Bridging fixation with locking plate for the treatment of subtrochanteric femoral fractures of Seinsheimer type V / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effect of bridging fixation with locking plate for the Seinsheimer type V subtrochanteric femoral fracture.</p><p><b>METHODS</b>From March 2009 to September 2014,18 cases of Seinsheimer type V subtrochanteric femoral fracture were treated by open reduction and bridging fixation with locking plate through proximal and distal approach including 16 males and 2 females with an average age of 41 years old ranging from 22 to 67 years old. Among them, 12 cases caused by traffic accident, 5 cases by falling, 1 case by heavy aboving. All cases were fresh and closed fractures. Time between injury and operation was from 4 to 9 days with an average of 6.2 days. Of them, 11 cases were fixed with reverse LISS and the other 7 cases were fixed with anatomical locking plates of proximal femur.</p><p><b>RESULTS</b>The mean time of operation was 110 min (ranged from 90 to 155 min). The mean blood loss during operation was 425 ml (ranged from 350 to 650 ml) and 16 cases got blood transfusion which was meanly 300 ml. The mean hospital time was 14 days (ranged from 12 to 18 days). The mean duration of followed up was 11.8 months (ranged from 8 to 22 months). The mean time of bone union was 6.6 months (ranged from 5 to 8 months). There was not any complication such as infection, implant failure, hip varus, external rotation deformity of low limb or fat embolism. The Sanders hip scores were 53.22 ± 6.48, the result was excellent in 12 cases and good in 6 cases at the last follow-up.</p><p><b>CONCLUSION</b>Under the principle of biological osteosynthesis, treatment of Seinsheimer type V subtrochanteric femoral fracture with bridging locking plate fixation has such advantages as high mechanism, less interference of blood supply, stable fixation and little complication. It is a safe and idea way for the treatment of the Seinsheimer type V subtrochanteric femoral fracture.</p>

Case-control study on close manipulative reduction combined with minimally invasive percutaneous plate fixation for the treatment of proximal humeral fractures / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical effects of close manipulative reduction combined with minimally invasive percutaneous plate fixation(MIPPO) and conventional open reduction and internal fixation (ORIF) for the treatment of proximal humerus fractures.</p><p><b>METHODS</b>From April 2008 to March 2013, among the 75 patients with fractures of proximal humerus, 26 patients were male and 49 patients were female, ranging in age from 22 to 80 years; 18 patients had injuries caused by traffic accident and 57 patients had injuries caused by falling down. According to Neer classification, there were 49 cases of two-part fractures and 26 cases of three-part fractures. All the patients were divided into two groups: MIPPO group and ORIF group. There were 12 males and 21 females in the MIPPO group,including 22 cases of Neer two parts and 11 cases of Neer three parts, who were treated with close manipulative reduction combined with MIPPO. While the other 42 patients were in the ORIF group,including 16 males and 26 females. Among those patients,27 cases belonged to Neer two parts and 15 cases of Neer three parts, who were treated with ORIF. Length of the incision, blood loss, operating time, early postoperative pain(recorded by VAS), neck-shaft angle of proximal humerus and postoperative function of shoulder(recorded by Constant-Murley score, including pain, function, ROM and muscle length) were compared.</p><p><b>RESULTS</b>The mean lengths of incision were (6.74 +/- 0.38) cm in MIPPO group and (16.82 +/- 1.74) cm in ORIF group;blood losses were (110.15 +/- 29.49) ml in MIPPO group and (326.19 +/- 59.71) ml in ORIF group; operation times were (48.60 +/- 10.18) min in MIPPO group and (68.84-16.22) min in ORIF group. VAS of patients in MIPPO group on the 1st and 3rd days postoperatively were lower than those of patients in the ORIF group. The postoperative radiographs verified good position of all screws and satisfactory reduction of bone fracture reduction in both groups. All the patients were followed up,and the durig ranged from 8 to 24 months (mean 14.2 months). In the MIPPO group, there was no humeral head necrosis and all patients gained bone union; while in the ORIF group, 3 patients sustained nonunion and received reoperation for bone grafting, and 2 patients sustained humeral head necrosis. The mean Constant-Murley scores of shoulder were 88.94 +/- 2.57 in the MIPPO group and 86.00 +/- 3.36 in the ORIF group.</p><p><b>CONCLUSION</b>The close manipulative reduction combined with MIPPO is a better choice for fixation of proximal humerus fractures, compared with conventional plate. This method possesses such advantages as a shorter incision, less disturbance of the blood supply and stable fixation of the fracture, allowing early exercise so that the function of shoulder recovers rapidly.</p>

