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Objective To explore the feasibility of tibial nerve motor branches transfer to the deep fibular nerve in an anatomical study.Methods Twenty-three sides lower limbs from 12 adult cadavers which preserved in Formalin were used for dissection of the tibial nerve and its all motor branches,and the proximal deep and superficial fibular nerve.Experimental measurement were performed for the parameters of each branch such as length,diameter,the location of original point relative to the level of the fibular head.The diameter of proximal part of the deep fibular nerve was measured simultaneously.Finally,the length from original point of each branch to the fibular neck was also measured during simulation of nerve transfer procedure.Results The average length of motor branches to the flexor digitorum longus muscle,to the flexor hallucis longus muscle and the superficial branches to the soleus muscle were (95.70 ± 13.40)mm,(96.90± 13.60)mm and (73.60 ± 12.00)mm respectively.Their average diameter were (0.63 ± 0.16)mm,(0.65 ±0.20)mm and ( 1.56 ± 0.26)mm respectively.The average diameter of proximal deep fibular nerve was (2.54± 0.26)mm.Based on length,branches to the flexor digitorum longus muscle and flexor hallucis longus muscle were adequate for direct nerve transfer to the deep fibular nerve in all specimens without interpositional grafr.And in 22 specimens (95.7 percent),the superficial branches to the soleus muscle were long enough to directly transfer.Other branches of the tibial nerve were not adequate for direct nerve transfer Conclusion This study confirmed the anatomical feasibility of using motor branches from tibial nerve for direct transfer to restore the deep fibular nerve.The superficial branches to soleus muscle were the best donor nerve if considering the branches,length,diameter and the difficulty of surgical procedures.
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Objective To study the methods and therapeutic effect of coverage the soft tissue defect in the foot and ankle with neurocutaneous sural artery island flap.Methods 30 patients had been reconstructed foot and ankle soft-tissue defects with neurocutaneous sural artery island flap,the area of soft tissue defect from 2.0 cm × 3.5 cm～ 8.0 cm× 16.5 cm,the flaps were designed with the size measuring 2.5 cm × 4.0 cm to 8.5 cm × 18cm.Results 26 flaps survived completely and 4 with partial or margin necrosis,the wound infection occurred in 6 patients and were treated with dressing,shin graft and antibiotic drug.Conclusions Sural neurocutaneous island flaps are easy to separate.Major arteries are not injured.It is the ideal flap to repair the soft tissue defect around ankle and foot,the texture,color and contour of the flap is similar to recipient area.
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Objective To investigate the methods and therapeutic effects in reconstructing and restoring the knee stability of floating knee injury. Methods A total of 38 patients with floating knee injury combined with acute knee instability treated from January 2000 to January 2006 were retrospectively studied to evaluate the efficacy of different procedures. Results All patients were followed up for 1-4 years (mean 1.5 years), which showed fracture healing in all patients. There occurred postoperative wound infection in three, internal fixator loosening in two, anterior cruciate ligament laxity in one and osteearthritis in two. According to Score of Hospital for Special Surgery (HSS) for knee function,the knee function was excellent in 32 patients, good in five and fair in one, with excellence rate of 84%. Conclnsions During the treatment of floating knee injury, attention should not only be paid to the reconstruction of the bone continaity, but also to the restoration of ligaments, meniscus, joint capsule and muscles.
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[Objective]To analyze the character of the complex proximal humeral fracture,study their operative methods and evluate the efficiency of treatment for complex proximal humeral fracture in elder patients with LCP plate.[Method]From(Oct 2004 to June 2006,16 elder patients with complex proximal humeral fracture were admitted and treated with open reduction and LCP plate internal fixation,regular clinical follow-up was executed by our medical team,the postoperative results were observed and the efficiency were evaluated by us.[Result]Sixteen cases obtained postoperative clinical results from 6 to 18 months(average 12.3 months),the fracture were healed in all cases,the shoulder function were evaluated with Neer shoulder functoin scoring systerm,the execellent result were 11,good 2,normal 2 and poor 1,the execellent and good results were 81.3% in all cases,6 cases got anatomic reduction,6 cases got nearly anatomic reduction,3 normal and 1 poor which were certified by radiographic examination.[Conclusion]The treatment for complex proximal humeral fracture in elder with LCP plate has less invasive,firm internal fixation and satisfactory shoulder function recovery.It is a very satisfactory internal fixtion for complex proximal humeral fracture in elder patients.