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Objective:To evaluate the effects of exosomes derived from cardiac fibroblasts pretreated with sevoflurane on ventricular electrical conduction in isolated rat hearts subjected to hypothermic ischemia-reperfusion (I/R) using the multi-electrode array mapping technique.Methods:Primary cardiac fibroblasts were extracted by differential adhesion in SPF Sprague-Dawley rats of either sex.Cardiac fibroblasts of passage 2-4 were treated with 2.5% sevoflurane for 1 h, and then cultured for 24-48 h to extract exosome.SPF healthy male Sprague-Dawley rats, aged 2-3 months, weighing 280-320 g, were divided into 3 groups ( n=8 each) using a random number table method: control group (group C), I/R group and sevoflurane-pretreated cardiac fibroblast-derived exosome+ IR group (group S+ IR). Hearts were perfused for 110-min equilibration in group C. After 20 min of equilibration, the perfusion was suspended for 60 min (global ischemia) followed by 30 min of reperfusion in IR and S+ IR groups.Exosomes 1 ml (200 μg) derived from cardiac fibroblasts pretreated with sevoflurane were injected through the tail vein at 48 h before surgery in group S+ IR, and the equal volume of normal saline was injected instead in C and IR groups.The cardiac conduction velocity (CV), conduction absolute inhomogeneity (P 5-95) and inhomogeneity index (P 5-95/P 50) were obtained at 20 min of equilibration (T 0) and 15 and 30 min of reperfusion (T 1, 2) using the microelectrode array attaching to the left ventricular surface of the isolated heart. Results:Compared with group C, CV was significantly decreased and P 5-95 and P 5-95/P 50 were increased at T 1 ( P<0.05), and no significant change was found at T 2 in group S+ IR ( P>0.05), and CV was significantly decreased and P 5-95 and P 5-95/P 50 were increased at T 1, 2 in group IR ( P<0.05). Compared with group IR, CV was significantly increased and P 5-95 and P 5-95/P 50 were decreased at T 1, 2 in group S+ IR ( P<0.05). Conclusions:Exosomes derived from cardiac fibroblasts pretreated with sevoflurane can improve ventricular electrical conduction in isolated rat hearts subjected to hypothermic I/R.
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Objective:To explore the surgical technique and clinical effect of pressure boost in repairing soft tissue defects of limbs with thinned anterolateral thigh perforator flap (ALTP) .Methods:From January, 2015 to December, 2018, 18 cases with soft tissue defects of limbs with various damages of blood vessels and nerves with explosure of tendon and bone. There were 13 males and 5 females aged between 18 to 56 (averaged of 36.3) years, which were 6 defects in shank, 4 in foot and ankle, 5 in forearm, and 3 in hand. The soft tissue defect area was 7 cm ×12 cm to 13 cm ×30 cm. Thinned ALTP was used to repair the wound surface. The perforating vessels of the distal flap were anastomosed with one branch of the internal vessel pedicle flap to increase the pressure hence the blood supply of the distal region. The donor sites were sutured directly or covered by skin graft. Followed-up was conducted by 1-2 monthly clinic visits and telephone or on-line review to check the flap survival and recovery of functions.Results:All flaps survived without arterial or venous crisis. One flap had partial necrosis at the distal end, and healed after dressing change. One case had a swelling flap due to a congestion beneath the flap. The wound achieved primary healing after removal of sutures, ligation of subcutaneous vessels and drainage of hematoma. All patients were followed-up for 6 to 18 (average, 9.5) months. All flaps had good appearance and texture. After rehabilitation treatment, most of the joint activity had been recovered: extension and flexion of wrists joints ranged 60°-80°, 70°-80° for metacarpophalangeal joints and 40°-60° for ankle joints. One patient underwent ankle joint dorsiflexion function reconstruction and flap thinning at 6 months after operation due to the defects of most of the extensor tendon.Conclusion:During the use of free ALTP to repair soft tissue defect of limbs, application of the technique of pressure boost is able to increase blood supply to the distal region of flap. It helps to reduce the incidence of infection and necrosis at the edge of the flap.
