Measurement of femoral neck anteversion of developmental dislocation of hip in children by 3D printing technique / 中国骨伤

OBJECTIVE@#To explore the method and accuracy of measuring the femoral neck anteversion in children with developmental dislocation of the hip by using 3D printing technology, so as to find out the method of measuring the femoral neck anteversion accurately and guide the formulation of the operation plan.@*METHODS@#From June 2016 to September 2018, 17 patients with unilateral developmental dislocation of the hip were enrolled in the study, including 2 males and 15 females, aged 2 to 13 (5.47±0.81) years old, 11 on the left and 6 on the right. The methods of CT, 3D printing and intraoperative anteversion of femoral neck were used to measure the anteversion of femoral neck respectively. The intraoperative measurement was used as the standard reference value forstatistical analysis, and the accuracy of the first two methods was compared.@*RESULTS@#The average value of CT was (36.00±1.66)°, the average value of model method was(43.91±1.62)°, and the average value of intraoperative method was(44.21±1.62)°. There were significant differences in CT measurement, model measurement and intraoperative measurement(0.05).@*CONCLUSION@#Compared with the traditional CT method, the 3D printing model method is simpler, more accurate and more repeatable, and can simulate the operation before operation. It is an ideal method to measure the femoral neck anteversion.

Nomograma prediction of the surgical treatment in triad of elbow / 中国骨伤

OBJECTIVE@#To establish an individualized Nomogram prediction model for predicting the postoperative recovery of patients with triad of elbow (TE) by analyzing risk factors of triad of elbow joint.@*METHODS@#From January 2012 to December 2018, 116 patients with TE who met the criteria were collected. The independent risk factors were screened by univariate Logistic regression analysis. The statistically significant risk factors were included in the multivariate Logistic regression model. The R software was used to establish the Nomogram diagram model to predict the postoperative recovery of TE patients. C index was used to verify the discrimination, Calibration plot of the model, and the decision curve (decision curve analysis, DCA) to verify the net clinical benefit rate of the model.@*RESULTS@#Forty-four of the 116 patients with TE developed symptoms after operation, with an incidence of 37.93%. Age (@*CONCLUSION@#The Nomogram for predicting postoperative results of TE patients based on six independent risk factors:age, work, smoking, Mason classification of radial head, Regan-Morrey classification of coronal process and immobilization time of elbow joint after operation, has good distinguishing capacity and consistency. Thepredictive model could help clinicians to identify high risk population and establish appropriate intervention strategies.

Experimental study on internal fixation with screws through femoral epiphyseal plate / 中国骨伤

<p><b>OBJECTIVE</b>To explore the effect of internal fixation with screw through femoral epiphyseal plate on growth in- hibition via an experimental study.</p><p><b>METHODS</b>Forty New Zealand rabbits were randomly divided into 4 groups and 10 rabbits in each group. Epiphyseal plate was injured by penetrating of screws, and the size of damage area was controlled by changing the number of threads. Group A: blank group; group B: injury area accounted for 4% of the epiphyseal plate; group C: injury area accounted for 6%; group D: injury area accounted for 8%. The internal fixation was removed after 2 weeks, and the results were observed with X-ray film for 4 groups to judge the complications such as early closure of epiphyseal.</p><p><b>RESULTS</b>In each group, there were no statistical differences in the length of the femoral neck, the diameter of femoral neck, the diameter of the femoral head, and the epiphyseal plate closure time. The growth speed of the length and diameter of the femoral neck, as well as the diameter of femoral head, were quicker on the early phase, and the speed was slowest when the epiphyseal plate was being closed.</p><p><b>CONCLUSION</b>The injury area of epiphyseal plate under 8% is safe for its growth. Because no evidences demonstrate the growth inhibition of epiphyseal plate, the screws can be used for rabbit epiphyseal plates.</p>

Treatment of radial neck fracture in children with elastic stable intramedullary nails / 中国骨伤

