Analysis of risk factors of infection for complex tibial plateau fractures after operation / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the risk factor of infection for complex tibial plateau fractures after operation.</p><p><b>METHODS</b>Totally clinical data of 293 patients with complex tibial plateau fractures underwent open reduction and internal fixation were retrospectively analyzed from September 2010 to March 2015, including 199 males and 94 females, ranging in age from 17 to 80 years old with an average of 47.3 years old. The possible risk factors such as gender, age, smoking, diabetes, type of fracture(open/closed), classification of open fracture(Gustilo-Anderson classification), classification of soft tissue injury in closed fracture (Tscherne-Gotzen classification), fracture classification(Schatzker V/VI), osteofascial compartment syndrome, ASA score, anesthesia, timing of surgery, operative time(<=150 min/>150 min), surgical approach, combined approach or not, internal fixation site were studied. The multivariate Logistic regression model was used to analyze the risk factors.</p><p><b>RESULTS</b>Twelve patients were infected of all 293 patients after operation, the infection rate was 4.10%. Univariate analysis showed that fracture type(χ ² =14.496,=0.001), fracture classification(χ²=4.560,=0.033), osteofascial compartment syndrome(χ²=15.631,=0.001), operative time(χ²=11.233,=0.001) were correlated with complex tibial plateau fractures postoperative infection. Multivariate analysis showed that open fractures(χ²=9.696,=0.002) and osteofascial compartment syndrome(χ²=9.119,=0.003) were complex tibial plateau fracture risk factors for infection after operation.</p><p><b>CONCLUSIONS</b>Open fractures and osteofascial compartment syndrome are risk factor of complex tibial plateau fracture for infection after operation. While through debridement for open fracture patients, early diagnosis and promt treatment for osteofascial compartment syndrome could reduce incidence of infection.</p>

Early diagnosis and treatment for trauma around the knee with popliteal vascular injury / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the early diagnosis and treatment for trauma around the knee with popliteal vascular injury.</p><p><b>METHODS</b>A retrospective analysis was employed to analyze the clinical data from 15 patients (9 males and 6 females were with a mean age of 39.2 years old,ranging from 26 to 62 years old) with fracture or dislocation around the knee with popliteal vascular injury from January 2007 to January 2013. Combined with clinical symptoms and signs, oxygen saturation monitors, color ultrasound, DSA angiography and interventional surgery were used to determine the vascular injury. The knee fracture and dislocation were fixed with hybrid external fixation and plate-screw fixation, respectively. Then, the blood circulation was reconstructed by thrombectomy, repair and autologous vein graft for individual injured vascular. The average total operation time, average hospitalization days, predictive salvage index (PSI), average blood transfusion amount, average medical expenses and infection cases were recorded to determine the effect of early diagnosis and treatment.</p><p><b>RESULTS</b>There was one patient with death, 8 patients with amputation, and 6 patients with successful repair surgery for popliteal artery, anterior tibial and posterior tibial arteries. These six patients with surviving limbs were followed up for an average of 28.3 months (ranged, 12 to 60 months). Among the 6 successful patients, the joint function of 4 patients was good and excellent.</p><p><b>CONCLUSION</b>The trauma around the knee with popliteal vascular injury is characterized by complex and serious injury, easy misdiagnosis and loss diagnosis, poor prognosis and high risk of amputation. The early diagnosis of trauma around the knee with popliteal vascular injury should depend on the mechanism of trauma, local anatomical characteristics of injury site, clinical presentations and appropriate auxiliary examinations. The appropriate indications for limb salvage and amputation should be used to achieve more effective clinical results.</p>

Case-control study on operative treatment for complex tibial plateau fracture / 中国骨伤

<p><b>OBJECTIVE</b>To explore optimal choice of surgical treatment and operative approach for closed complex tibial plateau fractures and its influencing factors.</p><p><b>METHODS</b>From January 2003 to January 2011, 95 patients with closed complex tibial plateau fractures were estimated Schatzker V and Vl, and treated with three different surgical methods. The methods included single plate through anterolateral incision (Group A, 22 cases), double plates through inside and outside incisions (Group B, 36 cases), and double plates through antero-midline incisions (Group C, 37 cases). There were 56 males and 39 females, ranged the age from 19 to 57 years (averaged, 36.3 years), 50 cases in left, 45 cases in right. According to Schatzker classification, 51 cases were type V, 44 cases were VI. The data of operation time, intraoperative blood loss, complications (infectious of wound, necrosis, bad incision, collapse fracture, loosen of internal fixation, fracture failure)and recovery of function of lower limb joint were collected.</p><p><b>RESULTS</b>There were no significant difference among three groups in operation time (P > 0.05); blood loss in group A was obvious better than other groups (P < 0.05); collapse of joint surface and failure rate of internal fixation in group A was higher than other groups (P > 0.05); Merchant score after 1 year were higher in group B, C than group A. For lower limb function, 10 cases got excellent results, 5 good, 4 fair and 3 poor in group A; 21 cases got excellent results, 11 good, 3 fair and 1 poor in group B; 23 cases got excellent results, 11 good,2 fair and 1 poor in group C.</p><p><b>CONCLUSION</b>The blood loss in group A was least, but fracture exposure and joint surface was not satisfactory, and stable fixation could not be achieved, the long-term result was not good. For fractures with double condyles and dislocated involved, double plates through inside and outside incisions or double plates through antero-midline incisions was suggested,which benefit good reduction of joint surface, stable fixation, and erlier exercise.</p>

