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The cultivation of medical students' humanistic care ability is one of the most important tasks of medical education. In this study, "Teddy Bear Simulation Hospital" was launched to cultivate humanistic care ability for pre-clinical medical students in the early stage. Firstly, pre-clinical students were organized to visit clinical functional zoning and diagnosis and treatment processes, listen to pediatrician lectures, and understand the diagnosis and treatment process of pediatric patients. Then, students were organized to build a simulated hospital for kids in the kindergarten with reference to the actual situation and carry out simulated diagnosis and treatment. In the process of implementation, students divide the labor, make the plan and take the action independently. After the simulation scenario was created, the kids played the role of parents of the sick children, and their favorite plush toy was pretended to be the sick baby; the medical students played the various roles of the medical staffs in the simulated hospital to carry out various diagnosis and treatment activities in an orderly manner. The results showed that the activity has provided a safe and friendly simulation diagnosis and treatment platform for pre-clinical students. In the interaction with children, the humanistic care ability of the students was significantly improved.
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Objective:To develop an innovational hybrid simulation-based education of bone traction with co-Debriefer for medical students and to evaluate its effectiveness.Methods:This study was designed as a cross-controlled study. From June 2018 to June 2019, 28 medical students were randomized into two groups. The two groups adopted simulation-based education and traditional teaching method respectively. In the second week of internship, the teaching methods of the two groups exchanged. Scores rating of the skill were used to assess the students' performance in the end of each teaching methods. SPSS 23.0 software was used to analyze the collected data.Results:In the first weekend of orthopedic-internship, students in the experimental group scored significantly higher than the control group, with an average score of 85.07 points versus 67.92 points. In the second weekend of practice, there was no obvious change in the skill score of the experimental group, but the score of the control group was significantly improved, and there was no obvious difference with the experimental group.Conclusion:The hybrid simulation-based education with co-debriefing is a reliable teaching method for medical interns to learn skills of bone traction, which can effectively help improve students' skills, reduce their errors, and ensure patient's safety.
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Objective To investigate the value of electromagnetic field real-time system (EFRTS) in the distal locking of intramedullary nailing for humeral shaft fractures.Methods From April 2015 to January 2017,data of 32 consequent patients with humeral shaft fracture (22 males,10 females;ranged from 18 years to 78 years old,average of 40.4 years;9 domestic falls,15 traffic accidents,6 fall from height,and 2 sports injury;AO12 A1:9 cases;A2:14 cases;A3:4 cases;B2:5 cases) were retrospectively analyzed.All were treated with Humeral Antegrade Locking Nail.For inserting the two distal locking screws,the SURESHOT Distal Targeting System was used.Results Accurate placement of the distal screws was accomplished in all 32 cases,which meant one drilling and one screw locking.The mean duration of the two distal screw locking was 197±30 s (range,156-253 s) in the preparation phase and 393±39 s (range,336-481 s) in the operation phase.The mean follow-up period was 18 months,ranging from 11 to 25 months.All the fractures were healed in an average time of 15.9 weeks,ranging from 12 to 20 weeks.The range of motion was:80° to 180° in abduction (155° in average),80° to 180° in anteflexion (160° in average),60° to 100° in external rotation (80° in average),and 17 cases internal rotation to L3 level,10 to T12 level and 5 to T7 level.The mean score of ConstantMurley was 89,ranging from 74 to 96.All the patients obtained good results.27 patients restored self-care ability within 3 months after surgery.Shoulder discomfort occurred in 2 patients because of nail tail outside the articular surface.The symptom recovered after removal of the nail as well as joint release in arthroscopy.Conclusion The distal aiming device can be used in humeral intramedullary nailing,by which the distal screw can be inserted by one time.Meanwhile,it has the advantages of short time-consuming,secure operation,and no X-ray radiation.