Close reduction combined with minimally invasive percutaneous plate osteosynthesis for proximal and distal tibial fractures: a report of 56 patients / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of close reduction combined with minimally invasive percutanous plate osteosynthesis (MIPPO) for proximal and distal tibial fractures.</p><p><b>METHODS</b>From March 2007 to December 2010, 56 patients with proximal and distal tibial fractures were treated with close reduction combined with MIPPO technique. There were 39 males and 17 females,aged from 22 to 67 years with an average of 41.3 years. Left fracture was in 25 cases and right fracture was in 31 cases; proximal tibial fracture was in 15 cases and distal tibial fractures was in 41 cases; 34 cases caused by fall down and 22 cases caused by road accident. The mean time from injury to operation was 1.7 d. Clinical manifestation included pain, swelling of leg with limitation of activity. According to the standard of Johner-Wruhs, clinical effects were evaluated.</p><p><b>RESULTS</b>The mean operative time was 46 min in 56 patients. All fractures obtained satisfactory reduction and the location of plate was good. Incisions healed with one-stage and no superficial or deep infection was found. All the patients were followed up from 8 to 23 months with an average of 14.2 months. Only one fracture complication with delayed union,and after auto grafting with ilium bone,the fracture got union. Other 55 cases obtained bone healing in 15 to 20 weeks after operation and no internal fixation failure was found. The time of walking was 4-6 months after operation,without limping at 7 months after operation. Both lower extremities were symmetrical and the function of knee and ankle got complete recovery. According to the criteria of Johner-Wruhs score,46 cases obtained excellent results,9 good and 2 fair.</p><p><b>CONCLUSION</b>Treatment of proximal and distal tibial fractures with close reduction and MIPPO technique can not only preserve soft tissue,simplify operative procedure and decrease wound, but also can obtain rigid internal fixation and guarantee early function exercises of knee and ankle joints. The method has the advantages of less soft tissue injury, less blood loss, reliable fixation, which is effective method in treating proximal and distal tibial fractures and corresponds with the standpoint of biological fixation.</p>

Research on the repair of acute large osteochondral defects with mosaicplasty associated with genes-enhanced tissue engineering in different proportion / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the optimum proportion of Mosaicplasty and genes-enhanced tissue engineering for the repair of acute osteochondral defects.</p><p><b>METHODS</b>Western blot test was conducted to detect the expression of hTGF-beta1, Col II and Aggrecan in 3 groups, including hTGF-beta1, transduction group, Adv-betagal transduction group and control group without transduction. Eighteen 6-month-old Shanghai male goats (weight: 22 to 25 kg) were used. BMSCs were isolated from the autologous bone marrow, and were subcultured to get the cells at passage 3. Thirty-six medial femoral condyles were used and divided into 6 groups named AR, AL, BR, BL, CR, and CL. Acute cylindrical defects (9 mm in diameter and 3 mm in depth)were created in the weight bearing area of the medial femoral condyle of hind limbs. In the single group, the autologous osteochondral mosaicplasty was performed to repair the defect; in the combination group, besides the mosaicplasty, the dead space between the cylindrical grafts and the host cartilage were injected with the suspension of hTGF-beta1, gene enhanced autogenous BMSCs in sodium alginate, and CaCl2 was dropped into it to form calcium alginate gels. The autologous osteochondral transplantation cover rates of group AR was 44.44% single group, AL was 44.44% combination group, BR was 33.33% single group, BL was 33.33% combination group, CR was 22.22% single group, and CL was 22.22% combination group. The goats were killed 24 weeks after operation to receive gross and histology observation, which was evaluated by the histological grading scale of O'Driscoll, Keeley and Salter. Immunohistochemistry and TEM observation were also performed.</p><p><b>RESULTS</b>Western blot test showed the expression of the hTGF-beta1, Col II and the Aggrecan in the hTGF-beta1 transduction group were significantly higher than that of the Adv-betaga1 transduction and the blank control groups. The gross and histology observation revealed that each defects of six groups had different degrees of repairing. There was no significantly difference among the BL, AR, and AL groups. But the scores of the other three groups (BR, CR, and CL) were significantly poorer than the former three groups.</p><p><b>CONCLUSION</b>Mosaicplasty associated with genes enhanced tissue engineering could repair the osteochondral defects effectively. With the autologous osteochondral transplantation coverage reducing, the advantage of the combination could have a better representation.</p>

