Minimally-invasive internal fixation for mid-lateral 1/3 clavicle fracture with distal clavicular anatomic locking plate / 中国骨伤

OBJECTIVE@#To investigate clinical effects of minimally-invasive internal fixation for mid-lateral 1/3 clavicle fracture with distal clavicular anatomic locking plate.@*METHODS@#From February 2016 to March 2017, 32 patients with mid-lateral 1/3 clavicle fractures treated by minimally-invasive internal fixation with distal clavicular anatomic locking plate, including 24 males and 8 females with an average of (42.3±12.7) years old (ranged from 22 to 68 years old). According to Robinson classification, 6 patients were type 2A2, 18 patients were type 2B1 and 8 patients were type 2B2. No vessel and nerve injury occurred before operation. The time from injury to operation ranged from 0 to 6 days with an average of (3.1±1.4) days. Length of bilateral clavicule were compared before and after operation to evaluate fracture reduction. Constant score at 6 months after operation was applied to assess recovery of shoulder function.@*RESULTS@#Thirty patients were followed up from 11 to 18 months with an average of (13.3±2.2 ) months. No vessel and nerve injury, implant failure, nonunion or delayed union occurred after operation, and facture wound healed at stage I, the time ranged from 8 to 12 weeks with an average of(10.2±1.1) weeks. Shortened length of clavicle decreased from(11.2±3.6) % before operation to (0.4±0.3)% after operation at 2 days. Ten patients removed internal fixation at 8 months after operation without re-fracture occurred after remove plate. Constant score increased from 23.53±5.21 before operation to 94.30±5.60 after operation at 6 months, and 26 patients got excellent results, and 4 good. Patients were satisfied aesthetic degree of scar and shoulder joint function.@*CONCLUSIONS@#Minimally-invasive internal fixation for mid-lateral 1/3 clavicle fracture with distal clavicular anatomic locking plate, which has advantages of less trauma, rapid recover, less scar, could receive good clinical effects and not effect beauty.

Descending branch of anterior lateral malleolar artery based anterograde island flaps for reconstruction of foot and ankle defects / 中国骨伤

<p><b>OBJECTIVE</b>To explore surgical method and clinical effects of descending branch of the anterior lateral malleolar artery based anterograde island flap for repairing foot and ankle wounds.</p><p><b>METHODS</b>Nine patients with skin defects of foot and ankle repaired by descending branch of the anterior lateral malleolar artery based anterograde island flap were studied from June 2015 to January 2017, including 6 males and 3 females aged from 32 to 63 years old. The wound were located on foot and ankle and associated with exposure of bone, tendon, blood vessels or nerves. The surface of wound located on foot in 6 patients, and 3 patients in ankle joint. The area of defect ranged from 1.5 cm×2.0 cm to 6.0 cm×13.0 cm, and the area of flap ranged from 2.0 cm×3.0 cm to 7.0 cm×15.0 cm. The donor site was skin grafted with split-thickness skin from abdomen. Appearance, texture, condition of donor site of island flaps after operation were observed, satisfied degree of clinical effects were evaluated by ZHANG Hao's evaluation, and AOFAS score were used to evaluate function.</p><p><b>RESULTS</b>Circulations of flaps in 9 cases were stable without blockage, and healed well at 2 weeks after operation. All patients were followed up from 2 to 18 months with an average of(8.0±2.3) months. All flap were survived at stage I, pedicles looked smooth and tidy, no cat-ear formed, the texture of flap was soft with satisfied appearance, the color was near to surrounding skin. The surface of wound were tidy after skin graft of donor sites without scar hypertrophy. Nine patients got satisfied results according to ZHANG Hao's evaluation, and AOFAS score was excellent.</p><p><b>CONCLUSIONS</b>Descending branch of the anterior lateral malleolar artery based anterograde island flap for repairing foot and ankle wounds, which has advantages of protect main vessel, thin flap, is a simple and effective method.</p>

Indirect reduction technique using a distraction support in minimally invasive percutaneous plate osteosynthesis of tibial shaft fractures / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To describe an indirect reduction technique during minimally invasive percutaneous plate osteosynthesis (MIPPO) of tibial shaft fractures with the use of a distraction support.</p><p><b>METHODS</b>Between March 2011 and October 2014, 52 patients with a mean age of 48 years (16-72 years) sustaining tibial shaft fractures were included. All the patients underwent MIPPO for the fractures using a distraction support prior to insertion of the plate. Fracture angular deformity was assessed by goni- ometer measurement on preoperative and postoperative images.</p><p><b>RESULTS</b>Preoperative radiographs revealed a mean of 7.6°(1.2°-28°) angulation in coronal plane and a mean of 6.8°(0.5°-19°) angulation in sagittal plane. Postoperative anteroposterior and lateral radio- graphs showed a mean of 0.8°(0°-4.0°) and 0.6°(0°-3.6°) of varus/valgus and apex anterior/posterior angulation, respectively. No intraoperative or postoperative complications were noted.</p><p><b>CONCLUSIONS</b>This study suggests that the distraction support during MIPPO of tibial shaft fractures is an effective and safe method with no associated complications.</p>