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Objective:To determine the biomechanical stability of atlantoaxial and occipitocervical fixations with unilateral spinous process screw plus contralateral pedicle screw.Methods:After nonlinear finite element models of the intact upper cervical spine (C0-3) were constructed and validated, they were processed into 3 kinds with normal axis anatomy, a high-riding vertebral artery and a thin axis lamina, re-spectively.In the models, the odontoid fracture stabilized by atlantoaxial fixation and the atlas fracture sta-bilized by occipitocervical fixation were simulated.In the atlantoaxial fixation, the group of unilateral spinous process screw+contralateral pedicle screw+bilateral atlas lateral mass screws (spinous process screw group) was compared with that of bilateral axis pedicle screws+bilateral atlas lateral mass screws (pedicle screw group); in the occipitocervical fixation, the group of unilateral spinous process screw+contralateral pedicle screw+occipital screws (spinous process screw group) was compared with that of bilateral axis pedicle screws+occipital screws (pedicle screw group).Three different techniques in insertion of spinous process screws (horizontal, oblique and vertical) were applied.The range of motion (ROM) was measured in extension-flexion, lateral flexion and rotation of occipitocervical bodies (C0-C3) after internal fixation.Results:Compared with the intact models, the ROMs of extension-flexion, lateral flexion and rotation of C1-C2 were obviously reduced in the spinous process screw group and the pedicle screw group in the models with atlantoaxial and occipitocervical fixations.In the atlantoaxial fixation, the ROMs of extension-flexion, lateral flexion and rotation of C1-C2 were greater in the spinous process screw group than in the pedicle screw group; in the occipitocervical fixation, the spinous process screw group had greater ROM of lateral flexion of C1-C2 and greater ROM of rotation of C0-C2 than the pedicle screw group.There were unobvious differences in insertion of spinous process screws between the horizontal, oblique and vertical techniques.Conclusions:In the atlantoaxial and occipitocervical fixations, the unilateral spinous process screw plus contralateral pedicle screw can provide as fine stability as the bilateral axis pedicle screws.In the atlantoaxial fixation, the bilateral axis pedicle screws may lead to better stability of C1-C2 than the unilateral spinous process screw plus contralateral pedicle screw.In the occipitocervical fixation, the bilateral axis pedicle screws may lead to better stability of C1-C2 in lateral flexion and rotation than the unilateral spinous process screw plus contralateral pedicle screw. The 3 different techniques in insertion of spinous process screws lead to an unobvious difference in the stability of C1-C2.
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Chronic osteomyelitis combined with bone defects has a long treatment period, and is always a problem for orthopedists. Ilizarov technique is one of the classic ways to treat chronic osteomyelitis combined with bone defects. But in recent years, the application of Masquelet technology can achieve better clinical effects than Ilizarov technology in some cases. The authors review the studies related to the application of Ilizarov technique and Masquelet technique in the treatment of chronic osteomyeliis combined with bone defects so as to provide a certain reference for clinical treatment.
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Objective:To evaluate the efficacy of orthogonal low profile double-plate osteosynthesis (DPO) in the treatment of Neer type IIB distal clavicular fractures.Methods:A retrospective case-control study was carried out to analyze the clinical data of 31 patients with Neer type IIB distal clavicular fractures admitted to Second Affiliated Hospital of Zhejiang University School of Medicine from June 2016 to October 2017. There were 23 males and 8 females, aged 45-76 years(mean, 61.8 years). The left side was involved in 24 patients and right sidein 7. Out Of them, 7 patients were treated with hook plate osteosynthesis (HPO) (HPO group), 13 patients with precontoured distal clavicular locking plate osteosynthesis (LPO) (LPO group), and 11 patients with DPO (DPO group). The Constant-Murley shoulder functional outcomes, clavicle-coracoids distance (CCD), complications and hardware related symptomswere compared between groups.Results:All the patients were followed up for 10-27months(mean, 15.1 months). At the latest follow-up, Constant-Murley score was (93.8±5.1)points in LPO group and (94.8±5.8)points in DPO group, better than (84.3±13.2)points in HPO group ( P<0.05), while there was no significant difference between DPO and LPO groups ( P>0.05). CCD was increased(1 patient in HPO group, 5 in LPO group, 3 in DPO group), but there was no significantdifference between groups( P>0.05). No infection or implant breakage occurred in each group. One patient had nonunion in HPO group, 1 had malunion at trapezoid ligament bony end in LPO group and all had bone union in DPO group, showing no significant difference between groups ( P>0.05). Two patients had acromial bone corrosion and 1 had distal clavicle osteolysisin in HPO group, but not in LPO and DPO groups ( P<0.05). Three patients had hardware related symptoms in HPO group, 6 in LPO group, and none in DPO group ( P<0.05). Conclusion:Orthogonal low profile DPO can be a good choice for the treatment of distal clavicle Neer type IIB fractures, for it has advantages of good functional outcomes, lower complications and less hardware related symptoms.
