Antibiotic-PMMA beads combined with external fixator for treating the infected fracture nonunion / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effects of antibiotic-PMMA (polymethyl-methacrylate) beads combined with external fixator in treatment of infected fracture nonunion.</p><p><b>METHODS</b>Twenty-two cases of infected fracture-nonunions were reviewed involving 20 male and 2 female with an average age of 34.68 years (ranging 21 to 74 years). The data consisted of 9 cases of tibial fractures, 2 distal fractures of the femur, 6 femoral shaft fractures, 3 intertrochanteric fracture of the femur and 2 humeral shaft fractures. The procedure included thorough debridement to wipe out dead bone and granulation tissue, then antibiotic-PMMA bead chains imbedded into the dead space. One week later, secondary debridement was performed, antibiotic-PMMA bead chains were changed according to result of bacterial culture and susceptibility test, and fractures were stabilized with external fixator. Three months after debridement, antibiotic-PMMA bead chains were taken out and bone graft with autogenous iliac cancellous bone chips was performed.</p><p><b>RESULTS</b>The mean follow-up period was 19.98 months (ranging 15 to 28 months). Infection was controlled in 20 cases. One tibial fracture and 1 intertrochanteric fracture of the femur needed repeated debridement 2 and 3 months after bone grafting respectively,because of infection recurrence and sinus formation. All 22 cases achieved bony union averaged 15.09 weeks after bone grafting with a range of 8 to 24 weeks.</p><p><b>CONCLUSION</b>Thorough debridement, imbedding antibiotic-PMMA bead chains combined with external fixator and staged bone grafting has proven to be effective and simple for treatment of infected fracture nonunion. The antibiotic bead delivers high tissue levels,obliterates dead space, aids bone repair.</p>

Comparative study of antegrade and retrograde intramedullary nailing for the treatment of humeral shaft fractures / 中国骨伤

<p><b>OBJECTIVE</b>To compare therapeutic effects between antegrade intramedullary nailing and retrograde intramedullary nailing for the treatment of humeral shaft fractures.</p><p><b>METHODS</b>From March 1999 to October 2006, 105 patients with humeral shaft fractures were treated with locked intramedullary nail and were adequately followed up. There were 82 antegrade nailing and 23 retrograde nailing. The follow-up parameters included operation time, blood loss,fracture healing rate, healing time, complications, Constant-Murley shoulder score and Mayo elbow performance score.</p><p><b>RESULTS</b>The mean follow-up period was 31.2 months. Antegrade intramedullary nailing had significantly less blood loss than that in retrograde intramedullary nailing (P=0.002). The differences in operation time, complications, healing time and bone healing rate between he two groups had no statistical significance. Complications in the antegrade intramedullary nail group included 4 patients with nonunions, 1 patient with radial nerve palsy, and 8 patients with shoulder pains and decrement in shoulder range of motion. Complications in the retrograde intramedullary nail group included 1 patient with radial nerve palsy and 3 patients with iatrogenic fractures. For shoulder joints,the difference in the average Constant-Murley shoulder score between the two groups was statistically significant (P=0.04). For elbow joints, the average postoperative Mayo elbow performance score between these two approaches did not differ significantly.</p><p><b>CONCLUSION</b>Both the antegrade intramedullary nailing and the retrograde intramedullary nailing are good alternatives for the treatment of humeral shaft fractures. Because of higher incidence of iatrogenic fractures, the insertion point of retrograde intramedullary nailing should be carefully prepared. With antegrade insertion, it important to bury the humeral nail below the rotator cuff to prevent the subacromial impingement, and the rotator cuff should be carefully repaired to avoid shoulder pain and improve shoulder function.</p>

The diagnosis and treatment of rotational unstable nonunion of femoral shaft fracture after interlocking nailing / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the principle and treatment of rotational unstable nonunion of the femoral shaft fracture after interlocking nailing.</p><p><b>METHODS</b>From April 2003 to June 2007, 18 cases of rotational unstable nonunion of femoral shaft fractures after interlocking nailing were treated with exchanged reamed nailing and/or LCP fixation and iliac bone graft. The average age was 40 years old (from 22 to 52).</p><p><b>RESULTS</b>All patients were followed up for an average time of 28 months (from 12 to 58). All the fractures were united in an average time of 7 months (from 6 to 8). There were no perioperative complications occurred and no wound infection were observed. No loosening was found around the implant till the last follow-up.</p><p><b>CONCLUSIONS</b>Rotational instability is one of the reasons of nonunion of femoral shaft fracture after interlocking nailing. Reaming and nail exchanging or LCP fixation with iliac bone graft are the appropriate methods which can achieve a great clinic results.</p>

Surgical treatment of shotgun injuries of the sciatic nerve / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the clinical characteristics and the effect of surgical therapy for shotgun injuries of the sciatic nerve.</p><p><b>METHODS</b>From 1996 to 2000, 19 sciatic nerve injuries resulted from shotgun were observed. Among 19 cases of shotgun sciatic nerve wounds, the gluteal wound was in 2 cases, thigh wound in 15 cases, and knee wound in 2 cases. The firing distance was between 0.5-9 m. According to Shermen classification of shotgun injury, 4 cases belonged to type I injury, 11 cases type II, 4 cases type III. The time from injury to admission was between 2 months-14 months except 1 patient who underwent emergency operation 4 hours after injury, and 1 patient was treated with debridement and epineurial neurorrhaphy, 7 cases with nerve trunk grafting, 6 cases with nerve cable grafting, 4 cases with neurolysis, 1 case with arthrodesis of ankle.</p><p><b>RESULTS</b>Nineteen cases were followed-up for 0.8-3.5 years (mean, 19 months). The excellent and good nerve functional recovery was found in 52.6% according to MCRR.</p><p><b>CONCLUSIONS</b>Shotgun injuries of the sciatic nerve are very severe and complicated, and injuries in most patients were usually complicated by open fracture, vascular injury, soft-tissue loss and infection; the character of nerve injury was classified as 4-5 degree according to Sunderland Standard, nerve transfer is effective in the treatment of shotgun injuries of the sciatic nerve, but outcome is poor; the recovery of the sciatic nerve should be observed continually after injury; selecting correct initial treatment after injury, strict minimally invasive surgical procedure, physical therapy and reasonable preoperative and postoperative medication can improve the surgical results.</p>