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Objective@#To evaluate the surgical treatment of calcaneal fracture malunion.@*Methods@#A retrospective analysis was conducted of the 19 patients with calcaneal fracture malunion (19 feet) who had been treated from January 2011 to September 2017 at Departments of Joint Surgery and Orthopedic Trauma, The Third Affiliated Hospital, Sun Yat-Sen University. They were 16 males and 3 females with the average age of 36.2 years (from 22 to 57 years). According to Stephens-Sanders classification, the malunion was defined as type Ⅰ in 10 cases, as type Ⅱ in 6 and as type Ⅲ in 3. The patients with malunion of type Ⅰ were treated by lateral wall osteotomy and decompression of long and short peroneus muscles to preserve the subtalar joint, those with malunion of type Ⅱ by lateral wall osteotomy and decompression of long and short peroneus muscles followed by subtalar joint fusion, and those with malunion of type Ⅲ by lateral wall osteotomy, decompression of long and short peroneus muscles, medial oblique osteotomy for correction of varus deformity and subtalar joint fusion via both the medial and lateral approaches. The Maryland functional scores were used to assess the postoperative surgical efficacy.@*Results@#No such complications happened as incision or implant infection, screw breakage or joint non-fusion. Of the 19 patients, 17 were followed up for 18 to 26 months (mean, 20.5 months). The Maryland scores at the final follow-ups were 90.2±7.3, significantly higher than the preoperative values (38.6±5.5) (t=53.370, P<0.001).@*Conclusions@#In the surgical treatment of calcaneal fracture malunion, satisfactory clinical efficacy can be achieved by lateral wall osteotomy and preservation of the subtalar joint for patients with maunion of Stephens-Sanders type Ⅰ, and by subtalar fusion for those with maunion of Stephens-Sanders types Ⅱ-Ⅲ.
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Objective To evaluate the surgical treatment of calcaneal fracture malunion.Methods A retrospective analysis was conducted of the 19 patients with calcaneal fracture malunion (19 feet) who had been treated from January 2011 to September 2017 at Departments of Joint Surgery and Orthopedic Trauma,The Third Affiliated Hospital,Sun Yat-Sen University.They were 16 males and 3 females with the average age of 36.2 years (from 22 to 57 years).According to Stephens-Sanders classification,the malunion was defined as type Ⅰ in 10 cases,as type Ⅱ in 6 and as type Ⅲ in 3.The patients with malunion of type Ⅰ were treated by lateral wall osteotomy and decompression of long and short peroneus muscles to preserve the subtalar joint,those with malunion of type Ⅱ by lateral wall osteotomy and decompression of long and short peroneus muscles followed by subtalar joint fusion,and those with malunion of type Ⅲ by lateral wall osteotomy,decompression of long and short peroneus muscles,medial oblique osteotomy for correction of varus deformity and subtalar joint fusion via both the medial and lateral approaches.The Maryland functional scores were used to assess the postoperative surgical efficacy.Results No such complications happened as incision or implant infection,screw breakage or joint non-fusion.Of the 19 patients,17 were followed up for 18 to 26 months (mean,20.5 months).The Maryland scores at the final follow-ups were 90.2 ± 7.3,significantly higher than the preoperative values (38.6 ± 5.5) (t =53.370,P ＜ 0.001).Conclusions In the surgical treatment of calcaneal fracture malunion,satisfactory clinical efficacy can be achieved by lateral wall osteotomy and preservation of the subtalar joint for patients with maunion of Stephens-Sanders type Ⅰ,and by subtalar fusion for those with maunion of Stephens-Sanders types Ⅱ-Ⅲ.
