Be alert to insidious fracture-related infections secondary to severe open fractures / 中华创伤骨科杂志

Objective:To report our experience in using the Ilizarov technique to treat bone defects secondary to Gustilo Ⅲb open tibial fractures with negative clinical signs and serological inflammatory markers.Methods:A retrospective study was performed to analyze the 19 patients with bone defects secondary to Gustilo Ⅲb open tibial fracture who had been treated at Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital between January of 2010 and June of 2021. They were 15 males and 4 females with an age of (41±11) years. Their inclusion criteria: undergoing treatment with Ilizarov technique (consecutive compression-distraction or bone transport), soft tissue coverage procedures resulting in wound closure and negative clinical infection signs for at least 3 months and normal serological inflammatory markers, and follow-up for more than 3 months after frame removal. Three-phase bone scan was performed for the patients before the present surgery. Debridement, sampling of deep tissues for bacterial culture, and external stabilization with a fixator were performed in the present surgery. Osteotomy for compression-distraction or bone transport technique was carried out at 1 stage or 2 stages. Systemic antibiotic therapy for 6 weeks was continued for those with positive microbiological analysis guided by antibiogram. Recorded were results of intra-operative pus detection around defects, microbiological findings, length of bone defect reconstructed, rate and time of infection recurrence during treatment, fracture union rate, bone healing index, bony and functional results.Results:The interval between primary injury to the present surgery was (10±8) months. The preoperative three-phase bone scan showed infection free in 8 cases, chronic osteomyelitis in 7 cases, and suspicious infection in 4 cases. No pus was found during intra-operative debridement in all. The intra-operative microbiological detection was positive in 1 sample in 1 patient (infection free indicated by bone scan), and in ≥2 samples in 3 patients (bone scan indicating non-infection, infection not excluded and osteomyelitis in 1 case each). The length of bone defect reconstructed was (8±3) cm. The follow-up after the present surgery was (37±15) months. Fracture union was achieved in all cases, with a bone healing index of (1.7±0.5) months/cm. Clinical infection signs were observed 1 (1, 1) month after the present surgery in 6 patients whose microbiological results were all negative. All the 6 patients ended up with no clinical recurrence after empirical use of systemic antibiotics in 5 and radical debridement in one. The bony results showed 16 excellent and 3 good cases while the functional results showed 10 excellent and 9 good cases.Conclusions:In treatment of bone defects secondary to Gustilo Ⅲb open tibial fractures with negative clinical signs and serological inflammatory markers, constant vigilance is needed against low-grade infection. Intra-operative multiple sampling of deep tissues with a standardized protocol and microbiological testing are extremely valuable for diagnosis of fracture-related infections.

Effect of Sishenwan on PI3K/Akt/mTOR Signal Pathway in Colonic Tissue of Rats with Ulcerative Colitis Model of Spleen Kidney Yang Deficiency / 中国实验方剂学杂志