Case-control study on MDCT and MRI for the diagnosis of complex fractures of tibial plateau / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical value of MDCT and MRI in the diagnosis and treatment of complex fractures of tibial plateau.</p><p><b>METHODS</b>From March 2004 to January 2009,71 patients with complex fractures of tibial plateau estimated Schatzker III, V and VI were included in the study. Their X-ray films, MDCT, MRI were analyzed and compared. Twenty-four patients (14 males and 10 females with a mean age of 33.6 years) were treated with double incision and single plate. Average follow-up period was 31.4 months. Twenty-one patients (12 males and 9 females with a mean age of 33.2 years) were treated with double incision and bilateral plates. Average follow-up period was 28.4 months. Twenty-six patients (17 males and 9 females with a mean age of 35.3 years) were treated with bilateral plates via genicular anterior midline incision. Average follow-up period was 28.4 months. The index such as diagnosis correction for fracture location, fracture comminuted degree,fracture displacement degree,bone defect degree,and positive ration for number of collapsed joint surface,injuries of cruciate ligament, collateral ligament and menisci of knee joint.</p><p><b>RESULTS</b>The satisfaction score of X-ray flims, MDCT and MRI were (1.04 +/- 0.20), (1.82 +/- 0.38) and (1.12 +/- 0.33) separately for fracture positions; (0.81 +/- 0.51), (1.92 +/- 0.26) and (0.83 +/- 0.60) separately for fractures comminuted degree; (1.23 +/- 0.48), (1.92 +/- 0.26) and (0.46 +/- 0.58) separately for fracture displacement degree; (0.36 +/- 0.51), (1.55 +/- 0.79) and (0.26 +/- 0.53) separately for bone defect; the number of patients having collapse of tibial articular surface were 6,61 and 12 separately; the number of patients having cruciate ligaments were 3,10 and 17 separately; the number of patients having menisci injuries were 0,0 and 6 separately;the number of patients having collateral ligament injuries were 1, 1 and 8 separately. MDCT was the most sensitive method in the diagnosis of tibial articular surface collapse,avulsion tibial fracture at the point of cruciate ligament,fracture comminuted degree and fracture displacement degree (P < 0.01). MRI was the most sensitive method in the diagnosis of injuries of cruciate ligament, collateral ligament, menisci, the cartilage peeling of articular surface (P < 0.01).</p><p><b>CONCLUSION</b>MDCT and MRI further detail the Schatzker classification based on X-ray films, which also conduce to make precise diagnosis and reasonable treatments. MDCT and MRI are more sensitive for the diagnosis of insidious damages around knee.</p>

Biomechanical strength of bone cement impregnated with diphosphonate / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the biomechanical strength of diphosphonate impregnated bone cement (DIBC).</p><p><b>METHODS</b>DIBC specimens were manufactured and randomly assigned to the control groups and the DIBC groups. According to the corresponding ASTM/ISO standards, the static biomechanical strength and the fatigue limit were tested systematically. The particle size distribution of diphosphonate powder was analyzed with the laser light scattering method. The fatigue test results, given as number of cycles-to-failure, were analyzed using the linearized format of the two-parameter Weibull function.</p><p><b>RESULTS</b>With the drug load increased, there was a slight increase in static biomechanical strength and a moderate decrease in fatigue limit, both with statistical significance. When immersed in PBS before the tests, the DIBC specimens presented an overall significant decrease of static biomechanical strength and fatigue limit. The profile of drug particle sizes presented a normal distribution.</p><p><b>CONCLUSIONS</b>The adopted diphosphonate is a much homogeneous powder which contains particles with a low range of sizes. The impregnation of diphosphonate exerted no or less negative effect on the biomechanical strength of the acrylic bone cement, of which the static strength of DIBC is maintained high above the ASTM/ISO standards.</p>

Examination and surgical treatment of lost instability of traumatic dislocation of the knee joint / 中国骨伤

<p><b>OBJECTIVE</b>To study the examination,surgical opportunity and surgery methods of lost instability of traumatic dislocation of the knee joint.</p><p><b>METHODS</b>Sixty-three patients (48 males and 15 females,ranging in age from 16 to 75 years,with an average of 36.6 years) were checked, treated and followed up from January 2001 to April 2006. According to classification of Wascher for knee dislocation, there was 1 case of KD-I, 13 KD-II, 17 KD-III, 18 KD-IV, 14 KD-V. Stability of the knee was evaluated by physical and radiological examinations, of which 53 patients were treated with open surgery, 4 patients were treated with arthroscope, 4 patients were treated with arthroscope and open surgery, 1 patient was treated with amputation, 1 patient was treated with total knee arthroplasty.</p><p><b>RESULTS</b>The detection rate of MRI was 100% (39/39), stress radiography was 100% (19/19), arthroscpoe was 93.3% (14/15). According to Lysholm Criteria for knee joint function,the preoperative Lysholm score in old traumatic group was 37.17 +/- 5.33, fresh traumatic group was 37.41 +/- 5.38. The postoperative Lysholm score in old traumatic group was 67.33 +/- 14.72, fresh traumatic group was 82.45 +/- 12.13 (Z = -3.061, P = 0.002).</p><p><b>CONCLUSION</b>MRI stress radiography and arthroscope do well for the evaluation of stability of the knee. Instable traumatic dislocation of the knee joint must be operated promptly. Fresh instable dislocations of knee prefer repair,old instable dislocations of knee prefer reconstruction.</p>