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BACKGROUND:Kienb?ck disease lacks of suitable animal models, which are similar to the pathological process of avascular necrosis of human lunate bone. OBJECTIVE:To establish a new animal model of Kienb?ck disease using medical TH adhesive embolism and to explore the rationality of model establishment. METHODS:A total of 30 healthy adult New Zealand rabbits, male or female, were selected. Using self-control method, the rabbits were randomly assigned to experimental sides and control sides. By dril ing in the center of the lunate bone, 0.2 mL of medical TH glue was injected three times. An equal volume of physiological saline was injected into the center of the lunate bone on the control side. X-ray examination, general observation, Micro-CT measurement of bone, and tissue pathology detection were conducted at 4, 8 and 12 weeks. RESULTS AND CONCLUSION:Gross specimen, X-ray and histological results showed that ischemic necrosis of the lunate bone on the experimental side was visible at 8 weeks after model induction. The ischemic necrosis of the lunate bone became more typical at 12 weeks. Among the Micro-CT microscopic parameters of trabecular bone, trabecular bone density parameters bone volume fraction and the number of trabecular bone were significantly lower on the experimental side than those on the control side (P<0.05). Spatial parameters of trabecular bone significantly increased. Trabecular separation and structure model index on the experimental side were significantly greater than those on the control side. Results suggested that ischemic necrosis of the lunate bone appeared on the experimental side at 8 weeks after injection of medical TH glue. Rabbit models of ischemic necrosis of the lunate bone can be established at 12 weeks. Thus, alterations, which were similar to ischemic necrosis of human lunate bone, appeared, such as blood transportation damage in the lunate bone, trabecular bone fracture, and empty lacuna, when surrounding tissues were not obviously injured.
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Objectives To evaluate the clinical effect of one-stage reconstruction of dorsal hand softtissue defects using tendon allograft and free anterolateral thigh flaps.Methods From July 2006 to July 2011,fifteen cases of complex soft-tissue defects in dorsal hands were repaired using tendon allografts and anterolateral thigh flaps,sizing from 9 cm ×5 cm to 14 cm× 11 cm,in one stage.Two to 4 digital extensor tendons were reconstructed.With a brace on,early finger exercises were started after 2 weeks postoperatively when the flaps had survived.Results All the 15 flaps survived uneventfully.Twelve of the 15 patients were available for follow-up from 12-24 months (averaged 16 months).Two cases received tendolysis due to poor finger movement 6 moths postoperatively.At the end of follow-up,the range of wrist joint active flexion is from 40 to 70degrees and extension is from 25 to 50 degrees.The motion range of the related metacarpophalangeal joints was from 60 to 85 degrees,that of the interphalangeal joints from 80 to 90 degrees.The overall effective rate was 92 percent.Conclusion Simultaneous composite repair using tendon allografts and skin flaps proved to be reliable and cost-effective for complex dorsal hand soft-tissue defects.Allograft tendon reconstruction can not only obliterates new morbidities of autografting but also facilitates timely rehabilitation,avoiding extension loss of hand joints.
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Objective To introduce experience of using the new AO anterolateral distal tibia locking com-pression plate (LCP) for treatment of Pilon fractures. Methods Between February and August of 2009,8 closed Pi-lon fractures were treated by open reduction and internal fixation. The distal fibula was fixed with a one-third tubular plate or an recontruction plate via a straight incision posterior to the fibular crest. The distal tibia was approched by a straight incision over the ankle joint, and the fracture was stabilized using an anterolateral distal tibia LCP. Regular follow up was made to observe and evaluate the preliminary clinical outcomes. Results Seven of the 8 patients were availabe for follow up for 3 ～ 6 months (average 4.5 months). All incisions obtained primary healing, though one ex-perienced mild superficial inflammation,and none developed deep infections. Based on the Burwell and Charnley radi-ographic criteria,anatomical reduction was obtained in 5 cases,good in 1 ,and fair in 1. Among the 5 cases exceeding 5 months postsurgery,4 were evaluated as excellent and 1 us good according to Tometta' s clinically based criteria for Pilon fractures. Conclusion With good surgical timing,internal fixation with anterolateral LCP for Pilon fractures is reliable and warrants less complications.
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@#Objective To investigate the potential application of human transforming growth factor-beta-1 (hTGF-β1) gene mediated by type 2 recombinant adeno-associated virus (rAAV2) vector inducing chondrogenic differentiation of canine mesenchymal stem cells (MSCs) in vitro. Methods Canine MSCs from bone marrow were isolated and cultured in vitro by density gradient centrifngation and adherence screening methods. The morphology of MSCs was observed by inverted phase contrast microscope and Giemsa stain. Flow eytometry was used to detect surface antigens of MSCs, The third generation of MSCs were transfected by rAAV2-hTGF-β1 with or without MOI of 1 ×105 v.g./cell or 5×105 v.g./cell. The expression of hTGF-β1 was detected by Western blot after 10 days, and TGF-β1 synthesis was determined by ELISA at 3, 6 and 9 day, respectively. After 2 weeks of culturing, mRNA expressions of type Ⅱ collagen and aggrecan were determined by RT-PCR and the collagen Ⅱ protein was detected by immunocytochemistry. Results The MSCs appeared to be morphologically spindle-shaped and showed active capability of proliferation both in primary and passage generations. Flow cytometry analysis indicated that MSCs were universally positive for CD29, CD44 and CD105, but negative for CD34 and CD45. TGF-β1 expression can be observed by Western blot after 10 days in two transfection groups, MOI of 5 × 105 group and MOI of 1× 105 group. With the extension of time, the contents of hTGF-β1 increased in the two groups detected by ELISA, while there was a significant difference between them two (P < 0.01). After 2 weeks of transfection of MSCs by rAAV2-hTGF-β1, the expression of collagen Ⅱ and Aggreacan mRNAs were positive. It also showed positive of collagen Ⅱ detected by immunocytochemistry. Conclusion Canine MSCs show chondrogenesis differentiation after induction by Type 2 rAAV mediated transfer of TGF-β1 gene. The process is a potential application for cartilage tissue engineering.