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Objective To explore the therapeutic advantages of suprapatellar nailing for treatment of segmental tibial fractures. Methods Twenty-one tibial segmental fractures were managed and followed-up regularly in our hospital from March 2012 to August 2018. They were 15 males and 6 females, with an average age of 46.0 years (range, from 26 to 71 years). There were 13 cases of type Ⅰ,4 cases of type Ⅱ, 2 cases of typeⅢand 2 cases of typeⅣ, according to Melis classification. There were totally 10 open fractures (5 cases of type Ⅰ, 2 cases of type Ⅱ, one case of type ⅢA and 2 cases of type ⅢB, according to Gustilo classification). All the cases received closed reduction and internal fixation with suprapatellar locked tibial nailing of the third generation. Non-weight-bearing exercises of the knee and ankle and muscular strength training for the low ex-tremity commenced 3 days after internal fixation. The knee functions were evaluated postoperatively using the Lysholm knee scoring. Results All the 21 cases were followed up for 10 to 36 months (average, 17.8 months; more than 3 times during at least 10 months). X-ray revealed occurrence of the callus from 2 to 11 months (average, 7.1 months) after operation. One case of nonunion occurred at the tibial mid-shaft. There was no wound infection, soft tissue necrosis or osteomyelitis. Two cases complained of knee pain and 5 cases of ankle pain, with VAS scores ranging from 2 to 3. After symptomatic management, the knee pain was relieved in 2 cases after 5 months and the ankle pain was relieved in 3 cases. The average Lysholm score 10 months after surgery was 95 points (range, from 87 to 99 points). Conclusion Suprapatellar nailing is an effective treatment for segmental tibial shaft fractures, especially for those involving injuries to the metaphyseal region and peripatellar soft tissue, because it can provide effective fixation of the multiple metaphyseal fractures and avoid disadvantages of conventional intramedullary nailing, leading to limited postoperative knee pain.
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Osteoarthritis is a common articular cartilage degenerative disease and the main cause is mechanical instability. The mechanical instability can reduce the number of chondrocytes and destroy extracellular matrix through direct injury, inducing cell apoptosis, and stimulating the production of inflammatory factors, leading to decrease of matrix typeⅡ collagen and proteoglycan and degeneration of cartilage. Long-term cartilage degeneration can result in osteoarthritis. Therefore, understanding how mechanical instability leads to the incidence of osteoarthritis can better improve the course of osteoarthritis from the perspective of mechanics.
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Objective To evaluate the effectiveness of water jet debridement combined with negative pressure wound therapy (NPWT) for the treatment of early infection after fracture internal fixation.Methods The study cohort included 6 men and one woman with an average age of 43.6 years (range,from 36 to 58 years) who had presented with early infection after fracture internal fixation from October 2013 to March 2015.All the patients sustained closed fractures initially.The wound debridement was done within 3 to 5 days after the infection was confirmed.The length and depth of an incision was determined by the methylene staining range.Water jet was used to eliminate the dying tissues thoroughly from a shallower layer to a deeper layer while the internal fixator was retained.The wound was closed by full thickness sutures in a sparse fashion for drainage.Sensitive antibiotics were systematically administered for all the patients.The NPWT device was kept for 5 days.Results All the wounds healed uneventfully after an average of 18 days (range,from 10 to 25 days).The mean follow-up time was 12 months (range,from 8 to 24 months).No antibiotics were used during follow-up.There were no local or systematical symptoms like new sinus,broken wound or fever.Bony callus formed at the fracture sites after an average of 4.3 months (range,from 2.5 to 8.0 months) and no fracture nonunion happened.All the fractures healed after an average of 10.1 months (range,from 5.5 to 16.0 months).All the patients were satisfied with their treatment outcomes.Conclusion Since water jet provides simple,rapid and radical debridement while NPWT simplifies operative procedures and promotes wound healing,combination of the two can be an effective treatment for early infection after fracture internal fixation.
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Objective To evaluate the clinical outcome of anterior subcutaneous internal fixator (ASIF) system with triple pedicle screws in stabilizing Tile type B pelvic fractures.Methods From August 2013 to April 2015,38 cases of pelvic fractures were stabilized with the ASIF system using triple pedicle screws.There were 24 male and 14 female cases,with the age range of 16-74 years [(41.5 ±5.5) years].Causes of injury were traffic accidents (n =28),crushing injury (n =6) and fall from height (n =4).All cases had Tile type B fractures,including 5 cases of type B1,29 type B2 and 4 type B3.Intraoperative blood loss,operation time,length of hospitalization and complications were detected.Postoperative function evaluation was done using the Majeed score.Results All cases were available for follow-up of 6.5-13.5 months (mean,10.5 months).Intraoperative blood loss was (30.8 ± 7.1)ml,operation time was (51.5 ± 9.2) minutes,and length of hospitalization was (5.0 ± 3.1) days.Among them,34 cases showed bilateral hip flexion over 95 degrees after operation,and 24 cases were able to squat fully 1.5 months after operation.No cases experienced nonunion,delayed union,superficial or deep surgical wound infection,urethral injury and dysuresia.Two cases developed temporary lateral femoral cutaneous nerve numbness.According to the Majeed score,excellent results were found in 32 cases (84％) and good results in 6 cases (16％).Conclusion ASIF system with triple pedicle screws results in high healing rate and few complications in the treatment of Tile type B pelvic fractures,and hence deserves popularization in clinic.