Objective:To discuss the effect of Sishenwan on phosphatidylinositol-3 kinase/protein kinase B/mammalian target of rapamycin（PI3K/Akt/mTOR） signaling pathway related genes and proteins in colon tissue and interleukin-1<italic>β</italic>（IL-1<italic>β</italic>） and interleukin-10（IL-10） expression levels in serum of ulcerative colitis （UC） model rats with spleen kidney Yang deficiency. Method:The 120 SPF Wistar rats were randomly divided into normal group and model group after 7 days of adaptive feeding in SPF laboratory. The model group were given dinitrobenzene sulfonate （DNBS）/ethanol solution enema+hydrocortisone subcutaneously injection+senna leaf gavage to establish UC model of spleen kidney yang deficiency. The rats who successfully established the model were randomly divided into five groups：model group， mesalazine （0.36 g·kg^-1） group， and Sishenwan high， medium and low dose （3.2，1.6，0.8 g·kg^-1） groups， the volume of which was 10 mL·kg^-1. The model group and the blank group were given distilled water of the same volume. Once a day for 21 days. Observe the general conditions of the rats daily， and record the weight， fecal traits and occult blood of the mice for disease activity index （DAI） scoring.Take the rat colon tissue to observe the gross morphology and colon injury， and score the colon mucosal injury index （CMDI）. Hematoxylin-eosin （HE） staining was used to observe pathological changes. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）was used to detect the expression level of PI3K， Akt， mTOR mRNA in colon tissue. The levels of IL-1<italic>β</italic> and IL-10 in serum were detected by enzyme-linked immunosorbent assay （ELISA）. Western blot was used to detect the expression level of PI3K， phosphorylation （p）-PI3K， Akt， p-Akt， mTOR， p-mTOR protein in colon tissue. Result:Compared with blank group， the general survival status of the rats in model group was relatively poor， the DAI score and the CMDI index were significantly increased （<italic>P<</italic>0.01）. The intestinal mucosa partially disappears， the glands disappear， and a large number of inflammatory cells infiltrate and gather in the mucosal layer and the base layer in the pathological sections of the model group. The expression levels of PI3K， Akt， and mTOR mRNA were significantly increased （<italic>P</italic><0.01）. The IL-1<italic>β</italic> content was significantly increased and the IL-10 content was significantly decreased （<italic>P</italic><0.01）. The expression levels of p-PI3K，p-Akt and p-mTOR protein were significantly increased （<italic>P</italic><0.01）. Compared with the model group， the DAI scores of Sishenwan high and medium dose groups and mesalazine group decreased （<italic>P</italic><0.05）. The CMDI index of mesalazine group and the high， middle and low dose groups of Sishenwan was significantly reduced （<italic>P</italic><0.01）. Pathological sections of rats showed that the inflammatory cells in the drug group decreased， and the mucosal layer structure returned to normal to varying degrees. The mesalazine group and the Sishenwan medium-dose group had the best effects， and the mucosal structure was close to the blank control group. The expression levels of PI3K， Akt， mTOR mRNA in the high and medium dose groups of Sishenwan， mesalazine group and Akt mRNA in low dose group of Sishenwan were significantly reduced （<italic>P</italic><0.05，<italic>P</italic><0.01）. The expression levels of PI3K and mTOR mRNA in low-dose group of Sishenwan decreased， but the difference was not statistically significant. The IL-1<italic>β</italic> content was significantly reduced and the IL-10 content was significantly increased in high， medium dose groups of Sishenwan and mesalazine groups （<italic>P</italic><0.05，<italic>P</italic><0.01）. The level of IL-1<italic>β</italic> decreased and the level of IL-10 increased in the low-dose group of Sishenwan， but the difference was not statistically significant. The expression levels of p-PI3K， p-Akt and p-mTOR protein in the high， medium， and low dose groups of Sishenwan and mesalazine group decreased to varying degrees， and the differences were statistically significant（<italic>P</italic><0.05，<italic>P</italic><0.01）. Conclusion:Sishenwan has the effect of improving the general condition and intestinal mucosal damage of ulcerative colitis model rats with spleen and kidney Yang deficiency. The mechanism may be related to the inhibition of PI3K/Akt/mTOR signaling pathway.

The treatment of nonunion of femoral shaft fractures after intramedullarynaildynamizationwith temporary compression using external fixator followed by relocking of the internal intramedullary nail / 中华骨科杂志

Objective To introduce the technique we invented to treat hypertrophic and oligotrophic nonunion of femoral shaft fracture after dynamization of intramedullary nail (IMN) and to report its preliminary results.Methods The data of 2 cases with hypertrophic nonunions of femoral shaft fracture and 1 case with oligotrophic nonunion following IMN dynamization who had been treated by the technique from March 2006 to July 2017 in Beijing Jishuitan hospital were retrospectively studied.There were 2 females and 1 male,aged 50,66 and 24 years old.2 parallel half pins were inserted from anterior to posterior at the trochanteric and condylar zones of the femur for antegrade intramedullary nailing patients,and from lateral to medial sides for retrograde intramedullary nailing patient respectively,then the pins were connected with monolateral limb reconstruction fixator.The fracture nonunion site was compressed by the fixator up to 10-15 mm.The holes at the end of intramedullary nail where their screws were removed for dynamization were locked again with 2 locking screws,and then the frame was removed.The patients are allowed to start their rehabilitation and fully bear their body weight 1 day after the operation.Results The three patients were followed up for 25,22,and 7 months after the surgery,respectively.The X-ray films showed the fracture healed at 7 months in two case,and at 12 months in one.One patient got her nail removed 25 months after the operation,feeling good 37 months after the removal.Conclusion This technique is an option to manage the hypertrophic and oligotrophic fracture nonunion of the femur after dynamization of IMN.It is mini-invasive to the nonunion site,easy to practice and allows early rehabilitation.

