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We carry out the tutorial system in the standardized training of residents,promote students to grasp the clinical skills and clinical research and thinking,and promote teachers' professional theoretical level and teaching ability.In the orthopedic rotation we define the teaching focus to the trainees of different seniority:for junior trainees,the training of medical records writing and basic clinical skills should be focused,and for senior trainees,the emphasis of training is to improve their clinical capacity of diagnosis and treatment.In teaching,the teaching methods of a combination of Multidisciplinary team (MDT) of bone and soft tissue tumors and problem based learning (PBL) have been actively tried to improve students' learning enthusiasm and initiative,which helps the trainees fully grasp the diagnosis and treatment of certain diseases.
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BACKGROUND:Posterior maleolar fractures are often accompanied by ankle joint instability,if the stability of ankle joint is not recovered,it is prone to traumatic arthritis of the ankle.However,the indications of internal fixation of posterior maleolar fractures remain controversial.OBJECTIVE:To explore the indications for internal fixation of posterior maleolar fractures by comparing the clinical effects of posterior maleolar fractures treated with internal fixation or not.METHODS:42 patients with maleolar fractures involving posterior ankle were recruited from the First Affiliated Hospital of Chongqing Medical University from January 2007 to January 2012.According to preoperative CT scans of ankle joint,42 cases were divided into the internal fixation group and the non-fixation group.27 cases in the fixation group had posterior maleolar fractures in more than 10％of the distal tibial articular surface and/or dislocation of the posterior maleolar fractures greater than 2 mm,and were treated with screws.15 cases in the non-fixation group had posterior maleolar fractures in less than 10％of the distal tibial articular surface anddislocation of the posterior maleolar fractures less than 2 mm,and were treated with non-operation.The average healing time of posterior maleolar fractures,postoperative complications,ankle-hindfoot scores of American Orthopedic Foot and Ankle Society were compared during the folow-up postoperatively.RESULTS AND CONCLUSION:Al of 42 patients with ankle fractures achieved bony union within 6 months.In the fixation group,1 case had postoperative superficial infection of the wounds in the medial ankle and lateral ankle,and the wound got healed completely with anti-infection therapy.One case in each group had postoperative superficial necrosis in the incisional edges,and got healed by dress changing.For the other cases,there was no wound infection,internal fixation loosening,breakage or failure and other adverse events during the folow-ups.Ankle functions were evaluated one year after operations according to the ankle-hindfoot score standard of American Orthopedic Foot and Ankle Society.The score of the fixation group was (83.74±10.35) points,with excelent ankle functions in 10 cases,good in 12 cases,fair in 5 cases,and no poor case,and the rate of patients achieving excelent and good ankle functions reached 82％; the score of non-fixation group was (85.60±10.40) points,with excelent ankle functions in 7 cases,good in 5 cases,fair in 3 cases and no poor case.The rate of patients achieving excelent and good ankle functions reached 80％.The ankle function evaluation results of both groups showed no statistical difference (P＞0.05).It is reasonable to consider posterior maleolar fractures is higher than 10％of the distal tibial articular surface and/or dislocation of the posterior maleolar fractures greater than 2 mm as the indications for internal fixation of posterior maleolar fractures.