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OBJECTIVE@#To explore the integration method and technical realization of artificial intelligence bone age assessment system with the hospital RIS-PACS network and workflow.@*METHODS@#Two sets of artificial intelligence based on bone age assessment systems (CHBoneAI 1.0/2.0) were developed. The intelligent system was further integrated with RIS-PACS based on the http protocol in Python flask web framework.@*RESULTS@#The two sets of systems were successfully integrated into the local network and RIS-PACS in hospital. The deployment has been smoothly running for nearly 3 years. Within the current network setting, it takes less than 3 s to complete bone age assessment for a single patient.@*CONCLUSIONS@#The artificial intelligence based bone age assessment system has been deployed in clinical RIS-PACS platform and the "running in parallel", which is marking a success of Stage-I and paving the way to Stage-II where the intelligent systems can evolve to become more powerful in particular of the system self-evolution and the "running alternatively".
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Humans , Age Determination by Skeleton , Artificial Intelligence , Bone and Bones , Hospital Information Systems , Hospitals , Radiology Information Systems , Systems IntegrationABSTRACT
Objective To investigate the incidence of intercalary fragment in adult ankle fractures and analyze the morphological characteristics of intercalary fragment as well as its relationship with the type of posterior malleolus fractures.Methods Data of 247 cases with posterior malleolus fractures from 369 cases of adult ankle fractures who were treated from January 2014 to January 2016 were retrospectively analyzed.The pre-operative Ⅹ-ray and CT data of the group were analyzed,and the incidence of intercalary fragment was measured.The intercalary fragment was classified by position,size and shape of its morphological features.The posterior malleolus fracture was classified according to Bartonícek classification system.The relationship between type of posterior malleolar fracture and the intercalary fragment was studied.The incidence of malreduction was also studied using the criterion of more than 2 mm separation or step.Results One hundred and six cases had intercalary fragment,accounting for 42.91％ (106/247) of the posterior malleolus fracture,and 28.73％ (106/369) of all ankle fractures.There were 81 cases with intercalary fragment larger than 2 mm,accounting for 32.79％ (81/247) of the posterior malleolus fracture.There were 33 cases with intercalary fragment larger than 5 mm,accounting for 13.36％ (33/247) of the posterior malleolus fracture.The incidence of intercalary fragment occurred in the posterolateral side was 64.15％ (68/247).According to Bartonícek classification,the incidence of type Ⅰ,Ⅱ,Ⅲ,and Ⅳ posterior ankle fracture was 8.91％ (22/247),49.39％ (122/247),21.86％ (54/247),and 19.84％ (49/247),respectively.The incidence of intercalary fragment was 4.54％ (1/22) in type Ⅰ posterior ankle fractures,40.16％ (49/122) in type Ⅱ,70.37％ (38/54) in type Ⅲ,and 36.73％ (18/49) in type Ⅳ.The incidence in type Ⅲ posterior malleolus fracture was significantly higher than that of other types of posterior malleolus fracture.CT scan after operation was conducted in 43 cases in which 19 cases had their intercalary fragment malreducted,accounting for 44.19％(19/43).Conclusion Intercalary fragment has high incidence in the posterior malleolus fracture,and the highest incidence occurs in Bartoníeek Ⅲ type posterior malleolus fracture.The study helps to further understanding and treatment of the posterior malleolus fracture.
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Objective To investigate the differences and clinical effects of extended anterolateral approach in the treatment of simple/complex tibial plateau fractures with posterolateral bone fragment.Methods From January 2013 to December 2015,forty-six patients with posterolateral tibial plateau fractures treated in our hospital were included in our research.The posterolateral plateau fractures were reduced and fixed by the extended anterolateral approach.According to Schatzker fracture classification,patients with type Ⅱ fractures were treated as simple group and patients with type Ⅴ and type Ⅵ fractures were treated as complex group.According to tibial plateau three column classification,patients were divided into single column group,double column group and three column group.The operative time,bleeding volume,fracture healing time,postoperative Rasmussen score,knee mobility,reduction and fixation of fractures and postoperative complications were compared among the groups.Results All 46 patients were followed up for 23-45 months,with an average of 31.9 months.There were 24 cases in simple fracture group and 22 cases in complex fracture group.The mean operation time of simple group was 124±33.8 min,and that of complex group was 175±65.5 min,with significant difference (t=2.302,P=0.025);the mean bleeding volume of simple group was 118±93.5 ml,and that of complex group was 190± 149.4 ml,with significant difference (t=1.905,P=0.028).12 cases were treated with arthroscopy.Bone union was achieved in all patients at the last follow-up,and daily activities were not limited.The average healing time was 4.58 months in simple group and 5.54 months in complex group.The excellent rate of fracture reduction was 83.3％ in simple group and 27.3％ in complex group (x2=14.679,P=0.000).Posterolateral bone fragment was not completely fixed in 4 cases (16.7％) in simple group and 8 cases (36.4％) in complex group.The average Rasmussen function score was 26.8±2.1 and the range of motion of knee joint was 100°-120° (average 115.5°±6.2°) in simple group;The average Rasmussen function score was 23.5±3.4 points and the range of motion of knee joint was 95°-115° (average 106.3°±7.4°) in complex group,neither with no significant differences.According to the three-column fracture classification system,there were 6 cases in the single-column group,24 cases in the double-column group and 16 cases in the three-column group.There were significant differences in the operative time (F=5.039,P=0.000),bleeding volume (F=5.215,P=0.000) and the excellent rate of fracture reduction (x2=7.003,P=0.030) between these three groups.But there was no significant difference in the time of fracture healing,un-fixation rate of posterolateral bone fragment,knee joint Rasmussen score and knee jointactivity.The excellent rate of fracture reduction was 83.3％ in arthroscopy assisted cases and 47.1％ in arthroscopy un-assisted cases respectively (x2=4.749,P=0.002).Postoperative wound infection occurred in 1 patient.Conclusion Extended anterolateral approach could provide good reduction and fixation of tibial plateau fractures with posterolateral bone fragment with satisfactory clinical outcomes obtained in both simple and complex fractures.The operation was relatively simple and posterolateral bone fracture could get better reduction and fixation in simple tibial plateau fractures,and arthroscopy treatment was helpful to improve fracture reduction.
