The use of uncemented extensively porous-coated femoral components in the management of Vancouver type B2 periprosthetic femoral fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the outcome of patients with Vancouver type B2 periprosthetic fractures treated with femoral revision using an uncemented extensively porous-coated implant.</p><p><b>METHODS</b>From October 2002 to May 2007, a retrospective clinical and radiographic assessment of 10 patients with Vancouver type B2 periprosthetic fractures treated with femoral revision was evaluated, among which 4 was cement fixation, 6 was non-cement fixation in the index procedure.</p><p><b>RESULTS</b>The mean follow-up for these patients was 44 months (range, 12 to 67 months). The mean Harris hip score was 87.6 points. All 10 reconstructions showed solid fracture union and a stable prosthesis, 8 was bone ingrowth, 2 was fibrous ingrowth. Complications in 4 patients included thigh pain in 1, stress shield in 3.</p><p><b>CONCLUSIONS</b>Vancouver type B2 periprosthetic fractures treated with uncemented extensively porous-coated femoral stems incorporate distally allowing stable fixation.</p>

The use of a pneumatic tourniquet in total knee arthroplasty: a prospective, randomized study / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the value of the use of a pneumatic tourniquet in total knee arthroplasty.</p><p><b>METHODS</b>Sixty patients were prospectively randomized into 2 groups, one group underwent total knee replacement with a tourniquet (n = 30) and one without (n = 30). Operating time, blood loss, postoperative mean morphine requirement, swelling, ecchymosis, earlier straight-leg raising and postoperative knee flexion were measured in both groups.</p><p><b>RESULTS</b>There was no significant difference in the total blood loss between the 2 groups although the intraoperative blood loss was significantly greater in those without a tourniquet. The mean morphine requirement, postoperative swelling, scope of ecchymosis, earlier straight-leg raising and postoperative knee flexion in the patients that had surgery without a tourniquet were significantly better than those with a tourniquet.</p><p><b>CONCLUSION</b>Knee arthroplasty operation with the use of a tourniquet has only small benefits on the total blood loss, but hinder in patients' early postoperative rehabilitation exercises.</p>

Patella reshaping versus resurfacing in total knee arthroplasty: a prospective randomized study / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the differences in the clinical outcome of total knee arthroplasty according to patellar reshaping or resurfacing.</p><p><b>METHODS</b>From January 2002 to December 2002, 60 patients (60 knees) undergoing primary total knee arthroplasty for the treatment of osteoarthritis were enrolled in a prospective, randomized study. All patients received the same posterior-cruciate-substituting total knee prosthetic components. Patients were randomized to the treatment with reshaping or resurfacing of the patella, and the results were followed up for a mean of 54 months (40-60 months). Evaluations consisted of the determination of a Knee Society Score, range of motion for knees, patient satisfaction, and radiographs.</p><p><b>RESULTS</b>With the numbers available for study, no significant difference was found between the knees that had patellar resurfacing and those that had patellar reshaping with regard to the overall score (P=0.12), the subscore for pain (P=0.90), and patient satisfaction (P=0.22). The results showed that the same prevalence of any anterior knee pain in two groups was 10%, and it did not represent a significant difference. The two groups showed statistical difference with regard to the total function score and range of motion.</p><p><b>CONCLUSIONS</b>It has shown that total knee arthroplasty with patella reshaping or resurfacing dramatically relieves pain and improves the function. It seems that postoperative anterior knee pain is related either to the component design or to the details of the surgical technique, rather than to whether or not the patella is resurfaced.</p>

Evaluation of injuries first week after Wenchuan earthquake in field hospital / 上海第二医科大学学报