Treatment of complete acromioclavicular joint dislocation with transfer of the medial half of the coracoacromial ligament to reconstruct the coracoclavicular ligament / 中国骨伤

<p><b>OBJECTIVE</b>To explore the operation methods and clinical effects of transfer of the medial half of the coracoacromial ligament to reconstruct the coracoclavicular ligament in treating complete acromioclavicular joint dislocation.</p><p><b>METHODS</b>From January 2006 to June 2012,26 patients with acute complete acromioclavicular joint dislocation underwent surgery. Transfer of the medial half of the coracoacromial ligament to reconstruct the coracoclavicular ligament, additional clavical hoot plate and Kirschner wires fixation, were performed in all the patients. Among the patients, 18 patients were male and 8 patients were female, with an average age of 36.7 years old (ranged from 25 to 51 years). The duration from injury to operation was from 3 to 12 days with an average of 5 days. According to the Rockwood classification, 4 cases were grade III and 22 cases were grade V . Clinical manifestation included local swelling, tenderness with snapping, limitation of shoulder joint motion. In preoperative bilateral shoulder joint X-rays, the injured coracoclavicular distance was (16.2 ± 5.0) mm which was significantly wider than that of uninjured sides (7.6 ± 1.0) mm. Clinical results were evaluated according to X-rays and Constant-Murley score.</p><p><b>RESULTS</b>All incisions obtained primary healing after operation without complication of infection, internal fixation breakage, redislocation. All the patients were followed up from 12 to 30 months with an average of 18 months. Kirschner wires and internal fixation plate were removed at 1 month and 8-10 months after operation, respectively. At final follow-up, the motion of shoulder joint recovered to normal and a no pain joint was obtained. According to Constant-Murley score, 24 cases got excellent results and 2 cases good. There was no significant difference after operation between the injured coracoclavicular distance and the uninjured contralateral side [(7.7 ± 1.2) mm vs (7.6 ± 1.0) mm), P > 0.05].</p><p><b>CONCLUSION</b>Transfer of the medial half of the coracoacromial ligament to reconstruct the coracoclavicular ligament, additional fixation using hook plate and Kirschner wires is the effective surgical method in treating complete acute acromioclavicular joint dislocation.</p>

Percutaneous fixation for the treatment of un-displaced scaphoid fractures with herbert cannulated screws through volar approach / 中国骨伤

<p><b>OBJECTIVE</b>To summarize the experience of percutaneous fixation of scaphoid fractures with Herbert screws through volar approach, and provide a reliable and efficient treatment method for scaphoid fractures.</p><p><b>METHODS</b>From April 2008 to September 2012,15 patients with scaphoid fractures were treated by percutaneous fixation with Herbert cannulated screws through volar approach including 14 males and 1 female with an average age of 35 years ranging from 25 to 45 years old. Among them, 10 cases were on left side and 5 cases were on right side. Durations from injury to operation ranged from 3 to 10 days with an average of 5 days. All these cases were identified as B2 type according to the Herbert classification based on X-ray and CT scan. In order to assess the function of wrist, all patients were calculated according to Krimmer's score postoperatively.</p><p><b>RESULTS</b>The follow-up period were from 5 to 18 months with an average of 10 months. At 3 months after operation,X-ray was re-checked every month. All the patients achieved bone union with a mean time of 10 weeks (ranged from 7 to 14 weeks) postoperatively. According to Krimmer's score, 14 cases gained 100 scores as perfect and one case got 90 scores as good. The small volar incision of all patients were union at the first period. No operation complications such as infection and nonunion occurred.</p><p><b>CONCLUSION</b>Percutaneous fixation with Herbert cannulated screws through volar approach is a reliable and efficient treatment method for scaphoid fractures with small invasion, high bone union rate, and fewer complications.</p>

Clinical and prognostic analysis of nasopharyngeal carcinoma in 44 children and adolescents / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the clinical effect and prognostic factors of nasopharyngeal carcinoma in 44 children and adolescents.@*METHODS@#From June 1987 to December 2003,44 children and adolescents with nasopharyngeal carcinoma were treated by radiotherapy, and some patients also received chemotherapy. Kaplan-Meier method was used for the survival rate and univariate analysis, and Cox proportional hazard model was used in multivariate analysis.@*RESULTS@#The 3.5 year survival rate was 84.2% and 62.3%.In the univariate analysis, clinical stage, lymph node (N) stage, radiotherapy dose and chemotherapy were significant prognostic factors of survival.In the multivariate analysis, N stage and chemotherapy were the prognostic factors in the survival rate.@*CONCLUSION@#Most nasopharyngeal carcinomas belong to the advanced degree. These patients are sensitive to radiotherapy and chemotherapy. Combined modality therapy can improve the clinical effect of nasopharyngeal carcinoma in children and adolescents.