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Objective To explore the treatment methods and prognosis of early infection and delayed infection after intramedullary nail fixation.Methods Data of 22 cases of postoperative infections after intramedullary nail from January 2013 to August 2017 were retrospectively analyzed.There were 18 males and 4 females aged from 20 to 72 years old,with an average age of 46.8 years.14 cases were tibias and 8 cases were femurs.In the early infection group,6 cases showed swelling,heat and pain in the affected area with drainage and pus.In the late infection group,12 cases showed sinus formation and 4 cases showed no sinus tract.According to whether the infection occurred within six weeks,it was divided into early infection and delayed infection groups.Of 6 patients in early infection group,there was 1 case of septic shock which underwent removal of intramedullary nails,debridement and antibiotic bone cement stick implantation.5 cases were retained intramedullary nail and underwent local debridement treatment.Late infection occurred in 16 patients.One patient with tibia infection was given partial dressing to heal the fracture.Then the intramedullary nail was removed and intramedullary debridement was performed.Two patients with poor general condition,the intramedullary nails were removed and debridement was performed.Calcium sulphate cement was implanted and fixed with external fixation.The remaining 13 cases were treated with debridement and antibiotic cement stick implantation.We compared the differences between early and late infections of internal fixation,infection control,fracture healing,and secondary fracture fixation.Results Of the 6 patients with early infection,1 patient with septic shock removed intramedullary nails to control infection.After infection controlled,the fracture was treated with intramedullary nailing.Of the 5 patients with retained intramedullary nails,2 patients' infection were controlled and 3 were uncontrolled.After removal of the intramedullary nails the infection was control.The success rate of retaining intramedullary nails was 33.3％ (2/6).Late infection occurred in 16 cases and infection was all controlled.The fractures healed in 22 patients.The fracture healing time of 6 patients with early infection was 2-6 months,with an average of 3.67±2.08 months.The fracture healing time of 16 patients with late infection was 2-4 months (average 3.2±0.79) months.Conclusion Patients with early bone infections after femoral and tibial intramedullary nail surgery may attempt debridement therapy with retained intramedullary nails,but the failure rate is high.If the intramedullary nail fails to remain,follow the treatment of patients with delayed bone infection.For patients with delayed bone infection,because the fracture has not yet healed,thorough debridement is used after the removal of internal fixation,then calcium sulfate or antibiotic bone cement stick should be implanted and fixed with external fixation.For the second phase,we may choose plate,intramedullary nail or external fixation to fix the fractures according to the soft tissue condition.All of the fixation methods could provide good fracture healing.
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Objective To evaluate the induced membrane technique (Masquelet technique) used for restoration of long bone defects of infected tibia.Methods This retrospective study evaluated 44 patients with long bone defect of infected tibia who had been treated at Department of Orthopedics,The Second Affiliated Hospital by the induced membrane technique between January 2004 and January 2017.They were 31 males and 13 females,aged from 18 to 71 years (mean,43.7 years).Of them,17 were complicated with diabetes,13 with primary hypertension,and 12 with more than two basic diseases.Their bone defects ranged from 6 to 17 cm (average,11 cm).Their postoperative fracture healing and complications were observed.Results This cohort received from 2 to 5 operations on average (average,3.7 operations).All the patents obtained bony union after 9 to 13 months (average,11.3 months).Their follow-ups ranged from 16 months to 11 years (average,3.1 years).Nineteen complications related to the surgery occurred in 15 cases.Skin healing problem after implantation of bone cement was found in 5 cases which called for operative intervention,infection relapsed in 8 patients after the first phase of cement implantation which necessitated further surgical debridement for successful management,local haematoma appeared after bone grafting in one case of 17 cm bone defect,implant failure occurred in one case,leg length discrepancy larger than 2 cm was observed in 3 cases,and a discharging sinus developed in one case 2 years after successful healing of a tibial defect.Conclusions The induced membrane technique appears to be a good alternative management for large tibial defects secondary to infection.The technique should be considered in the surgeon's armamentarium and patients conditions as it is effective and associated with a low rate of complications.
