for repair and reconstruction of the PCL.The technique of pulling and steel wire and semitendinosas drawn out "U" shaped pins fixation are essential methods to repair and reconstruct the PCL.