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Objective To explore the clinical significance of the inferior displacement sign on the initial anterioposterior (AP) view X-ray for fractures of humeral greater tuberosity.Methods This study retrospectively analyzed the imaging and clinical data of 24 patients with isolated fracture of humeral greater tuberosity who had sought medical treatment during the period from January 2008 to June 2015.They were 10 males and 14 females,with an average age of 54 years (from 19 to 68 years).Laterality:8 left sides and 16 right sides.The AP view X-ray films of the 24 patients present the inferior displacement sign defined as the inferior cortical margin of the greater tuberosity overlapping the proximal humeral shaft on the initial AP view.The patients received further CT examination to determine the displacement direction and whether the humeral neck fracture was complicated.Results A slight displacement of humeral anatomic neck fracture was shown on the initial AP view X-ray in 10 patients.Further CT examination revealed that humeral anatomic neck fracture was confirmed in 23 patients,the greater tuberosity was displaced posteriorly in 22 patients and posteroinferiorly in 2 patients.Radiographic measurements showed:the mean posterior displacement was 10.5 ±4.5 mm;the displacement between the humeral head and the humeral shaft was 2.5 ± 1.5 mm;the neck shaft angle was 147.2° ± 9.2°;the distance between the humeral head and greater tuberosity was 10.8 ± 3.4 mm;the overlap between the inferior edge of greater tuberosity and the upper edge of lateral humeral shaft was 12.5±5.9 mm.Pearson correlation analysis showed no correlation between the overlap and the head-tuberosity distance (P ＞ 0.05),but a significant correlation between the overlap and the neck-shaft angle (P ＜ 0.05).Conclusions The inferior displacement sign on the initial AP view X-ray is actually the overlap of posterior displaced greater tuberosity fracture shown on the X-ray.The posterior displaced greater tuberosity fracture complicated with slight displaced anatomic neck fracture is a presentation of the valgus impacted fracture of the proximal humerus.The inferior displacement sign in the fracture of humeral greater tuberosity can highly suggest the presence of occult or slight displacement of the humeral anatomic neck fracture.
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Objective: We aimed to analyze the intracapsular pressure of the hip joint following femoral neck fracture and its relationship to the position of the hip or to traction and [using superselective arteriography] to evaluate the blood supply to the femoral head and the influence of traction and hip position on the blood supply
Subjects and Methods:Twenty- six cases of fresh Garden type I-III femoral neck fractures were enrolled. After being placed in the neutral position, in internal rotation or with traction of 3 and 5 kg, respectively, intracapsular manometric changes were measured. Eight cases underwent superselective arteriography of the medial circumflex femoral artery and its branches under the manometric changes of the hip joint capsule
Results:Twenty-four to 48 h after the injury, the intracapsular pressure was significantly higher on the fractured side than on the normal side. The mean pressure was 28.41 +/- 9.339 mm Hg in fully extended hips in the neutral position, 79.92 +/- 12.80 mm Hg in internally rotated hips, 51.39 +/- 15.41 mm Hg in hips with 3 kg of traction and 64.81 +/- 13.56 mm Hg in hips with 5 kg of traction. The arteriographic findings revealed that traction and internal rotation reduced the perfusion of the femoral head at the medial circumflex femoral artery and its branches, and also negatively influenced venous reflux
Conclusion:Traction and internal rotation both caused the intracapsular pressure of the hip joint to rise considerably, which reduced the femoral head perfusion and impeded venous reflux. This could lead to avascular necrosis of the femoral head