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Bone defects,a challenge in orthopedics,are mostly caused by severe trauma,bone tumor and bone infection.Their chief treatments include bone graft,distraction osteogenesis and Masquelet technique.Compared with other treatments,Masquelet technique is simpler and causes fewer complications,especially for infectious defects.In the first stage of Masquelet technique,a bone defect is filled with bone cement.The spacer most commonly used is polymethylmethacrylate(PMMA).PMMA can form induced membrane rich in blood vessels and bioactive components promoting osteogenesis,but it is not biodegradable,lacks bone conductibility,has an obvious thermal effect during operation,and is hard to remove in the second phase of Masquelet technique.Calcium sulfate and calcium phosphate bone cement are biodegradable materials which overcome the defects of PMMA due to their biological absorbability,bone conduction and bone inducement.It is possible for them to replace PMMA in Masquelet technique,but their poor mechanical strength limits their application.There is clinical evidence showing that calcium sulfate bone cement can form obvious induced membrane.As calcium silicate cement can also form a layer of fibrous tissue around the shell,it may be applied in orthopaedic surgery after improvement as a potential filling agent.A structure like induced membrane can form around a silicone prosthesis,and it functions similarly as induced membrane around PMMA and is more resistant to a radiation environment.Silicone has obvious advantages over PMMA after resection of bone tumor.Spacers used in the first stage of Masquelet technique have important effects on formation process and quality of induced membranes.By comparing membranes induced by different types of spacer,we can know more about the effects of spacers on induced membranes in the first stage of Masquelet technique and thus discover the most suitable spacers good for fracture healing and membrane formation.
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Objective To report the clinical results of surgical treatment of fracture of the anteromedial facet of the coronoid process in terrible triad injury.Methods Of the 59 patients with terrible triad injury of the elbow,17 were surgically treated for fracture of the anteromedial facet of the coronoid process from July 2010 to July 2014.They were 12 men and 5 women,from 29 to 70 years of age (average,50 years).By the Mason classification for the radial head fractures,2 cases were type Ⅰ,13 type Ⅱ and 2 type Ⅲ;by the O'Driscoll classification for coronoid process fractures,one was type Ⅰ,14 were type Ⅱ and 2 type Ⅲ.All patients were treated through combined approaches.The lateral Kocher approach was used to fixate or replace the radial head and to repair the lateral ligament complex;the anteromedial approach was used to fixate the coronoid process fracture and to explore and repair the medial collateral ligament if necessary.Fracture union,implant loosening,ectopic ossification,regression and articular alignment were assessed on the postoperative X-rays.At final follow-ups,the elbow function was evaluated using Mayo elbow performance score (MEPS) and Broberg & Morrey grading system for traumatic arthritis.Results The average follow-up duration for the 17 patients was 32 months (range,from 24 to 60 months).Final follow-ups showed that the mean arc of flexion-extension was 97° (from 70° to 120°),the mean extension limitation 23° (from 0 to 40°),the mean arc of forearm rotation 139° (from 90° to 145°),the mean pronation 71° (from 60° to 90°)and the mean supination 67° (from 60° to 85°).The MEPT scores averaged 87 points (from 80 to 100 points),yielding 7 excellent,8 good and 2 fair cases.By the Broberg & Morrey grading,there were 4 cases of grade 1 and one of grade 2.No evidence of elbow instability,nonunion or implant failure was found.Ectopic ossification around the elbow happened in 4 cases,transient ulnar nerve palsy was found in one,and the Kirschner wire was removed operatively in 2 because it had loosened after fracture union.Conclusion The treatment of anteromedial coronoid fractures in terrible triad injury should be anatomically reduced through direct exposure and fixated rigidly.
