Arthroscopic classification and management for the popliteal hiatus of the lateral meniscus tears / 北京大学学报(医学版)

OBJECTIVE@#To bring forward an arthroscopic classification of the popliteal hiatus of the lateral meniscus (PHLM) tears and to assess the effects of arthroscopic all-inside repair with suture hook in management of such injuries.@*METHODS@#This study involved 146 patients who underwent arthroscopic operation because of PHLM tears from April 2014 to October 2017, eliminating the patients who had discoid lateral meniscus. There were 81 males and 65 females, with 54 left knees and 92 right knees. The average ages were (34.7±3.7) years. Among the selected participants, there were 107 patients with anterior cruciate ligament (ACL) injuries, 39 patients with medial collateral ligament (MCL) injuries, and 48 patients with medial meniscus tears. The average preoperative Lysholm and International Knee Documentation Committee (IKDC) scores were 57.7±9.2 and 54.1±8.9, respectively. The arthroscopic classification was based on the extent and degree of PHLM tears and using the arthroscopic all-inside repair with suture hook for such injuries. For the patients associated with ACL injuries, the ipsilateral autograft hamstring tendons use as the reconstruction graft for single bundle ACL reconstructions. The suture anchors were used for treatment of MCL Ⅲ injuries, and the arthroscopic all-inside repair for medial meniscus tears.@*RESULTS@#A total of 146 PHLM tears in 146 patients were divided into type Ⅰ (tears not involved in popliteus tendon incisura; n=86, 58.9%), type Ⅱ (tears involved in popliteomeniscal fascicles; n=36, 24.7%), and type Ⅲ (tears involved in popliteus tendon incisura; n=24, 16.4%). For type Ⅰ, there were three subtypes, including type Ⅰa: longitudinal tear (n=53, 61.6%), type Ⅰb: horizontal tear (n=27, 31.4%), and type Ⅰc: radial tear (n=6, 7.0%). For type Ⅱ, there were also three subtypes, including type Ⅱa: anterosuperior popliteomeniscal fascicle tear (n=5, 13.9%), type Ⅱb: posterosuperior popliteomeniscal fascicle tear (n=20, 55.6%), and type Ⅱc: both tears (n=11, 30.6%). For type Ⅲ, there were two subtypes, including type Ⅲa: horizontal tear (n=9, 37.5%), type Ⅲb: radial tear (n=15, 62.5%). In the follow-up for an average of 15.3±2.6 months, all the patients had done well with significantly improved Lysholm (84.6±14.3) and IKDC (83.2±12.8) scores at the end of the last follow-up relative to preoperative scores (P > 0.01).@*CONCLUSION@#We propose that it is possible to classify lateral meniscus tears at the popliteal hiatus region for three types, which can summarize the injury characteristics of this area. The arthroscopic all-inside repair with suture hook for the PHLM tears can avoid stitching to popliteal tendon or narrowing popliteal hiatus and have satisfactory clinical results.

Ulnar osteotomy and internal fixation for old anterior dislocation of radial head in children / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical results of ulnar osteotomy and internal fixation in treating old anterior dislocation of radial head in children.</p><p><b>METHODS</b>From Jan.2004 to Jan.2010, 18 patients with old anterior dislocation of radial head were treated with open reduction for radial head and ulnar osteotomy and internal fixation, including 12 males and 6 females with an average age of (6.9 +/- 1.3) years (3 to 15 years). Among them, 15 cases had history of external injury, from injury to operation was for 5-65 months with an average of (24.0 +/- 5.5) months. Limitation of activity occurred in all patients including flexion and extension of elbow joint and rotation of forearm, without radial nerve injury and obviously radial head deformation.</p><p><b>RESULTS</b>All incisions obtained primary healing and no nonunion, re-dislocation of radial head and nerve injury were found. All patients were followed up from 9 to 38 months with an average of (17.0 +/- 4.5) months. Union time of fracture was from 2.3 to 3.9 months with an average of (2.8 +/- 0.5) months. Postoperative activity in flexion and extension of elbow joint and rotation of forearm improved significantly compared with preoperative. The clinical effects were evaluated according to Zhuyukui criteria, 14 patients got excellent results, 3 good, 1 fair.</p><p><b>CONCLUSION</b>Ulnar osteotomy and internal fixation in treating old anterior dislocation of radial head in children can obtain satisfactory results and effectively improve the activities in flexion and extension of elbow joint and rotation of forearm and prevent re-dislocation of radial head.</p>