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Objective To evaluate the clinical effect of femoral neck fracture fixed with 7.5mm QWIX screws and to find out risk factors for avascular necrosis of the femoral head postoperatively.Methods From January 2009 and March 2013, 53 patients underwent closed or open reduction of femoral neck fracture with 7.5mm QWIX screws.Healing process of fracture, complications of internal fixation, Harris hip score and avascular necrosis of the femoral head were followed up.The data reviewed were age, gender, injury patterns, fracture type, preoperative waiting time, reduction ways, reduction condition, and others.Unilateral and multivariate Logistic analysis were applied to identify factors for avascular necrosis of the femoral head.Results All patients were followed up for 2-5 years (mean, 3.4 years).There was no non-union at follow-up, and all the screws were in the original site without loosening, cut-out or penetration.Mean Harris score was 91.2 points (range, 68 to 100 points) 2 years after operation, including 42 excellent, 6 good, 1 fair and 4 poor results with the excellent-good rate of 91％.Four patients (8％) had avascular necrosis 12 to 15 months after operation.With Logistic regression analysis, fracture anatomic type was identified as the only factor for avascular necrosis of the femoral head.Conclusions The 7.5 mm QWIX fixation screw provides rigid fixation, high healing rate and low incidence of avascular necrosis of the femoral head, appearing to be a good hardware to repair femoral neck fracture.Avascular necrosis of the femoral head is associated with the anatomic type of femoral neck fracture after operation.
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Objective To investigate the effects of laminar shear stress ( LSS) on the proliferation and apoptosis of mesenchymal stem cells ( MSCs) . Methods The influences of laminar shear stress ( the physiological levels) on MSCs were studied. DNA synthesis and cell cycle were measured,to detect the cellular proliferation. The apoptosis-related gene expression ( Bcl-2/Bax) was examined to determine the effect of LSS. Results The percentage of MSCs’ proliferation rate was reduced by the fluid shear stress. Furthermore,it was detected that LSS exerted a potent suppression effect on MSC apoptosis. Conclusion These data revealed a critical role of LSS in maintaining the quies-cence of MSCs.
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BACKGROUND:The most important influence caused by patel ar fracture is the breakage of knee extension apparatus continuity and potential uncoordination of patel ofemoral joint. The aim of patel ar fracture surgery is to restore the smoothness of patel ar articular surface and to maintain the continuity of knee extension apparatus, to provide stable effective fixation, so as to do early functional exercises. OBJECTIVE:To evaluate the clinical effectiveness of a fixation technique for patel ar fractures using QWIX combined with Kirschner wire and wire. METHODS:From September 2011 to September 2012, 30 patients with patel ar fractures were treated using QWIX screws combined with Kirschner wire and wire in the First Affiliated Hospital of Chongqing Medical University, China. There were 17 males and 13 females, at the age of 47.7 years on average. In accordance with the situation of comminuted fracture and the degree of displacement, QWIX screws or QWIX screws+tension band wire or QWIX screws+Kirschner wire+tension band wire were used for fixation. Active and passive knee motion exercises began at 1 day after surgery, without any external fixation. At 6 weeks, 3, 6, 12 months, and 1 year after surgery, the patients were fol owed up in out-patient clinic to identify fracture healing and to make sure whether complications appeared or not. The range of flexion and extension of bilateral knee was measured. The knee function of the affected side was evaluated using Bostman score at 1 year postoperatively. RESULTS AND CONCLUSION:Al patients were fol owed up for 12 to 24 months. 24 cases were healed within 3 months after surgery, and 6 cases were healed within 4 months after surgery, with an average healing time of 3.2 months. With time prolonged, the range of flexion and extension of bilateral knee gradual y increased. The knee function of patients recovered to the level before injury at 1 year after surgery. During fol ow-up, one patient experienced knee pain due to Kirschner wire loosening. No infection, knee pain, fixation failure, or flexion dysfunction occurred in the remaining patients. In accordance with Bostman score, there were excellent in 27 cases, good in 3 cases, and poor in 0 case, with an excellent and good rate of 100%at 1 year fol owing surgery. Results data suggested that QWIX screws combined with Kirschner wire and wire fixation in repair of patel ar fracture have some advantages such as continuous dynamic and static pressure at the broken ends of the bones, early flexion and extension exercises, and reducing the fixation-related complications. It is an effective method to repair patel ar fracture.