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Objective To explore the classification system and outcomes of surgical treatment for terrible triad of the elbow.Methods Data of 42 patients with terrible triad elbow injuries who were surgically treated between 2009 and 2015 were retrospectively analyzed.There were 29 males and 13 females with a mean age of 47 years at the time of injury.42 patients of terrible triad injuries were classified into four types:type ⅠA,ⅠB,Ⅱ,Ⅲ,and Ⅳ injuries.Type ⅠA and Ⅱ injuries were treated through an isolated lateral approach,while type ⅠB,Ⅲ and Ⅳ injuries were treated by a combined lateral and anteromedial approach.Operative treatment consisted of repair or replacement of the radial head,repair of the lateral collateral ligament (LCL) and coronoid fracture fixation.Type ⅠA injuries were treated with radial head and LCL repair without coronoid fixation.Type Ⅳ elbow injuries were treated with medial collateral ligament (MCL) repair.Elbow functional status was evaluated using the Mayo elbow performance score (MEPS).Results There were three patients with type ⅠA injuries,7 patients type ⅠB injuries,15 type Ⅱ injuries,10 type Ⅲ injuries,and 7 type Ⅳ injuries.The average follow-up period was 30 months (range,24-56 months).All fractures of coronoid got union at average 11.5 months except for type ⅠA injuries.40 patients with fractures of radial head got union at average 12.4 months and two patients underwent radial head replacement without loosening.The mean flexion-extension arc was 107°±22°,the mean flexion contracture was 20°±10° and the mean flexion was 127°±14°.The average forearm rotation arc was 145°±14°,which included an average pronation of 73°±8° and an average supination of 71°±9°.The mean MEPS was 89±9 points (range,55-100 points),with excellent results in 24 elbows,good result in 17 and poor result in one;the excellence rate was 97％ (41/42).Thirteen patients had radiographic signs of arthrosis according to the Broberg-Morrey system (9 elbows were grade 1 and 4 were grade 2).5 patients had evidence of heterotopic ossification,of which four had minimal periarticular ossification and did not require additional surgery.The remaining patient showed significant heterotopic ossification and required an elbow release.1 patient with type Ⅲ injury developed transient median nerve paralysis and got full recovery after conservative treatment for 8 weeks.1 patient with type Ⅲ injury developed ulnar neuropathy and required an anterior ulnar nerve transposition.2 patients,who had shifting hardware but still achieved union,required a second surgery to remove the implant:one patient had a Kirschner wire shift from the radial head at 6 months after surgery,and the other had a loose screw in the coronoid process at one year after surgery.Conclusion Our classification system of terrible triad of the elbow may provide a guide for the selection of an ideal surgical approach and treatment modality.
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Objective To investigate the effect of treating tibial plateau fractures involving the posterior column via anterolateral approach.To discuss its merit and demerit,indications and contraindications.Methods From Jan 2012 to Jan 2015,37 patients with closed tibial plateau fractures involving the posterior column were treated by 3.5mm proximal tibial plate with narrow plate head through standard anterolateral approach.The group included 25 males and 12 females,aged from 23 to 65 years old (average 44.6 years old).During the treatment and follow-up period,the curative effect was evaluated by using Rasmussen's radiological grading for early radiological outcomes and HSS grading,Lysholm grading,Lachman test and Pivot-shift testfor clinical examination at the 1 year follow-up.Results The average time for the operation was 98 min (range,55-170 min).1 year follow-up was completed in 37 patients.The average fracture union time and full weight bearing were 10.6 weeks (range,8-16 weeks) and 11.2 weeks (range,8-20 weeks) respectively without reduction loss.No statistical difference was found in either the tibial plateau angle (TPA) or posterior slope angle (PA) when comparing the results at instant,3rd month,6th month and 12 month.The mean score of the Rasmussen' s radiological grading was 15.6(range,12-18) and the mean score of the HSS grading was 88.6 (range,80-100).The average range of motion of the knee joint was 128.6°(range,110°-150°).The mean score of the Lysholm grading was 91.6±3.9. The Lachman test and the Pivot-shift test were negtive.Conclusion Treating tibial plateau fractures involving the posterior column by 3.5 mm proximal tibial plate with narrow plate head through standard anterolateral approach is an effective method.The protocol is simple and safe,the approach is familiar by most clinicians.Good reduction and fixation,earlier functional exercise can be achieved easily.The knee function recovered well and earlier curative effect was satisfied.