Tunnel enlargement after anterior cruciate ligament reconstruction with peroneus longus muscle combined with BMP and allogeneic bone / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the incidence and variation of tunnel enlargement after anterior cruciate ligament (ACL) reconstruction with peroneus longus muscle combined with BMP and allogeneic bone.</p><p><b>METHODS</b>ACL reconstructions with peroneus longus muscle combined with BMP and allogeneic bone were performed in 18 patients (18 knees)in the study from March 2007 to July 2009. Among the patients,14 patients were male and 4 patients were female, ranging in age from 21 to 47 years, with an average of 35.5 years. Twelve patients had the injuries in the right knee and 6 patients in the left knee. The CT scans were taken in a consistent manner at the 1st week and the 3rd, 6th, 12th months after surgery to measure tibial and femoral tunnel expansion.</p><p><b>RESULTS</b>Tunnel enlargement didn't happen in 18 knees. The average enlargement of 18 cases of femoral tunnel was (1.10 +/- 0.42) mm; and the average enlargement of 18 cases of tibial tunnel was (1.00 +/- 0.51) mm. There was statistical significance of femoral tunnel between the 1st week and the 3rd month after surgery (P < 0.05); and there were no significant difference of the tunnel diameters among the 3rd, 6th, and the 24th months postoperatively (P > 0.05). There was statistical significance of tibial tunnel between the 1st week and the 3rd month after surgery (P < 0.05); there were no significant differences of the tunnel diameters among the 3rd, 6th, and 24th months postoperatively (P > 0.05).</p><p><b>CONCLUSION</b>Anterior cruciate ligament reconstruction with peroneus longus muscle combined with BMP and allogeneic bone could obviously reduce the incidence of tunnel enlargement. The tunnel diameter obviously increase in 3 months after surgery,and it remains basically unchanged later.</p>

Bone splint technique and plating application in adolescent high-energy comminuted fracture of distal femur with bone defects / 中华创伤杂志(英文版)

Comminuted fracture of distal femur is a common lower limb injury from traffic accidents, especially from motor accidents. Routine dynamic condylar screw (DCS) or 95-degree condylar plate (CP) sometimes cannot solve the bone defect in the center of alignment and contralateral diaphysis for the reason of absent screw anchor point, especially for AO C2.2-2.3 types. Many authors recommended open reduction and fixation with less invasive stabilization system (LISS) as the treatment of choice, but there are still problems in fusion and alignment. In this study, we reported our experiences with the use of bone splint technique in the high-energy commimuted fracture of distal femur with central and medial bone defect in adolescents.

Design and experimental study of an epiphyseal slide-traction plate / 中国骨伤

<p><b>OBJECTIVE</b>To develop an epiphyseal slide-traction plate in child, which can supply the fracture a sufficient internal fixation, and will not restrain the growth of epiphyses. Animal experiments were carried out with the plates to compare the slide-traction with traditional plate.</p><p><b>METHODS</b>Develop a slide-traction plate for the configuration of the femur condylus of children. Thirty adolescent goats in the experiment were divided into control group (12 goats) and plate group (18 goats). In plate group, right femurs of goats were fixed with common plates and the left femurs with slide-traction plates. All the goats were given X-ray examination at different time after surgery. And the goats were sacrificed at 3 and 6 month, histological method and electron microscopy were performed to evaluate the development of epiphyseal plate.</p><p><b>RESULTS</b>The both femurs of the goats in control group have no difference in evidence in length at all time we examined. And the both femurs of the goats fixed with plates have no difference in evidence in length at 1 day after surgery. However, the both femurs of the goats fixed with plates have difference in evidence in length at 1 month, 2 month, 3 month, 6 month after surgery. The increased length of the femurs at I month, 2 month, 3 month, 6 month after surgery was also compared with the length at 1 day after surgery, there was difference in evidence between the right femurs of the control group and the femurs were fixed with common plates, but no difference in evidence between the left femurs of the normal control group and the femurs were fixed with slide-traction plate (P > 0.05). More thicker epiphyseal plate were found in the left femurs than the right femurs of the group fixed with plates at 3 and 6 month after surgery (P < 0.01). In the plate group, safranine O staining showed epiphyseal plates at the left femurs had more fuscous staining than the right femurs at 3 and 6 month after surgery and electron microscopy also found that the cells of the epiphyseal plates of left femurs were more eugenic than the right femurs at 3 and 6 month after surgery.</p><p><b>CONCLUSION</b>The epiphyseal slide-traction plate can slide with the growth of epiphyses, which is suitable for fixation of the fracture in this part.</p>