Management of tibia deformity with fixator assisted nailing technique / 中华骨科杂志

Objective@#To discuss the result of treating tibia deformity with fixator assisted nailing technique (FAN).@*Methods@#A total of 5 patients with 7 limbs of tibial deformity-were treated with FAN technique. Etiology: 2 patients with bilateral tibial deformity suffered from Ricket's disease, 2 patients were malunion after tibial fracture, 1 patient was congenital pseudoarthrosis of tibia. This is a retrospective study. The unilateral external fixator was mounted on the medial side of tibia, and thenthe minimal invasive osteotomy was performed. After the deformity was corrected, the intramedullary nail was inserted to fix the tibia. None of the patients need bone autograft. The pre-operation and post-operation medial proximal tibia angle (MPTA), mechanical axis deviation (MAD) and range of motion (ROM) were measured and analyzed.@*Results@#All the 5 patients were followed-up for 12-60 months (average 32 months). The osteotomy site united in 3-5 months (average 4.5 months) post-operatively. According to Paley’s imaging scores, 4 patients were excellent and 1 patient was good. According to Paley's functional result scores, 5 patients were excellent; according to Paley’s bone results evaluation, 4 patients were excellent and 1 patient was good. We achieved desired post-operative MAD (from medial 15 mm-lateral 10 mm) in 6 limbs. The MPTA in 7 limbs was corrected to normal (84°-90°). The ROM was not significantly changed before and after operation. The average ROM of knee before operation was 125°(120°-135°), and average postoperative ROM was 120°(115°-130°), No deep infection or neurovascular injury occurred. All patients were satisfied with the method and results of the operation.@*Conclusion@#FAN technique combines the advantage of external fixation and intramedullary nail, and it is a good method to treat tibial deformity, the patient should be carefully evaluated and selected for applying this technique.

Management of tibia deformity with fixator assisted nailing technique / 中华骨科杂志

To discuss the result of treating tibia deformity with fixator assisted nailing technique (FAN). Methods A total of 5 patients with 7 limbs of tibial deformity?were treated with FAN technique. Etiology: 2 patients with bilater?al tibial deformity suffered from Ricket's disease, 2 patients were malunion after tibial fracture, 1 patient was congenital pseudoar?throsis of tibia. This is a retrospective study. The unilateral external fixator was mounted on the medial side of tibia, and thenthe minimal invasive osteotomy was performed. After the deformity was corrected, the intramedullary nail was inserted to fix the tibia. None of the patients need bone autograft. The pre?operation and post?operation medial proximal tibia angle (MPTA), mechanical axis deviation (MAD) and range of motion (ROM) were measured and analyzed. Results All the 5 patients were followed?up for 12-60 months (average 32 months). The osteotomy site united in 3-5 months (average 4.5 months) post?operatively. According to Paley’s imaging scores, 4 patients were excellent and 1 patient was good. According to Paley's functional result scores, 5 patients were excellent; according to Paley’s bone results evaluation , 4 patients were excellent and 1 patient was good. We achieved de?sired post?operative MAD (from medial 15 mm-lateral 10 mm) in 6 limbs. The MPTA in 7 limbs was corrected to normal (84°-90°). The ROM was not significantly changed before and after operation. The average ROM of knee before operation was 125° (120°-135°),and average postoperative ROM was 120°(115°-130°),No deep infection or neurovascular injury occurred. All pa?tients were satisfied with the method and results of the operation. Conclusion FAN technique combines the advantage of exter?nal fixation and intramedullary nail, and it is a good method to treat tibial deformity, the patient should be carefully evaluated and selected for applying this technique.