<p><b>OBJECTIVE</b>To investigate effects of elastic stable intramedullary nails for the treatment of radial neck fracture in children.</p><p><b>METHODS</b>From July 2006 to December 2011, 25 children with radical neck fractures, which included 16 males and 9 females aged from 7 to 15 years old (means 10.7), were treated with elastic stable intramedullary nails. According to Judet classification, 6 cases were type II, 17 cases were type III and 2 cases were type IV (including 1 case with type IVa and 1 case with type IVb). The fracture healing, pain, deformity and range of motion of elbow were recorded.</p><p><b>RESULTS</b>All patients were followed up for 6 to 24 months with an average of 14 months. Twenty-five patients were obtained bone healing. According to Tibone and Stoltz evaluation standard, 18 cases got excellet results, 4 cases in good and 3 cases in moderate.</p><p><b>CONCLUSION</b>Elastic stable intramedullary nails for the treatment of radial neck fracture in children has advantages of simple operation,less trauma and good results.</p>

Anatomic study of the posterior laminar screw fixation on C7 / 中国骨伤

<p><b>OBJECTIVE</b>To measure anatomic data of laminar of C7 and evaluate the possibility of the placement of C7 laminar screw.</p><p><b>METHODS</b>Twenty-two specimens of C7 were measured with an vernier caliper and a goniomete and finded out the anatomic data for prominent vertebra laminar screw placement. The indicators included the thickness of the superior, median and inferior part of C7 laminar (T1, T2, T3), the height of the laminar(H), the distance of the anchor point to the medial wall of C7 pedicle and the lateral wall of the lateral mass (L1, L2) and the angle between the axis of C7 lamina and sagittal plane(alpha).</p><p><b>RESULTS</b>The mean thickness of superior part of C7 lamina (T1) was (4.30 +/- 0.27) mm, (5.32 +/- 0.27) mm in median part (T2) with 27% (6 cases) of specimens thickness less than 4.50 mm and (4.78 +/- 0.26) mm in inferior part (T3). Both median part and inferior part were thicker than 4.50 mm. The mean height of C7 laminar (H) was (14.83 +/- 0.26) mm. The distance from the laminar anchor point to the medial wall of C7 pedicle (L1) and the lateral wall of the lateral mass (L2) was (26.99 +/- 0.48) mm and (41.60 +/- 1.10) mm respectively. The mean angle between the axis of C7 laminar and sagittal plane(alpha) was (49.3 +/- 1.1) degrees.</p><p><b>CONCLUSION</b>It is feasible to place screw in C7 laminar and this technique can be applied in 73% of Chinese. Compared with C7 pedicle screw technique, this technique is simple with little risk to the nerve and vascular structures.</p>

Comparison of two approaches for the treatment of supracondylar fractures in children by K-wires / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effect between two approaches for the treatment of supracondylar fractures of humerus by K-wires in children.</p><p><b>METHODS</b>From Jan. 2004 to Dec. 2006,117 children with supracondylar fractures of humerus were divided into two groups according to different methods of the K-wires fixation involving two K-wires group and three K-wires group. In two K-wires groups,there were 45 children including 31 boys and 14 girls with an average age of 5.6 years ranging from 1 to 11 years; according to Garland classification, 19 cases were type II, 26 cases were type III. In three K-wires groups, there were 72 children including 47 boys and 25 girls with an average age of 6.8 years ranging from 2 to 12 years; according to Garland classification, 22 cases were type II, 50 cases were type II. The movement and carrying angle of elbow joint were measured for all these patients. According to Flynn criteria for supracondylar fracture the results of two approaches with K-wires were compared.</p><p><b>RESULTS</b>All patients were followed-up from 2 to 24 months (means 15.4 months). In two K-wires group, the results of Flynn were excellent in 27 cases, good in 12 cases, fair in 4 cases and poor in 2 cases, 41 cases gained bony healing, however, fail of fixation arosed in 4 cases and cubitus varus arosed in 2 cases. In three K-wires group, the results of Flynn were excellent in 60 cases, good in 11 cases and poor in 1 case, all cases of three K-wires group achieved bony healing after 6 weeks of operation, the function of joints recovered through exercise and cubitus varus arosed in one case after operation.</p><p><b>CONCLUSION</b>The technique of fixation with K-wires is a stable and reliable methods for unstable supracondylar fracture but medial-lateral three-pin fixation is better than one with two pins.</p>

