Hoffa fracture associated with ipsilateral femoral shaft fracture: clinical feature and treatment / 中华创伤杂志(英文版)

Hoffa fracture associated with ipsilateral femoral shaft fracture is very rare. Three cases of this rare type of injury were retrospectively reviewed. The sites of femoral shaft fractures and Hoffa fractures were documented. All femoral shaft fractures were managed with internal fixation. The rate of misdiagnosis for the Hoffa fractures was documented. Functions of the affected knees were evaluated according to the modified Hospital for Special Surgery (HSS) scores at two years follow-up. Femoral fractures were either transverse or composite in all three cases. Ipsilateral Hoffa fractures occurred at medial condyle in two cases, and lateral condyle in one case. Only one Hoffa fracture was identified preoperatively. All the femoral shaft fractures healed uneventfully. In the patient whose Hoffa fracture was correctly diagnosed, the modified HSS score was 94. In another patient, whose Hoffa fracture was treated by a second operation, the modified HSS score was 93. And in the third case, who refused additional operation for the Hoffa fracture, the modified HSS score was only 70. Conclusively femoral shaft fracture can be associated with ipsilateral Hoffa fracture, especially in motorcycle accident. This type of injury is very rare and misdiagnosis is common.

Selection of approach and fixation in the treatment of type C fracture of distal humerus in adults / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study the surgical treatment for distal humeral fractures in adults according to the follow-up results.</p><p><b>METHODS</b>Twenty-one cases (16 males and 5 females) of distal humeral fracture were included in this study. The average age was 42.5 years (range: 37-52 years). Fractures were classified according to the AO classification system. Nine cases of C1, 8 C2 and 4 C3-type fractures were identified. Open reduction and internal fixation were performed in all cases. A tricep-reflecting approach was adopted, and either the AO orthogonal plating or parallel plating technique was chosen, based on the fracture type. The plaster cast was removed 3 weeks after operation. Rehabilitation was encouraged during this period and afterwards. The average follow-up time was 12.2 months (range: 8-28 months). The outcome was scored according to Aitken and Rorabeek system.</p><p><b>RESULTS</b>No nerve injury, nonunion or failure of fixation was encountered during the operation and follow-up. However, ossifying myositis occurred in one case.</p><p><b>CONCLUSIONS</b>A triceps-reflecting approach can provide adequate exposure to the joint. The use of AO orthogonal plating or parallel plating techniques based on the type of fractures can provide rigid fixation for the fracture.</p>

Posterolateral rotatory instability of the elbow: a case report and literature review / 中华创伤杂志(英文版)

Posterolateral rotatory instability of the elbow describes a condition that radial head subluxation or dislocation occurs when forearm rotates externally in relation to humerus. It is difficult to diagnose and treat. We reported a typical case which was confirmed by physical examination and MR images. Ligamentous insufficiency was confirmed under direct vision, and was reconstructed with triceps fascia as described by Gong et al with slight modification. Regain of full function was achieved one year after surgery.

Treatment of posterior wall fractures of acetabulum / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To explore the treatment methods and outcome of posterior wall fractures of the acetabulum.</p><p><b>METHODS</b>The data of 31 patients (25 males and 6 females, aged 19-59 years, mean: 40.5 years) with posterior wall fractures of the acetabulum hospitalized in our department from 2002 to 2006 were analyzed retrospectively in this study. The types of fractures, number of fragments, combined dislocations, and sciatic nerve function were documented before admission. All the fractures were treated with open reduction and internal fixation. Based on the fracture type and site, either screws alone or reconstructive plates were used. The patients were immobilized for an average of 12 weeks before partial weight bearing was permitted. After follow-up for 12-70 months (43.6 months on average), modified Merle d'Aubigne score was adopted to evaluate the outcomes of the operations.</p><p><b>RESULTS</b>The percentages of the excellent, good, fair and poor results were 48.4%, 41.9%, 6.5%, and 3.3%, respectively, with a good to excellent rate of 90.2%. Idiopathic sciatic nerve injury occurred in only one case.</p><p><b>CONCLUSIONS</b>The sciatic nerve should be routinely exposed and protected during the surgery. The type of fixation should be based on the fracture type and site. Prolonged immobilization may be helpful in improving the final outcomes.</p>

Analysis of change in length of glenohumeral ligaments in vivo during shoulder abduction / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the in vivo and three-dimensional (3D) length changes of the glenohumeral ligaments during shoulder abduction using open magnetic resonance imaging (MRI).</p><p><b>METHODS</b>From 2007 to 2008 3D attachment points of the glenohumeral ligaments were obtained by anatomical study and computed tomographic scanning of 10 embalmed cadaveric shoulders, including the superior glenohumeral ligament (SGHL), middle glenohumeral ligament (MGHL), the anterior band of the inferior glenohumeral ligament (AIGHL), axillary pouch and the posterior band of the inferior glenohumeral ligament (PIGHL). Then an in vivo study was conducted, in which 14 right shoulder joints of 14 healthy volunteers were evaluated in 7 isometric abduction positions (0 degrees , 30 degrees , 60 degrees , 90 degrees , 120 degrees , 150 degrees and 180 degrees ) using a noninvasive 3D motion-analysis system. 3D models of the shoulders and located the attachment points of the ligaments were created. Ligament lengths were based on the shortest calculated paths between each origin and insertion in 3D space along the 3D bone surface for each abduction position.</p><p><b>RESULTS</b>During shoulder abduction, the 3D distance of SGHL was found to elongated and attained maximal length at 30 degrees abduction (P = 0.2). MGHL and AIGHL attained maximal length at 60 degrees (P < 0.05) and 120 degrees (P < 0.05) abduction, respectively. Pouch and PIGHL reached the maximal length at 180 degrees abduction (P < 0.05).</p><p><b>CONCLUSIONS</b>The SGHL limits inferior translation of the humeral head at 30 degrees of abduction. MGHL maintains maximum anterior stability at 60 degrees of abduction. AIGHL prevents anterior dislocation of the humeral head at 120 degrees of abduction. In 180 degrees abduction, pouch provided anterior stability and PIGHL has the contribution to the inferior stability.</p>