Medial submuscular plating of the femur after limb lengthening and correction with frame in patients with limb length discrepancy and/or angular deformity / 中华创伤骨科杂志

Objective To evaluate the medial submuscular plating of the femur after limb lengthening and correction with frame in patients with limb length discrepancy and/or angular deformity.Methods A retrospective study was conducted involving 12 patients who had been referred to Department of Orthopaedic Trauma,Beijing Jishuitan Hospital from December 2009 to November 2016 for limb length discrepancy and/or angular deformity.They were 3 males and 9 females,with an average age of 23 years (from 14 to 32 years).Altogether 4 left and 8 right sides were involved.Of them,11 got their length discrepancy and/or angular deformity secondary to injury to distal femoral epiphyseal plate caused by trauma in their childhood and one had length discrepancy and angular deformity following unsuccessful conservative treatment of superior condylar fracture of the femur.The femoral shortening ranged from 3 to 11 cm (average,6.7 cm),and the varus or valgus deformity of the knee ranged from 8° to 18° (average,12°).First,a monolateral fixator was installed on the lateral femur.The limb was lengthened from 7 to 14 days after diaphysis osteotomy.Femoral supracondylar osteotomy was conducted again in patients with knee angular deformity after the lengthening reached the expected length and the deformity was corrected with the aid of external fixator.After medial submuscular plating via the femoral lateral approach using minimally invasive techniques,the external frames were removed.The time for plate removal,limb lengthening and correction of the varus or valgus deformity were documented.Results The mean follow-up was 31 months (from 23 to 43 months) for the 9 patients who had their plates still in situ,and 6.5 months (from 2 to 14 months) for the 3 patients who had subsequently their plates removed.None had blood transfusion.All underwent distraction osteogenesis of the femur to their preoperatively expected length,ranging from 3 to 9 cm (mean,6.2 cm).Both varus and valgus deformities were corrected.None developed a deep infection.The range of motion of the knee joint was similar to that before operation in all but one patient who had a range of motion 40° less than the pre-operative one.The time for external fixation averaged 91 days (from 46 to 113 days),with an external index of 22 d/cm.All patients were satisfied with their outcomes.Conclusion Medial femoral submuscular plating after limb lengthening and angular deformity correction with the external fixator on the lateral side is a useful technique for patients with femoral limb length discrepancy and/or angular deformity,significantly shortening the time for external fixation.

Management of valgus or varus knee deformity with fixator assist nailing technique and distal femur osteotomy / 北京大学学报(医学版)

Objective:To discuss the result of treating valgus or varus knee deformity with fixator assist nailing (FAN)technique and distal femur osteotomy(DFO).Methods:In this retrospective study,14 patients with 17 limbs,12 valgus and 5 varus knee deformity were treated with DFO and FAN.The aver-age age of the patients was 23 (17-44)years .The unilateral external fixator was mounted on the lateral side of femur,the minimal invasive distal femoral osteotomy was performed.After the deformity was cor-rected,the intramedully nail was inserted to fix the femur.None of the patients need bone autograft.The preoperation and postoperation lateral distal femur angle (LDFA ),mechanical axis deviation (MAD ) and range of motion (ROM)were measured and analyzed.Results:All the 14 patients were followed-up for 12 -72 months (average 34 months).The osteotomy site united in 3 -5 months (average 3.5 months)post-operatively.According to Paley’s functional scores,12 patients were excellent,2 patients were good.We achieved desired postoperative MAD (from medial 15 mm to lateral 10 mm)in 15 limbs of 12 patients.The LDFA in 1 1 limbs was corrected to normal (84°-90°).The ROM was not signifi-cantly changed before and after operation in the both groups.No infection or neuro-vascular injury oc-curred.Conclusion:The FAN technique is an effective method to treat valgus knee or varus knee de-formity in young patients with DFO.

Tibiotalar or tibiocalcaneal arthrodesis using the ilizarov technique in the presence of infected nonunions of ankle joints / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the results of managing the infected nonunions of distal tibial fractures combined with talar fracture and calcaneal fracture with tibial bone transport, tibiotalar or tibiocalcaneal arthrodesis using the hybrid external fixator.</p><p><b>METHODS</b>A retrospective review of 26 patients who underwent either tibiotalar arthodesis or tibiocalcaneal arthodesis using an hybrid external fixator for infected nonunions of distal tibial fractures, talar and calcaneal fractures after tibial bone distraction was made. Each patient had a debridement of all infected and nonviable bones, the wound area were 2 cm×4 cm-4 cm×8 cm. The bony surfaces of distal tibia and talus were prepared for the fusion followed by application of an Orthofix's hybrid external fixator.</p><p><b>RESULTS</b>The remaining 18 patients undertook debridement at the docking sites, and 14 of them had autogenous bone grafting. There was a mean follow-up of 32 months (22-38 months). All the patients had successful fusions. There were no recurrent deep infections or amputations. Two patients had 6° of varus deformity at the docking site.</p><p><b>CONCLUSION</b>Tibiotalar or tibiocalcaneal arthrodesis using the Ilizarov technique is viable alternative to amputation in patients with infected nonunions,especially if there is a large bone loss of the tibias, talus and calcaneus.</p>