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Objective This study is aimed to compare sinus tarsi approach and conventional extensile L shape approach in the management of Sanders type III calcaneal fractures. Methods A total of 36 cases of Sanders type III calcaneal fractures treated in our hospital between August 2011 to February 2014(35 patients, 27males, 8 females. Nineteen of them were performed a limited open reduction and internal fixation(ORIF) via the sinus tarsi approach(as minimal invasive group), while the other 17 cas?es were performed ORIF via conventional lateral extensile L shape approach(as conventional group). X?ray films were taken post?operatively to record the changes of B?hler angle and Gissane angle. The AOFAS ankle hind?foot scale, visual analogue scale and the MOS item short from health survey(SF?36) were adopted to assess the therapeutic effect. Results The average follow?up peri?od of minimal invasive group was 14.6 months. And conventional group were followed up for average period of 18.3 months. All the fractures in the series had a boney union at or before the final follow?up. The immediate correction and final correction of B?hler angle and Gissane angle were significantly increased in both minimal invasive group and conventional group, while there was sig?nificant difference between the two groups. The median AOFAS score ,VAS score and SF?36 score of the minimal invasive group were 84.74±8.14,1.68±0.95 and 89.36±4.69, while those in the conventional group were 82.06±10.95,1.94±1.43and 86.71±5.39. There was no significant statistically difference between the two groups. No wound problem happened in the minimal invasive group, 3 cases of subtalar joint stiffness were found, and 1 developed traumatic arthritis. Respectively, 2 cases in conventional group got hematoma and dehiscence for each, 8 cases of subtalar joint stiffness were found, and 2 cases developed traumatic arthri?tis finally. Conclusion Limited ORIF via a sinus tarsi incision have the familiar therapeutic effects to ORIF via a conventional extensile L shape incision in the management of type III calcaneal fractures. But the former has the advantage of lower incision complication rate and lower stiffness subtalar joint rate.
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Objective To discuss the clinical character and the therapeutic strategy of the super-proximal bicondylartibial plateau fracture.Methods A review of 8 patients with an average age of 40.8 years old (range,28-56 years; 6 males,2 females) surgically treated from June 2007 to October 2012 was conducted.Conventional pre-operative three-dimensional CT scans were used to clarify the types of fractures and the locations of major displaced bone fragments.All patients received open reduction and internal fixation 7-14 days after injury for recovery of soft tissue.Anterolateral incision combined anteromedial incision was made on those with limited posterior column shift.Otherwise anterolateral incision combined posteromedial might be better for those with obvious displacement.Six of the patients were implanted autograft bone or allograft bone.The collateral ligaments could be repaired in one stage,but a routine repair of cruciate ligaments was not concerned,and an immobilization for six weeks with a plaster or a brace should be followed.Results All cases were followed-up for 12 to 26 months (median follow-up period,18.6 months).All the fractures in the series achieved bone union at or before the last follow-up,and the healing time ranged from 18 to 26 weeks (median healing period,21.5 weeks).The X-rays showed the smooth surface and good alignment of knee joint at the last follow-up.The median hospital for special surgery knee score (HSS) was 78.12 (range,56-90),with 3 excellent cases,3 good cases,1 fair cases and 1 poor case; the excellent and good rate was 75％ (6 of 8).The median Lysholm score was 81.37 (range,58-91),with 4 good cases,3 fair cases and 1 poor case; the excellent and good rate was 50％ (4 of 8).Conclusion Super-proximal bicondylartibial plateau fracture is a special fracture type accompanied with posterior dislocation of knee,which is predominantly presented as an anterior plateau fracture.And injuries of blood vessels and nerve are common.Conventional pre-operative three-dimensional CT scans,paying attention to the stability of the knee,restoring the alignment and joint surface and early analgesic exercises with brace might be commended in management of such plateau fracture.
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Objective: To discuss the role of clinical pharmacists played in the pharmaceutical care for osteomyelitis patients. Methods:Clinical pharmacists participated in the treatment for a special patient with osteomyelitis. Taking the disease features, medi-cal history, adverse drug reactions into account, clinical pharmacists provided consultant opinions for establishing and adjusting the ap-propriate therapeutic regimens and individualized pharmaceutical care. Results:The drug treatment regimens for the patient were safe, effective and rational. By the individualized pharmaceutical care, clinical pharmacists were able to find the problems in the drug treat-ment and implement the efficient solutions. Conclusion: Clinical pharmacists show their own advantages in individual pharmaceutical care, and play an important role in improving the rational drug use.