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Objective To investigate the morphological properties of posterior Monteggia lesion with associated elbow dislocation,to propose its injury mechanism,and to present its surgical methods and its outcomes.Methods The injury mechanism,radiographs and surgical records of patients with posterior Monteggia fractures and associated elbow dislocation were retrospectively reviewed from January 2011 to December 2013.11 patients were included,with 43.3 years old on average.10 were resulted from high-energy injuries.According to the Jupiter classification,Ⅱ A fracture-dislocation 9 cases,Ⅱ B fracture-dislocation 1 case and Ⅱ C fracture-dislocation 1 case.The general medical data,morphological properties,and the surgical methods.Functional outcomes were followed up.Results These cases had several intrinsic morphologic features:fractures of the coronoid tip and its anteromedial aspect;dislocation of the olecranon from the trochlear notch;fracture of the radial head and disruption of the lateral collateral ligament;a normal proximal radioulnar joint.Operation was carried out with emphasis on elbow stability restoration.All patients underwent the primary operations in the supine position and a routine posterior approach was used.An additional anterior approach was used in 1 case (Ⅱ B).The coronoid tip was first fixed,followed by the anteromedial coronoid fragment,the radial head,the olecranon,and then the LCL.An anatomic olecranon plate was used as the fundamental fixation device.Anteromedial coronoid fractures were mostly fixed with a T-shaped metacarpal plate.The coronoid tip fractures were fixed with screw,Kwire or suture,and the injured LCL was repaired with suture anchors.Ten of the 11 patients were followed up with a mean period of 22.7 months.The extension-flexion motion ranged from 45°-140° (104° average),and the pronation-supination motion ranged from 45° 180° (128° average).According to the Broberg and Morrey functional index,the excellent to good ratio was 70％.Conclusion Patients with posterior Monteggia fracture and associated ulnohumeral dislocation have small and comminuted coronoid fractures,and mostly have a normal PRUJ relationship.It might experience a different mechanism to those of the posterior Monteggia fracture without elbow dislocation.Emphases should be address to restore the rotation stability of the elbow when operation.
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Objective To investigate the injury mechanism, fracture characteristics, treatment strategy and prognosis of Pilon fracture without fibula fracture. Methods 28 cases of Pilon fracture without fibula fracture (29 fractures) treated in our hos?pital were adapted from January 2009 to December 2014. 22 cases were male, 6 were female, aged 46 years old (23-75). Cause of injury:tumble in 14 cases, fall from high place in 8 cases, traffic accident in 5 cases, bruise in 1 case. 10 cases had associated in?juries, and 2 cases were open injuries. The OA/ATO fracture type, Rüedi&Allgower fracture type, and characteristics of fractures were summarized. The appropriate treatments were selected, and the operative method, operative time, surgical approach, fixation, fracture healing time, ankle Mazur score, Burwell?Charnley reduction score and postoperative complications were recorded. Re?sults On the mechanism of injury, 28 cases mostly had a median?low energy injury mechanism with little open injuries. On the fracture characteristics, there was a 96.6%anterior distal tibia articular fracture involved with no other specific fracture character?istics occurred. The treatment of the fracture mostly received a single operative approach to complete open reduction and internal fixation operation. The average operation time was 119 minutes, the average fracture healing time was 7.1 months, the excellent and good rate of ankle Mazur score was 86.2%and the satisfactory rate of Burwell?Charnley fracture reduction score was 93.1%. Skin infections occurred in 3 patients after operation. After effective antibiotic and correct clinical treatment, the incisions got healed in these 3 patients. Conclusion Pilon fracture with intact fibula mostly is caused by median to low energy injury when an?kle at neutral or varus position, most with anterior distal tibia articular fracture by foot dorsal flexion. Generally use a single anteri?or approach can complete open reduction and internal fixation operation with satisfactory clinical treatment. This kind of fracture could achieve good reduction, good bone healing, good function and little complications after correct treatment.
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Objective To evaluate the frequency and morphological characteristics of the posterolateral articular fracture in tibial plateau fractures.Methods A retrospective analysis of CT images and clinical data was taken among 309 cases of tibial plateau fractures from 2008 May to 2013 January.There are total 264 patients were recorded excluding 45 cases with which the CT image is missing or not compatible with the medical Picture Archiving and Communication Systems (PACS).To determine the occurrence rate of the posterolateral articular fracture in tibial plateau fractures and measure morphological parameters such as the axial angle of fracture line,articular surface area,sagittal fracture angle,fracture height,and amount of displacement.Results 39 cases of posterolateral articular fragments were found in 264 cases of tibial plateau fractures with the 14.8％ incidence (39/264).There were 18 males and 21 females,aged from 31-70 years (mean,52 years).17 left cases and 22 right cases.The mechanism of injury were traffic accident in 22 patients,blow by a heavy object in 2 patients,a fall in 11 patients,and other causes (unknown) in 4 patients.The posterolateral plateau articular fracture fragment has morphological characteristics of a conical shape fragment and the major articular fragment angle was 22° (range,-43°-62°),and an average accounted for 14.1％ of the articular surface of the total tibial plateau (range,8％-32％).The posterolateral fragment exhibits a vertical fracture pattern and an average sagittal fracture angle was 76° (range,58°-97°),suggestive of shear instability and vertical displacement.Maximum posterior cortical height was 28 mm (range,18-42 mm),and average size of the displacement was 10.48 mm (range,2-19 mm).Conclusion The posterolateral plateau articular fracture fragment has morphological characteristics of a conical shape fragment,relative small articular surface area and sagittal fracture angle.