Management of nonunion of femoral shaft fracture and deformity of femur with fixator-assisted nailing / 中华骨科杂志

Objective To evaluate the effect of fixator-assisted nailing (FAN) technique for the treatment of femoral deformity,nonunion of femoral shaft fracture with deformity and malunion.Methods The data of 8 patients with nonunion of femoral shaft fracture with deformity,3 patients with femoral deformity caused by Rickets disease and 2 patients with femoral fracture malunion who received treatment FAN technique was retrospectively analyzed.There were 11 males and 2 females,with an average age of 33 years (range,16-50 years).One-stage operation was used in 10 patients:after the fracture was distracted and reduced with external fixator,an intramedullary nail was used for final fixation.Two-stage strategy was used in 3 patients.Unilateral external fixator was used in 12 patients,ring fixator was used in 1 patient.Femoral intramedullary nailing was used in 8 patients,retro-femoral intramedullary nailing was used in 5 patients; autograft from callus of fracture site was used in 1 patient.Results The 12 patients were followed up for 12-48months with an average of 21 months.The fractures of 7 patients united 3-6 months (average,3.9 months)later after the operation.The osteotomy site of 5 patients united 3-5 months (average,3.5 months) later after the operation.The results were evaluated according to the Paley classification of functional results.There were 9 cases rated as excellent,2 as good and 1 as fair.The lower leg discrepancy (LLD) before and after operation was (48.2±23.0) mm and (27.3±24.6) mm,individually; the length of limb increased 4.6-41.0 mm (average,23.3 mm).The pre-and post-operative MAD was (27.5±24.4) mm and (6.3±8.3) mm.There was no neurovascular injury or infection occurred in any of the patients.All the patients were satisfied with the result of treatment.Conclusion FAN technique combines the accuracy,minimal invasiveness and safety of external fixation together with patient compliance of IM nail.It is an effective method to manage nonunion of femoral shaft fracture with deformity,malunion of femur,and femoral deformity cause by rickets.

Antitumor effect of capsaicin on colorectal carcinoma xenograft in nude mice / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the effect of capsaicin on nude mice xenografted with colorectal carcinoma cells, and to explore its mechanism of action.</p><p><b>METHODS</b>A nude mouse model of colorectal cancer was established by subcutaneous inoculation of human colorectal carcinoma HT-29 cells. Terminal deoxynucleotidyl transferase-mediated nicked labeling assay (TUNEL) was undertaken to detect the cell proliferation and apoptosis in the xenograft tissue in nude mice. Immunohistochemical (IHC) staining and Western blot were used to detect the expression of HSP27, Cyt-C and active caspase-3.</p><p><b>RESULTS</b>The tumor growth of the groups C10 and C20 was significantly slower than that of the group NS. The integrated optical density (IOD) of both the group C5 (2532.14 ± 578.11) and group C10 (6364.03 ± 1137.98) was significantly higher than that of the group NS (760.12 ± 238.05), (P < 0.05). The integrated optical density (IOD) of the group C20 was (15743.96 ± 1855.95), significantly higher than that of the groups C10, C5 and NS (all were P < 0.01). Immunohistochemistry showed that the cytoplasmic expression of HSP27 was strongly positive in the group NS, and significantly reduced with the increasing dose of capsaicin in the treated groups. The expression of active caspase-3 and Cyt-C in the group NS was weakly positive, and was significantly increased with the increasing dose of capsaicin in the groups C5 and C10 (P < 0.05), and the expression of active caspase-3 and Cyt-C of the group C20 was significantly higher than that of the groups C5, C10 and NS (P < 0.01). Western blot analysis showed that both the expressions of HSP27 of the group C5 (0.73 ± 0.05) and the group C10 (0.41 ± 0.03) were significantly lower than that of the group NS (P < 0.05). The expression of HSP27 of the group C20 (0.22 ± 0.06) was significantly lower than that of the groups C5, C10 and NS (P < 0.01). The expressions of active-caspase-3 and Cyt-C in the group C5 were (2.57 ± 0.34) and (2.03 ± 0.38), significantly higher than those of the group NS (P < 0.05). The expressions of active-caspase-3 and Cyt-C in the group C10 were (4.23 ± 0.45) and (3.13 ± 0.44), also significantly higher than those of the group NS (P < 0.05). The expressions of active-caspase-3 and Cyt-C in the group C20 were (5.78 ± 0.48) and (4.92 ± 0.52), significantly higher than those of the group C5, C10 and NS (P < 0.01). TUNEL analysis showed that there was a significant difference of cell apoptosis in comparison of each two groups. The higher dose of capsaicin was used, the more apoptosis was observed.</p><p><b>CONCLUSIONS</b>Capsaicin can significantly inhibit the tumor growth and induce cell apoptosis in the colorectal carcinoma xenograft in nude mice. Its mechanism of action is possibly related with the down-regulation of HSP27 expression and up-regulation of expression of active caspase-3 and Cyt-C in the colorectal carcinoma xenograft in nude mice.</p>