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Objective To explore the operative techniques for AO/OTA type 31-A3.1 and 31-A3.2 intertrochanteric fractures fixed with intrameduallary nail.Methods Seventy-four cases of unstable intertrochanteric fracture (AO/OTA type 31-A3.1 and 31-A3.2) from January 2007 to December 2010 were analyzed retrospectively.There were 33 males and 41 females,aged from 36-87 years (mean,71 years).The right hip was involved in 34 patients and the left in 40 patients.The mechanism of injury was traffic injuries in 27 cases,fall damage in 43 cases,injury by falling in 3 case and crush injury in 6 cases.Percutaneous joystick technique,Homann retractor technique,clamp technique and mini-incision was applied to aid reduction during the surgery.All cases were fixed with proximal intrameduallary nail.Clinical and radiographic outcomes were recorded.The postoperative hip function was evaluated using Harris score.Results With the aid of C-arm,closed reduction was performed in 73 cases.Only one patient experienced open reduction because of failure of closed reduction.Sixty-five cases were followed up for 8 to 23 months (mean,14.5 months).Bone union was observed in all cases with the average time of 7.4 months (range,8-23).The operation time,blood loss,the frequency of X-ray exposure was 75±4 minutes,135±5 ml and 24±3 times,respectively.At final follow-up,29 cases were classified as excellent,31 as good,and 5 as fair.The mean Harris hip score was 91.4 points (range,87-95).The overall rate of excellent or good result was 92.3％.Conclusion It is difficult to perform close reduction for unstable intertrochanteric hip fracture (AO/OTA type 31-A3.1and 31-A3.2),especially in relatively young patients.Special operative skills are necessary in some cases.
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Object To analyze reasons of complications induced by the clavicle hook plate in treatment of acute distal clavicle fractures and acute acromioclavicular joint dislocations,and to investigate corresponding solutions.Methods Seventy nine clavicle hook plates were facilitated in the treatment of acuteb distal clavicle fractures (47 cases) and acute high grade acromioclavicular joint dislocations (32 cases) from May 2006 to May 2009.There were 51 males and 28 females,with an average age of 42.6 years(range,15 to 78 years).Seventy eight patients underwent plate removal operation.Forty patients agreed to accept the CT examination to evaluate the acromion erosion around the plates.Among them,7 patients received further CT examination 3 months after the removal surgery.The shoulder function was evaluated by the constant scores at the final follow-up.Results All patients were followed up for at least one year (range,12 to 30 months).The mean duration for retaining the hook plate was 8.3 months with the mean Constant scores 92 points in the acute distal clavicle group; 7.2 months with the mean Constant scores 95 points in the acute acromioclavicular joint dislocation group.There were 8 kinds,totally 105 complications happened in 78 patients (98.7％).The complications were classified into four groups: (1) Due to the specific working mechanism of the plate(88/105,83.8％);(2) Due to the iatrogenic errors(12/105,11.4 ％);(3) Due to insufficiency design of the plate(3/105,2.9％);(4) Due to the etiology of the injury itself(2/105,1.9％).Conclusion The complication rate is unexpected higher.Most complications are unavoidable due to specific working mechanism of the plate.The patients should be well informed about this preoperatively in order to avoid the possible legal trouble.The iatrogenic errors can be avoided with proper indications and improved surgical techniques.The design of the plate needs to be improved,and the hook plate should be removed as early as possible.
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The purpose of this study was to evaluate the feasibility and clinical outcome of using an oblique AO [Association for the Study of Internal Fixation] metaphyseal locking compression plate [MLCP] in the treatment of adult extra-articular distal humeral diaphyseal fractures via a posterior approach. A series of 19 cases of adult extra-articular distal humeral diaphyseal fractures were surgically treated using an MLCP and lag screws, if necessary, via a posterior approach. All patients were followed for a mean time of 16.6 months [range from 12 to 20 months]. The patients were followed up to 1 year, and radiological assessment was performed to observe fracture reduction and healing. Functional outcome was measured including the range of motion of the shoulder and elbow, by the University of California at Los Angeles and the Mayo Elbow Performance Score. The incidence of iatrogenic radial nerve palsy was 5%. There was no failure of internal fixation and no infection. After 1 year, the University of California at Los Angeles scoring system rated 12 [63.2%] patients as excellent results. The Mayo elbow performance scoring system rated 10 [84%] cases as excellent results. Completely normal alignment was presented in 16 cases. Following surgical treatment of adult extra-articular distal humeral diaphyseal fractures, an oblique MLCP applied via a posterior approach achieved an adequate internal fixation and obtained an excellent functional outcome