Influence of the unevenness of articular surface on the osteochondral repair / 中国骨伤

<p><b>OBJECTIVE</b>To investigate whether the unevenness of articular surface would affect the osteochondral repair.</p><p><b>METHODS</b>Eight Shanghai Chongming 6-months-old masculine goats with a mean weight of 25 kg were used in this study. Different unevenness, which were 0.5 mm, 1.0 mm, 2.0 mm protrude or concavity, were created on the weight-bearing portion of the medial femoral condyles of the goats. The goats were sacrificed 12 weeks later and were observed with the general observation, HE staining and transmission electron microscope. To evaluate the microscopic morphology, a histological grading scale described by O'Driscoll, Keeley and Salter was used.</p><p><b>RESULTS</b>The general observation and HE staining showed that the unevenness of 0.5 mm or 1.0 mm protrudes or concavity could be repaired to get the surface smooth on the whole. The transmission electron microscope showed that the reparative tissues were the same as the normal cartilage. The 2.0 mm depth couldn't be repaired satisfactorily. The transmission electron microscope showed that the fiber bundle proliferated and the chondrocytes degenerated. The scores of the 2.0 mm depth were significantly lower than that of the 0.5 mm or 1.0 mm (P < 0.05).</p><p><b>CONCLUSION</b>The unevenness could have an influence on the repair. The limited unevenness could be repaired by itself.</p>

A study of proximal humerus fractures using close reduction and percutaneous minimally invasive fixation / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effects of close reduction and percutaneous minimally invasive fixation in the treatment of proximal humerus fractures.</p><p><b>METHODS</b>From April 2008 to March 2010, 28 patients with proximal humerus fracture were treated with close reduction and percutaneous minimally invasive fixation. There were 21 males and 7 females, ranging in age from 22 to 78 years,with an average of 42.6 years. The mean time from suffering injuries to the operation was 1.7 d. Nineteen cases caused by falling down, 9 cases by traffic accident. The main clinical manifestation was swelling, pain and limited mobility of shoulders. According to Neer classification, two part fractures were in 17 cases and three part fractures in 11 cases. The locking proximal humerus plate was used to minimally fixation through deltoid muscle under acromion. The operating time,volume of blood loss, the length of incision and Constant-Murley assessment were applied to evaluate the therapeutic effects.</p><p><b>RESULTS</b>The mean operating time was 40 min, the mean blood loss was 110 ml, and the mean length of incision was about 5.6 cm. The postoperative X-ray showed excellent reduction and the plate and screws were successfully place. Twenty-eight patients were followed up for 6 to 24 months (averaged 14.2 months). The healing time ranged from 6 to 8 weeks and all incision was primarily healed. There were no cases with necrosis head humerus, 24 cases without omalgia, and 4 cases with o-malgia occasionally. All the patients can complete the daily life. The mean score of Constant-Murley assessment was 91.0 +/- 5.8, 24 cases got an excellent result, 3 good and 1 fair.</p><p><b>CONCLUSION</b>Close reduction and percutaneous minimally invasive fixation, not only can reduce surgical invasive, but also guarantee the early function activities. It has the advantages of less invasive, fixed well and less damage of blood circulation.</p>