Controlled clinical study of treatment of non-operation and surgical operation for scapular fracture / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effect of treatment methods of non-operation and surgical operation for scapular fracture.</p><p><b>METHODS</b>A retrospective analysis of 52 patients (male 37, female 15, ranging in age from 20 to 48 years, meanly 31 years)with scapular fractures was done. According to Hardegger classification: the scapular body fracture in 24 cases, the surgical neck fracture in 12 cases, the anatomical neck fracture in 3 cases, the glenoidal lip fracture in 6 cases, the scapular spine fracrure in 7 cases. Of all 52 patients,17 cases were treated conservatively, and 35 were undergone surgical internal fixation. When followed up,the clinical examination was done and the X-ray films were taken to measure glenopolar angle (GPA). Hardegger function evaluation system was adopted. The results were analysed statiscally.</p><p><b>RESULTS</b>Fifty-two cases were all followed up for 9 weeks to 48 months. Among 17 patients treated by non-operation, Hardegger function evaluation system showed that the result were excellent in 7 cases, good in 6, fair in 2 and poor in 2; the X-ray film results showed that there were 14 cases of GPA > 20 degrees and 3 cases of GPA < 20 degrees. Of 35 patients treated by surgical operation, Hardegger function evaluation system showed that the result were excellent in 20 cases,good in 12 and fair in 3; the X-ray film results showed that there were 33 cases of GPA > 20 degrees and 2 cases of GPA < 20 degrees. There was no significant difference between the two groups (P = 0.27).</p><p><b>CONCLUSION</b>Before treatment of scapular fracture, with CT 3D -recontruction, complete understanding of fragments displacement, and correction indication selection, and perform early exercises, both of the two procedures can provide satisfactory outcome.</p>

Treatment of refracture in plate-screw fixation of femoral shaft with plate and xenogenic bony plate / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate curative effect of plate and xenogenic bony plate were applied in refracture in plate-screw fixation of femoral shaft.</p><p><b>METHODS</b>Thirteen cases of refracture in plate-screw fixation of femoral shaft included 8 males and 5 females, average age was 31.2 years ranging from 14 to 57. Fracture type was comminuted fracture in 7 cases, oblique fracture in 4 cases, transverse fracture in 2 cases. Fixation type used eight holes femoral LC-DCP in 5 cases, eight holes epipodite LC-DCP in 2 cases, six holes femoral LC-DCP in 2 cases, 8 holes La-Plate in 4 cases. All the patients were treated by femoral LC-DCP and xenogenic bony plate.</p><p><b>RESULTS</b>All of the patients were followed up from 16 to 40 months with average of 32 months. All cases had undergone only one operation and achieved bony union. Average time of bony union was 9 months. The lower limbs resumed walk and beared a heavy burden. According to criterion of Merchan, the results were excellent in 7 cases,good in 4,fair in 1 and poor in 1, the excellent and good rate of knee function was 84.6% (11/13) in one year after operation.</p><p><b>CONCLUSION</b>Treatment of refracture in plate-screw fixation of femoral shaft with armor plate and xenogenic bony plate is a reliable treatment.</p>

Treatment of infected bone defect with one stage open cancellous bone grafting / 中国骨伤

<p><b>OBJECTIVE</b>To explore the feasibility of the treatment of infected bone defect with one stage open cancellous bone grafting and summarize the key factors improving the curative effects.</p><p><b>METHODS</b>Twelve cases of infected bone defects were reviewed, which involved 8 male and 4 female with an average age of 42 years (range, 22 to 68 years). The study consisted of 7 cases of calcaneal defects, 4 tibial defects and 1 femoral defect. The procedure included dressing change, resection of the devitalized soft tissue and bone tissue. After the debridement, the bone defect at one stage was treated with cancellous bone grafting and the wound was open. The wound was closed with skin transplantation when it was covered by granulation tissue completely.</p><p><b>RESULTS</b>The wound was covered with granulation tissue in the average 24.1 days after operation and was closed in the average 30.3 days. All the patients were followed up for 8 to 30 months with an average time of 18 months. All the bone defects were healing after bone grafting and there was no infection recurrence.</p><p><b>CONCLUSION</b>One stage open cancellous bone graft is an easy and feasible treatment for infected bone defect. Resecting of the devitalized tissue before operation, radical debridement, enough bone graft in operation and careful dressing change after operation are all the key factors to acquire the satisfactory outcome.</p>