Management of postt aumatic flexion contracture in knee joint using Ilizarov technique / 中华骨科杂志

ObjectiveTo evaluate the effectiveness of correction of posttraumatic flexion contracture of knee(FCK) using Ilizarov technique.MethodsSix male patients with posttraumatic FCK,aging from 9 to 43 years(mean,24.5 years),treated by using Ilizarov technique from January 2006 to December 2010,were retrospectively analyzed.The preoperative flexion deformity of knee ranged from 35° to 85° (mean,47.6°),and the range of motion ranged from 0° to 70° (mean,15.8°).Among them,five patients had old fracture of knee joint combined with equinus foot deformity (deformity ranging from 25° to 37°,with an average of 31.8°); one patient had femoral supracondylar fracture.We used circular external fixator to correct the FCK and equinus foot deformity gradually,the knee arthrodesis operation was performed in 4 patients because of the damaged hone structure and poor soft tissue condition.ResultsAll patients were followed up for 12-22 months(mean,18 months).The flexion of knee joint was recoverd from preoperative 47.67°±18.63° to postoperative 9.33°±3.50°.Plantar flexion of ankle joint in five equinus foot deformity was recovered from preoperative 31.80°±4.65° to postoperative 3.00°±4.47°.The kuee joint was arthrodesised successfully in 4 patients and the other 2 patients got 30° and 75° ROM.All the patients can walk with a cane,and satisfied with the result of treatment.Pin-site infection was found in 4 patients and was controlled within two weeks.ConclusionIlizarov technique is an effective treatment method for posttraumatic FCK.Knee arthrodesis should be performed when patients had damaged bone structure and poor soft tissue condition.

Management of partial bone defect by a bone transport method using unilateral external fixator / 中华骨科杂志

Objective To evaluate the effect of a bone transport method using unilateral external fixator in treatment of partial bone defect.Methods Three patients with partial bone defect were reviewed,including 2 males and 1 female,and whose ages were 50,50,and 24 years,respectively.The defects were at medial part of the left proximal tibia in 2 cases.In the first case,the defect was 5 cm in length,1/3-2/3 of transverse diameter in width,with a 5 cm×3 cm skin loss.In the second case,the defect was 6 cm in length and 3 cm in width.For the remaining patient,the bone defect was located in lateral part of the right femur,which was 13 cm in length,1/3-2/3 of transverse diameter in width,with a 15 cm×7 cm scar on it.After debridement of the wound,the Orthofix's limb reconstruction external fixation system was mounted medially,initially with 2-3 HA coated screws in the middle clamp to anchor the near cortex of the segment to be transferred.A partial corticotomy was performed with multiple drill hole technique.The gradual segment transport was started 2 weeks after the operation at a rate of 1 mm/d,4 times/d.Results The follow-up time was 14,28 and 24 months,respectively.The external fixator was removed 8 and 6 months after the osteotomy in 2 patients,when radiographs demonstrated bony union of the docking site as well as mature consolidation of the generated callus.The range of motion of hip,knee,ankle on the injured side was similar to the uninjured side.The segment was unable to be transported successfully in the femur,because the compressiondistraction device was misused.Two months after the first operation,the osteotomy was performed at the same site for the second time.The frame was removed at 10 months after the second osteotomy when the new bone formed well and the fracture healed at the docking site.The patient was able to stand independently and walk with a stick at 17 months after the osteotomy.At the latest follow-up,there was no sign of osteomyelitis.Conclusion Bone transport method using unilateral external fixator is a practical option to treat partial bone defect.In addition to shorten the period with fixator,it can avoid malunion and donor injury.