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Objective To evaluate one-stage arthroscopic reconstruction of anterior crueiate ligament (ACL)and posterior cruciate ligament(PCL)using Achilles tendon-bone allografts. Methods From July 2000 to February 2005.we treated 15 patients(11 males and 4 females)whose ACL and PCL were ruptured at one knee but the eontralateral knee was intact.Their associated meniscus injuries were treated arthroscopically according to established procedures prior to ligament reconstruction.Thirty Achilles tendon-bone allografts were used to reconstruct torn ACL and PCL in 15 knees at one stage.Reconstruction of both ligaments was performed at subacute or chronic phase(>3 to 8 weeks)in 12 casses,and at acute phase in 3 cases(<3 weeks).All knees were graded pre-and postoperatively using the International Knee Documentation Committee(IKDC)and Lysholm scoring systems.At follow-up,functions were evaluated for all patients and compared with those of the contralateral healthy knee. Results All patients were followed up for a minimum of 3 years(mean,38 months).Preoperatively,the IKDC ratings showed all the injured knees were severely abnormal.At final postoperative f0Uow-up,9 knees received a normal rating,5 a nearly normal one and 1 an abnormal one.The differences in Lysholm score were statistically significant (t=15.660,P<0.05)between pre-and postoperative analyses.The most noticeable postoperative complication was a short localized fever coupled with arthroedema in 1 case. Conclusions Achilles tendon-bone allograft offers an alternative for simultaneous arthroseopic reconstruction of ACL and PCL.However,problems inherent in allograft tissues entail further investigation to ensure future application.
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BACKGROUND: Digit amputation coupled with neighboring composite skin loss frequently occurs. Conventional treatment for this lesion is somewhat less desirable in that it either results in shortened or lost fingers as well as delayed skin resurfacing. Therefore, the curative effect is not satisfactory.OBJECTIVE: To observe free forearm venous flap for soft-tissue reconstruction in digit amputation accompanied with neighboring soft tissue loss and postoperative rehabilitation and its effect on functional recovery.DESIGN: Before-and-after controlled observational trial based on the patients.SETTING: Department of orthopedics of a university hospital.PARTICIPANTS: Totally 11 patients, 8 males and 3 females aged 20 to 45years, who were treated between October 2000 and May 2004 in the Department of Orthopedics, Third Affiliated Hospital of Sun Yat-sen University,for digit amputations accompanied with composite skin flaps avulsed in dorsal fingers or hand, were recruited.METHODS: Eleven free venous flaps measuring 1. 5 cm × 1.0 cm to 5 cm × 6. 5 cm from anteromedial ipsilateral forearms were elevated and transferred to the defected sites either antegradely or retrogradely with respect to the nature of the defects. Microvascular anastomosis was performed at both ends of the flaps to the wounds in an end-to-end fashion. Digit replantations in 13 digits were performed simultaneously at one stage. The donor sites were closed primarily by direct suturing or skin grafting. After operation, early rehabilitation was initiated under professional guidance.RESULTS: Complete healing was achieved in 9 out of 11 venous flaps and 12 out of 13 replanted digits. After one-year follow-up, finger motion function in seven cases was satisfactory; however, all the flaps presented diminished sensation.CONCLUSION: The free venous flap from anteromedial forearm is an alternative flap for soft-tissue reconstruction in digit amputation. Easy access,ideal thickness, and good pliability are the advantages of the flap whereas limited sensory recovery is the main shortcoming.