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Objective To comparetheproximalfemoralnailantirotation(PFNA)anddynamichipscrew(DHS)treatmentonin-tertrochanteric femur fractures in the elderly .Methods Retrospective analysis was conducted on 60 patients with intertrochanteric femur fracture collected from December 2009 to December 2012 ,which underwent these two methods ,including 32 cases of PFNA group ,28 cases of DHS group .The 5 indicators including operation time ,intraoperative blood loss ,complications ,fracture healing time and hip function recovery were analyzed .Results Sixty cases were followed up for 10 to 25 months ,average 17 months ,com-pared with DHS group ,PFNA group was with short operation time ,less bleeding ,less complications ,short time of fracture healing , according to standard of Harris score ,the hip function recovered well .Conclusion PFNA treatment on intertrochanteric femur frac-tures is with little trauma ,reliable fixation ,fewer complications ,with which the hip function recovered well ,and it is the preferred method of operation in treatment of senile intertrochanteric femur fracture .
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Objective To analyze the postoperative complications of external fixator in treatment of elderly high-risk intertrochanteric fractures and its effect on length of hospital stay and on in-hospital fees.Methods The study involved 55 elderly patients with high-risk intertrochanteric fractures fixed with Orthofix external fixators from January 2009 to December 2011.There were 21 males and 34 females at age range of 70-79 years.All patients were associated with one underlying disease at least.Relationship of complications with patients' age,preoperative underlying diseases,surgery operation and postoperative care were analyzed.Results Common postoperative complications were lung infection (11％),screw channel exudation (25％),superficial pin tract infection (13％) and pain around the screws (22％).Factors for lung infection included the underlying lung disease and cerebral infarction before operation.Influential factor of screw channel exudation was the degree of damage to soft tissue intraoperatively.Influential factor of the superficial pin tract infection was postoperative care level.Average length of hospital stay was 5.17 days longer for patients who experienced complications after operation.Conclusions Common postoperative complications are influenced by preoperative occurrence of underlying lung disease as well as cerebral infarction,intraoperative damage to soft tissues and postoperative care level.Postoperative complications prolong the length of hospital stay and increase the treatment expense.
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Objective To evaluate the clinical efficacy of radial head prosthesis replacement in treatment of comminuted fracture of the radial head and discuss relative operative announcements.Methods There were 27 patients with comminuted fracture of the radial head who were treated with radial head prosthesis replacement. Results Of all,26 patients were followed up for averaged 14months.According to Broberg score,the post-operative function was excellent in 9 patients(35%),good in 13(50%)and fair in 4(15%),with no poor results and with excellence rate of 85%. Conclusion Radial head prosthesis replacement can better restore the stability,flexion and extension of the elbow as well as the rotational motion of the forearm and is worthy of clinical application.
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Objective To summarize the clinical effect of open reduction and internal fixation for the proximal humeral fracture with locking proximal humerus plate (LPHP). Methods A total of 45 cases with complex humeral fractures were operated via deltoid-pectoral approach. According to the Neer classification, there were 33 cases with three-part fractures and 12 with four-part fractures. Neer nu- merical rating system was employed to evaluate postoperative function of the involved shoulder. Results Of all, 38 cases were followed up for a mean 14.7 months, which showed fracture union within 3 months in 35 cases and fracture union within 4 months in 3. According to the Neer numerical rating system, re- suh was excellent in 20 eases and satisfactory in 15, with total excellence rate of 92%. Conclusion LPHP is characterized by stable fixation, minor complication and high satisfaction, and hence is an effec- tive method for proximal humeral fractures.
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Objective To explore the curative effects of open reduction and internal fixation with Cable Pin or tension band wire for patellar transverse fractures.Methods Totally 28 cases and another 30 cases were enrolled in the Cable Pin group(8 months for average follow-up time) and the tension band wire group respectively(16 months for average follow-up time).The operative time,the average clinical healing time and the average range of the knee flexion between the 2 groups were compared.Results Obvious superiority was observed in the Cable Pin group over the tension band wire group concerning the average clinical healing time and the average range of the knee flexion 6 months postoperatively (P