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To determine whether using a fixed-angle locked plate plus a fibular strut autograft to treat humeral surgical neck nonunions can result in improved union. Patients and Methods: The study cohort included 5 females and 2 males with an average age of 58.4 years [range 45-76] who presented with atrophic nonunion of the surgical neck of the humerus. All patients underwent revision surgery with locked plating plus a nonvascularized autologous fibular strut bone graft. Clinical and radiological union was documented in all patients. The mean time from initial trauma to last revision surgery was 20.1 +/- 12.6 months [range 12-48]. The average time between revision surgery and the date of union was 6.1 months [range 5-8]. The average active forward flexion was 124° [range 70-160] at final follow-up. The Constant-Murley score increased from an average of 25.7 points preoperatively to 77.7 points postoperatively [p < 0.001]. The average analog scale of pain decreased from 7.57 points [range 6-10] preoperatively to 0.57 points [range 0-2] postoperatively [p < 0.001]. Locked plate fixation and autologous fibular strut bone graft facilitated the successful treatment of humeral surgical neck nonunions
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Objective To construct the clinical database on pelvic trauma life cycle so as to provide reference for epidemiological investigations and development of pelvic damage control plan. Methods The existing pelvic trauma data of the hospital information system was analyzed to discuss the main evaluation indicators and data types at different stages, including basic data, injury severity index, underlying disease, fracture classification, specialist treatment, rehabilitation and follow-up information. Results Based on the V3.0 trauma scoring system, the clinical pelvic trauma ACCESS database was developed. The data of 588 patients with pelvic trauma were collected from November 2007 to May 2009 and preliminarily analyzed. Conclusions Clinical database of pelvic trauma can be used as the specific modules of general network trauma database system and a large-scale, multi-center and standard pelvic trauma database may play an important role in preparation of the prospective damage control plans.
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ObjectiveTo evaluate the technique and clinical outcomes of supra-acetabular external fixation in treating pelvic fractures associated with injuries of abdominal organs.MethodsThere were 17 cases of pelvic fractures associated with injuries of abdominal organs.Nine were males and 8 were females,with the average age of 42 years(range,21-75 years).The injury was caused by traffic accident in 9 cases,fall-down from height in 4,and crush by heavy objects in 6.According to Tile classification of pelvic fractures,7 were type B1,3 were type B2,2 were type B3,4 were type C1 and 1 was type C2.Fifteen cases suffered with hemorrhagic shock,2 with perineal injury and 12 with fractures of the limbs.All patients were treated with supra-acetabular external fixation and the outcomes were evaluated by Cole's clinical scoring,Matta and Tornetta's radiographic standards.ResultsAll 17 cases were followed up with the mean period of 6.5 months (range,2-18 months).The average time of operation was 15 min (range,9-25 min).The mean blood loss was 17 ml(range,5-25 ml).All fractures healed and the mean healing period was 9.2 weeks (range,8-12 weeks).Three had transient palsy of lateral femoral cutaneous nerve.Five had soft tissue infection while the bony structures were not involved.According to Cole's scoring for pelvic fractures,15 cases were excellent,1 case was good and 1 case was fair,with the good-excellent rate of 94.12％.According to Matta and Tornetta's standards of fracture reduction,12 were excellent,3 were good and 2 were fair,with the good-excellent rate of 88.24％.ConclusionSupra-acetabular external fixation is a minimal invasive and convenient method for treating pelvic fractures with abdominal organs injury which is mechanically stronger than traditional external fixation via iliac crest.
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To investigate whether or not reconstruction of the medial cortex in subtrochanteric fracture can reduce the risks of internal fixation failure, fracture malunion, and nonunion. Between 2005 and 2008, 46 patients with subtrochanteric fracture were treated with intramedullary nailing and followed up. The average age was 42 years. According to the Seinsheimer classification, 26 patients were type IIIA, 7 were type IIIB, 11 were type IV and 2 were type V. Medial cortex alignment was achieved under traction in 40 cases. In 5 cases, the medial fractures were too far away and we used minimally invasive open reduction with wire or titanium cable cerclage. In 1 case of type IIIA subtrochanteric fracture, the displaced medial fracture was not reconstructed and was fixed with a long Gamma nail. We reviewed all patients' radiographs before and after treatment to evaluate bone healing. The 46 patients were followed up for an average of 24.3 months. Bone union was achieved within an average of 18.7 weeks in 45 cases. One case, a type IIIA fracture nonunion with displaced medial fracture, was not reconstructed. Instead, we used a free fibular transplantation on the medial side and fracture union was achieved 6 months after revision surgery. In reconstructing the medial cortex in subtrochanteric fracture treatment, continuity and integrity are important. They can reduce the failure of internal fixation and the incidence of nonunion