Objective To evaluate the injuries in Jiangyou Field Hospital first week after Wenchuan earthquake,and accumulate experience for better medical services and better-built field hospitals to meet the demands of the earthquake-stricken areas.Methods Classification was performed in 1 905 patients with emergency treatment.The medical records of those with hospital stay were retrospectively analysed,including geographical distribution,trauma type,diagnosis,initial treatment and outcomes.Results Six hundred and twenty-nine(33%)patients were hospitalized,with an average of 2 to 100 years old(median,41.2).Three hundred and eighty-four patients(61%)were admitted within the first three days after earthquake.The patients were mainly from Jiangyou City(245,39%),Beichuan County(194,31%)and Pingwu County (158,25%).The most common types of injuries were superficial lacerations(326,51.8%),fractures(202,32.1%) and soft tissue contusions/sprains(87,13.9%),among whom 15 experienced severe squeeze.There were 318 injuries to pelvis and extremities(50.6%),117 to head(18.6%)and 43 to back(6.8%),and 73 cases had multiple injuries (11.6%).Of 376 patients(59.8%)with operation,326 received debridement,21 external fixation,19 internal fixation, 11 amputation,4 laparotomy,4 fasciotomy and 2 craniotomy.The incidence of postoperative infections was 11.8%.Death occurred in 39 patients due to cerebral trauma,pelvic fracture,abdominal hemorrhage and multiple injuries.Conclusion When the earthquake has destroyed the major medical facilities,rapid organization of medical rescue teams,making full use of remaining medical resources and recovering electricity play an important role in the rescue of victims and reduction of mortality.Orthopaedic surgeons must dominate the medical teams as most of the earthquake victims suffer from injuries to the extremities.

The use of a closed-suction drain in total knee arthroplasty: a prospective, randomized study / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the value of using a closed-suction drain in cemented knee arthroplasty.</p><p><b>METHODS</b>One hundred patients were prospectively randomized into two groups, one group underwent cemented total knee replacement with a single deep closed-suction drain, and the other group (n = 50) no drain.</p><p><b>RESULTS</b>The total blood loss was significantly greater in those with a drain although those without lost more blood into the dressings. There was no statistical difference in the postoperative swelling or pain score, ecchymosis, deep vein thromboses (DVT), time at which flexion was regained or the incidence of infection at a minimum of two years after surgery in the two groups.</p><p><b>CONCLUSION</b>There is no evidence to support the use of a closed-suction drain in cemented knee arthroplasty.</p>

Proximal humeral fractures treated with arthroplasty / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To explore arthroplasty in treating 3- and 4-part fractures of the proximal humerus.</p><p><b>METHODS</b>A total of 132 patients with proximal humeral fractures were treated in our hospital from July 1997 to February 2003. According to Neer's classification, the fractures of 45 patients (14 males and 31 females, aged 31-78 years, 56.1 years+/-7.8 years on an average) belonged to 3- or 4-part fractures (10 patients with 4-part fracture and 35 with 3-part comminuted fracture) and they were treated with shoulder joint arthroplasty. Unipolar prosthesis replacement of the head of humerus was made in 28 cases, while bipolar prosthesis replacement in 2 cases and total shoulder joint replacement in 15 cases.</p><p><b>RESULTS</b>During the follow-up period (range: 12-72 months, mean: 37.3 months+/-4.1 months), among the 45 patients who suffered from fractures of the proximal humerus and underwent arthroplasty surgery, 44 patients (97.8%) had no postoperative pain and were satisfied with the active range of motion and with the whole treatment results. And radiography showed that the prostheses were at their good position. One patient had postoperative pain because he had so narrow medullary cavity that the humeral prosthesis could not be put deeply enough and the prosthesis head was a little higher over the anatomic level. He did not have good postoperative active range of motion, either. Then he received a review surgery and got satisfied results. Temporary shoulder stiffness was observed in one patient. Manual release of these adhesions improved the shoulder function. No evidence of nonunion of the fracture segments around the humeral prosthesis stem was found.</p><p><b>CONCLUSIONS</b>Shoulder arthroplasty is a dependable method to restore the comfort and function of the shoulder joints of the patients with 3- or 4-part fractures of the proximal humerus.</p>