A rare case of tricuspid valve thrombus with acute pulmonary embolism / 中华医学杂志(英文版)

The development of thrombus on the tricuspid valve is very rare. This report describes a case of acute pulmonary embolism (PE) with a mass on the tricuspid valve in a normal heart, detected by bedside transthoracic echocardiography (TTE). After successful surgical management, the histopathological examination revealed the mass from the tricuspid valve to be mixed thrombus. The early use of bedside TTE can facilitate the prompt diagnosis and aggressive therapy when PE is suspected.

Posterior monteggia fracture-dislocations of proximal ulna / 中华外科杂志

<p><b>OBJECTIVES</b>To discuss the diagnosis and differential diagnosis, and to establish an effective protocol to treat the posterior Monteggia fracture-dislocations of proximal ulna in adult according to our experience.</p><p><b>METHODS</b>Between April 2004 and December 2007, 16 patients with posterior Monteggia fracture-dislocations were treated surgically, 13 were followed up at a mean of 28 months (range, 12 - 58 months). All the operations were through the posterior midline approach. The fractures of radial head and coronoid process were reduced and fixed, if possible. The proximal ulna fractures were fixed with a single plate in 7 cases, plate combined with K-wires in 2, plate combined with K-wires tension band in 3, and K-wires tension band combined with screws in 1.</p><p><b>RESULTS</b>No elbow was painful or unstable at the last follow up examination. They had an average of 100 degrees (range, 0 degrees to 145 degrees ) of flexion-extension of elbow. The average motion of forearm rotation was 119 degrees (range, 0 degrees to 170 degrees ). The mean Mayo Elbow Performance Score (MEPS) was 93.1 points (67 - 100 points), excellent and good results were achieved in 92.3%. The mean system of Broberg and Morrey score was 88.8 points (53 - 100 points), excellent and good results were achieved in 76.9%.</p><p><b>CONCLUSIONS</b>Attention should be paid to the diagnosis and differential diagnosis of the posterior Monteggia fracture-dislocation of proximal ulna. Anatomically reduction and stable fixation of proximal ulna is the keystone for the surgical treatment.</p>

Reconstruction of ACL with free autogenous B-PT-B grafts / 中华骨科杂志

Objective To investigate the characteristics of grafts after reconstruction of ACL with autogenous bone-patellar tendon-bone(B-PT-B)grafts. Methods Reconstruction of anterior cruciate ligament with free B-PT-B autograft fixed with interference screw was performed on 39 adult dogs. Mechanical testing was conducted on the grafts by translating the tibia anteriorly with the knee in 90 degrees of flexion, until complete failure. Failure site, cross sectional area, strength, stiffness and stress were documented. After decalcification and HE staining, the transformation of the intra-tunnel and intra-articular ligaments was evaluated, and the histological observation was conducted for the healing in the bone-tunnel, patellar tendon-tunnel and bone-patellar tendon interface. Results Union occurred in the bone-tunnel interface at 4th week. The patellar tendon-tunnel interface was linked by Sharpey's like fibers at 52nd week, the cement line and the tendency of chondrocyte lining were found. Mechanical testing of graft revealed that the rupture always occurred at mid-portion of ligaments instead of pulling-out from the tunnel under tension stress. Compared with the control group, the strength, stiffness and stress of the graft were 38%, 58% and 50% of normal anterior cruciate ligament at 52nd week respectively. Conclusion The union in the bone-tunnel interface occurs at 4th week, much earlier than the healing of the patellar tendon-tunnel interface. The healing of the tendon to tunnel presents to be indirect insertion at 52nd week with alignment of chondrocytes, which signifies the still ongoing of healing process at the interface. After fixation with interference screw for 4 weeks, the tendon proved to be the weakest part in bone-tendon-bone complex. No need to worry about the biomechanical character of the new insertion site during rehabilitation activities. The attachment fixed by interference screw is stable not only immediately after surgery but also during the healing of the insertion and the transformation of ligament. One year after reconstruction, the mechanical quality of the grafted tendon still remains inferior to that of normal anterior cruciate ligament in spite of similar histological structure. Protective device should be recommended during active activity.