ABSTRACT
Objective To investigate the characteristics,trauma mechanism and treatment of the hyperplantarflexion ankle fracture variant.Methods Between January 2013 and June 2015,125 consecutive patients with ankle fracture received operative treatment.In 18 of them,the ankle joint had been subjected to excessive violence of plantarflexion.They were 6 males and 12 females,aged from 15 to 67 years (average,47.6 years).Their pre-operative ankle radiographs showed sagittal ankle instability and posterior ankle dislocation or subluxation.The injury was complicated with medial malleolus fracture and fibular fracture.Posterolateral approach or posterolateral and posteromedial approach was adopted to treat the patients.Lag screws and anti-glide plates were applied.Results All the 18 patients were followed up for 10 to 25 months (average,16.8 months).All their fractures healed after 11 to 16 weeks (average,13 weeks).Superficial skin necrosis occurred in one patient undergoing dual-plate fixation of the dual malleoli but responded to change of dressing 3 weeks later.No screw loosening,fixation breakage or failure,nonunion or malunion happened.Their final follow-ups showed an average American Orthopedic Foot Ankle Society score of 94.8 ponits (from 76 to 100 points),yielding 13 excellent and 5 good cases (an excellent to good rate of 100％).Conclusions The hyperplantarflextion ankle fracture variant is caused by excessive violence of planter flexion to the ankle joint,with the force on the sagittal plane going from anteriorly to posteriorly,resulting in posterior talar displacement.Its treatment should vary from that for other ankle fractures because it has its own characteristics.Appropriate treatment may lead to satisfactory outcomes.
ABSTRACT
Abdominal compartment syndrome (ACS) has been increasingly recognized as a cause for significant morbidity and mortality in many diseases.Great advances have been made in many researches that are dedicated to the treatment of ACS.However,in the field of orthopedics,it has still not aroused enough attention from the orthopaedic surgeons,as the occurrence and development of ACS are occult following pelvic fracture trauma.This review introduces the relevant data and researches about ACS resulting from pelvic fractures.
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Objective To discuss the efficacy of the modified subinguinal approach for the treatment of acetabular anterior column and wall fractures.Methods A clinical retrospective study was performed of the 5 patients who had been treated at our department from January 2011 to April 2015 for acetabular anterior column and wall fractures and conformed to follow-ups.They were 3 males and 2 females,aged from 19 to 45 years (mean,35.6 years).The duration from injury to surgery averaged 7.6 days (range,from 4 to 10 days).The subinguinal ligament approach was adopted in the 5 cases,through which the inguinal ligament was preserved intact after sharp dissection of its insertion at the anterior superior iliac spine and medial-upper advancement,the advantage of expanded exposure of the first window by the Farid sub-ilioinguinal approach was retained,and additional lesions due to iliac osteotomy were avoided.The operation time,intraoperative bleeding,postoperative reduction and time for fracture union were documented.Merle d' Aubigne and Postel scoring system was used to assess the hip joint function of the affected limb at the final follow-ups.Results The operation time ranged from 110 to 150 minutes (mean,125 minutes);the intraoperative bleeding ranged from 415 to 550 mL (mean,450.2 mL).By the Matta's criteria,the postoperative reduction was rated as excellent in 4 cases and good in one.The 5 patients were followed up for an average of 32.4 months (range,from 6 to 43 months).Their fractures united clinically after an average of 4.6 months (range,from 3 to 6 months).The hip joint function was rated as excellent in 2 and good in 3 by the Merle d' Aubigne and Postel scoring system at the final follow-ups.Follow-ups observed no serious complications like inguinal hernia,internal fixation failure,myositis ossificans,or avascular necrosis of the femoral head.Conclusions As the modified subinguinal approach can provide a broad surgical exposure,lead to minimal injury to the inguinal ligament,avoid lesions caused by iliac osteotomy,and decrease operation time and bleeding,it may be a better approach for acetabular anterior column and wall fractures.
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Objective To analyze the complexity of molecular structure in porcine T cell receptor gene and its similarity compared to humans.Method Based on the gene of porcine T cell receptor alpha chain ( TCRα) from the Gen-Bank database, 93 swine T cell receptor alpha chain genes ( STA) were cloned by reverse transcription-polymerase chain reaction (RT-PCR) from porcine peripheral blood lymphocytes, lymph nodes and spleen.Result Sequence analysis showed that STA genes all contain a domain of variable signal peptide and V, hypervariable J and conservative C.Howev-er, nucleotide sequence of STA was not completely identical with only 68.4%to 98.7%homology among genes, and had extremely sophisticated polymorphism and diversity.This was accord with the genetic structure of TCRαchain.Molecular structure, genetic evolution and classification of these genes were carried out according to the homology of TCRαgene, which all have several sites and zones of mutation on the domain of signal peptide, FR1 and CDR1, FR2 and CDR2, FR3 and CDR3.Analysis of similarity and classification of TCRαV domain(STAV)and J domain (STAJ) of Hezuo minipig u-sing IMGT/V-QUEST tools compared with those of humans found the genetic evolution relationship that was closer, and each of TRAV and TRAJ also found to have a corresponding fragment of humans, ever in 92% of similarity of TRAV be-tween swine and humans.Conclusion Our results indicate that inbred Hezuo minipig possesses genetic diversity against complicated environment of microbes in healthy status, and Hezuo minipig is suitable as an animal model for research on human immunology and diseases.