VSD combined with fascio-cutaneous flap transferation staging operation to treat post-traumatic osteomyelitis / 中国骨伤

<p><b>OBJECTIVE</b>To explore the therapeutic effects of VSD combined with fascio-cutaneous flap transferation staging operation for the treatment of post-traumatic osteomyelitis.</p><p><b>METHODS</b>From December 2007 to December 2009, 14 patients were treated with the technology of VSD combined with fascio-cutaneous flap transferation staging operatinon. Nine patients were males and 5 patients were females, and mean age was 36 years. All the patients were postoperative wound infection. Osteomyelitis of the tibia was in 9 cases, calcaneus in 3 cases, femur in 1 case, radius and ulna in 1 case; infection of time were from 2 to 96 weeks, an average time of 32 weeks.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 12 to 36 months, with an average of 19.2 months. All the patients were treated with debridement and VSD for 1 to 3 times, with an average of 1.57 times. The wounds of 13 cases healed well after flaps transferation, but of 1 case leakaged and healed after 3 weeks with the therapy of drainaging and changing dressings. Due to delayed healing or defects of bone, 8 patients had autologous bone grafted on the second stage. All wounds and fractures healed without recurrence of postoperative infection.</p><p><b>CONCLUSION</b>VSD combined with flap transferation is an effective treatment of post-traumatic osteomyelitis, which can shorten the treatment time and have better security and reliability than traditional methods.</p>

Treatment of vertical unstable pelvic fracture by percutaneous iliosacral screws fixation / 中国骨伤

<p><b>OBJECTIVE</b>To retrospectively analyze the patients of vertically unstable pelvic fractures treated with percutaneous iliosacral screws fixation and to explore the operative techniques and its therapeutic efficacy.</p><p><b>METHODS</b>From June 2002 to August 2009, 54 patients with vertical unstable pelvic fracture were fixed with percutaneous iliosacral screws. After operation, 46 patients were followed up more than 18 months. Among them, 32 patients were male and 14 patients were female, the average age was 36.4 years old (ranged from 19 to 64 years). The average time from injury to operation was 8.5 days (ranged from 7 to 11 days). All pelvic fractures had vertical dislocation ranging from 8 to 40 mm (averaged 28.5 mm). After admitted, all patients were applied bone traction. After recuction, the fractures were fixed with percutaneous iliosacral 7.3 mm cannulated screws, which crossed the iliac and sacral-iliac joint and sacral promontory to S(1)vertebrae. After operation, all patients took X-ray examination. The reduction and the fracture reduction were judged according to Matta criterion and clinical function was judged according to Majeed functional scoring.</p><p><b>RESULTS</b>Forty-six patients were followed up from 1.5 to 3 years with an average of 29 months. Fracture uninon was achieved in all patients. All patients got clinical recovery at mean time of 5.2 months and returned to normal daily life. According to Matta criterion for fracture reduction, the results were excellent in 40 cases and good in 6 cases. According to Majeed functional scoring, 32 patients were excellent, 12 good and 2 normal. There were no serious complications of vascular damage.</p><p><b>CONCLUSION</b>Percutaneous iliosacral screw fixation is an effective technique with advantages of minimal invasive and faster recovery in the management of vertically unstable pelvic fractures.</p>

The value of modified POSSUM scoring system in predicting mortality and morbidity for the intertrochanteric fracture in elder patients / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the value of modified physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) scoring system in predicting mortality and morbidity for the intertrochanteric fracture in elder patients.</p><p><b>METHODS</b>A retrospective study was conducted over a period of nearly 2 years from January 2007 to December 2008. Complete data from 119 patients were analyzed to compare the mortality and morbidity predicted by the POSSUM and the observed mortality and morbidity. POSSUM risk was calculated using the original POSSUM equation.</p><p><b>RESULTS</b>POSSUM predicted 11(9.2%) deaths, which had no statistical significance with the observed mortality 5 (4.2%) (chi² = 2.412, P = 0.120). The estimated incidence of postoperative complications was 42 (35.3%), which also has no statistical significance with the observed morbidity 39 (32.8%) (chi² = 0.168, P = 0.682).</p><p><b>CONCLUSIONS</b>The modified POSSUM scoring system can predict accurately postoperative mortality and morbidity for the patients underwent intertrochanteric fracture and it predict more accurately in high risk band. The physiological score can be used to evaluate the physiological conditions preoperative and the pulmonary disease is the most important factor lead to death of the elder patients underwent intertrochanteric fracture.</p>

Augmentative plate fixation for the treatment of femoral hypertrophic nonunions subsequent to intramedullary nailing fixation / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effect of augmentative plate fixation to increase stability in the treatment of femoral shaft nonunions subsequent to intramedullary fixation.</p><p><b>METHODS</b>Nine patients with femoral nonunions after intramedullary nail internal fixation were treated with augmentative plate internal fixation from April 1998 to Jane 2008, included 8 males and 1 female, with an average age of 32 years old ranging from 21 to 54 years. One case was upper 1/3 femoral fractures, 5 cases were middle 1/3 femoral fractures, 3 cases were lower 1/3 femoral fractures. The interspace of bone nonunion was more than 5 mm in 6 cases, of them, iliac bone grafting were applied in 4 cases, artificial bone combined with iliac bone grafting were applied in 2 cases; The interspace of bone nonunion was less than 5 mm in other 3 cases,artificial bone grafting was applied in 1 case, fitting bone callus were applied in 2 cases. All patients got protected weight loading preventing the main screw break.</p><p><b>RESULTS</b>All patients achieved radiological solid union at an average of 8 months (ranged 6 to 11 months ). The fixation was removed during 6 to 11 months after operation in 5 cases. Donor site pain of iliac occurrenced on 4 cases,3 cases relieved 1 month later and 1 case relieved 3 months later. No infection, fixation loosening or breaking was observed.</p><p><b>CONCLUSION</b>The augmentative plate fixation can be applied at the fracture site to prevent the rotational instability. The technique is simple and does not require any special instrument, which facilitates an early weight bearing and gives a quick recovery from nonunion.</p>