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<p><b>BACKGROUND</b>Augmentation plating has been used successfully to treat hypertrophic non-union after nail fixation. This study compared the efficacy of augmentation plating and exchange plating for treating hypertrophic non-union of femoral shaft fracture after intramedullary nail fixation.</p><p><b>METHODS</b>A total of 12 patients received augmentation plating and 15 patients received exchange plating as treatment for femoral shaft hypertrophic non-union. The procedures were conducted at our medical centre between January 2005 and January 2012. Clinical follow-up was conducted at 2 weeks, 1 month and then monthly until union was achieved to compare union time, operation time, bleeding and complications between the two groups.</p><p><b>RESULTS</b>All patients underwent follow-up examinations until fracture union was achieved. The average length of follow-up time after the second treatment was (18.37 ± 3.28) months. The time needed for union was (4.17 ± 0.94) months in the augmentation plating group and (5.33 ± 1.72) months in the exchange plating group. The operation time was (90.00 ± 17.58) minutes in the augmentation plating group and (160.00 ± 25.35) minutes in the exchange plating group. The amount of blood loss during the operation was (270.00 ± 43.32) ml in the augmentation plating group and (530.00 ± 103.65) ml in the exchange plating group. Both groups showed significant difference (P < 0.05) in their results. No complications were reported after the second operation.</p><p><b>CONCLUSIONS</b>Augmentation plating after nail fixation could remove local rotation instability, facilitate simple operation, create minimal damage and enable exercise for early functional recovery. Therefore, augmentation plating is excellent for treating hypertrophic non-union after nail fixation in femoral shaft fracture.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Bone Nails , Femoral Fractures , General Surgery , Fracture Fixation, Internal , Methods , Fracture Fixation, Intramedullary , Methods , Retrospective StudiesABSTRACT
Objective To discuss the method and treatment outcome of vascular variation in repairing skin defect of the hand by free transplantation of posterior interosseous perforator flap.Methods Eight cases with vascular variation were adjusted flap position,two cases were repaired by single perforator flap,three cases were repaired by cutting perforator and anastomosing perforator after changing the path,three cases were repaired by designing composition leaves flap.Results Seven flaps survived,one flap partly necrosis and healed by skin-grafting,and all of the patients were followed-up 3 to 18 months.The color,texture and thickness of the flaps were satisfactory.The movements of the fingers were satisfactory.According to the hand function evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association,outcomes were rated excellent in 1 case,good in 5 cases,fair in 2 cases.The excellent and good rate was 75％.Conclusion When finding vascular variation in repairing skin defect of the hand by free transplantation of posterior interosseous perforator flap,adjust flap position,repair by single perforator flap,cutting perforator and anastomosing perforator after changing the path,or designing composition leaves flap is a good treatment option.
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Objective By measuring the height loss of humeral head and combined with the clinical curative effect of the contrast,to investigate the correlation between the medial column support with locking proximal humerus plate fracture efficacy.Methods From June 2009 to August 2012,70 cases with proximal humeral fractures underwent internal fixation with locking plates were retrospectively analyzed.Based on the presence of medial support,all the cases were divided into 2 groups according to the proximal humeral fracture block.By measuring the change of postoperative loss of lateral humeral head height and evaluating the shoulder function,to comparative analysis of the effect of medial column support in the recovery reduction maintenance and patient function.Results There were 66 cases access the follow-up of this study,loss of 4 cases in follow-up,with an average follow-up period of 13 months (range,10-18).Thirty-eight cases of medial support group loss to follow-up 3,and no medial support group 32 cases lost to follow-up 1.Intraoperative iliac bone graft in 7 cases,including 3 cases of medial support and 4 cases of no inner support.All cases achieved clinical bone healing in the last follow-up time.Medial support can effectively reduce the degree of reduction and loss,and the average height loss of humerus head is 1.4mm (standard deviation.1.0 mm).The average height loss of humerus bead is 6.2 mm (standard deviation.3.7 mm) in no support group,which was substantially higher than the medial support group.The inner support group had no obvious complications,and in the absence of 31 cases of medial support,3 cases showed screws wear out of the articular surface,2 cases showed screws loose.In 3 cases of screw penetrating the articular surface were underwent two operation to remove or replace screws.In the medial support group,according to the Neer centesimal system score,the results were excellent in 32 cases,good in 3.The excellent and good rate was 100％.In the no medial support group,the results were excellent in 25 cases,good in 1,and fair in 5.The excellent and good rate was 83.8％.Conclusion Locking plate in tension side does not fully support the humeral head.The medial column support can obtain better maintenance of reduction and postoperative effect through improving the medial column mechanical stability.