Analysis on complications of elastic nail treating children's long bone fractures / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the reasons on complications of treatment with elastic nail in children's long bone fracture.</p><p><b>METHODS</b>Sixty-six cases (75 parts of long bone fratures) were treated by elastic nail including 49 male and 17 female. The age ranged from 3 to 17 years, mean 7.8 years. There were 35 femur fractures (2 cases were hibateral), 20 tibia and fibula fractures (12 cases were tibia fractures), 8 radial fractures (1 case was ulna fracture) and 3 humerus fractures. The cases included 4 open fractures and 62 closed fractures. All cases were fresh fractures, no multi-segmental fractures. Three cases associated with brain and chest injuries. These cases were treated by open or closed reduction and internal fixaion with elastic nail. A cast or brace had been used after operation for a month. Following-up included the function of the joint,the bottom of the nail and the callus. Complications were timely recorded.</p><p><b>RESULTS</b>All the patients were followed-up for 12 to 29 months, averaged 17 months. The cases occurrenced compilications including 2 cases of nonunion, 2 of new fracture, 1 of displacment, 4 of joint dysfunction, 3 of irritation of the bottom of the nail and 1 malunion.</p><p><b>CONCLUSION</b>Strict indication, well design,canonical operation is a good way to avoid compliacations. At the same time,early treatment can reduce the sequela.</p>

The therapeutic strategy of humeral supracondylar fracture with never injury in children / 中国骨伤

<p><b>OBJECTIVE</b>To determine the clinical features and therapeutic strategy of humeral supracondylar fractures with nerve injuries in children.</p><p><b>METHODS</b>From June 2000 to December 2006,28 patients of humeral supracondylar fracture (Gartlang III) with never injuries were analyzed. Twenty-four patients were close injuries and the others were open. Sixteen cases (group A)were treated with close reduction and K-wires fixation. Twelve cases (group B)were treated with open reduction and nerve exploration, among them, contusive nerve injuries in 8 cases, incarceration in 3, complete neurotmesis in 1.</p><p><b>RESULTS</b>The symptoms of nerve injuries of 28 cases recovered completely within 4 to 6 weeks in 13 cases, 8 to 10 weeks in 2 cases and 12 weeks in 1 case in group A, meanwhile, within 4 to 6 weeks in 6 cases, 8 to 10 weeks in 3 cases and 12 to 16 weeks in 3 cases in group B.</p><p><b>CONCLUSION</b>Most nerve injuries in humeral supracondylar fractures in children can be cured after close reduction of the fracture. Sometimes, open reduction and nerve exploration are necessary, which has important practical significance.</p>

Prevention of ulnar nerve injury during fixation of supracondylar fractures in children by a medial-lateral three-pin fixation technique / 中国骨伤

<p><b>OBJECTIVE</b>To expore the prevention of ulnar nerve injury during fixation of supracondylar fracture in children by a medial-lateral three-pin fixation technique.</p><p><b>METHODS</b>Eighty-one patients including 54 boys and 27 girls with average age of 6 years old (2.5 to 11 years)were treated by a three-pin fixation technique with insertion of two Kirscher wires from the lateral side and the third wire through the medial side. They were followed-up without any complications related to the ulnar nerve. According to Garland system, there were 25 cases of type II supracondylar fracture and 56 of type III. All patients were treated by a medial-lateral three-pin fixation technique, and external fixation with plaster for 3 weeks.</p><p><b>RESULTS</b>All cases achieved immediate stability and long-term bony fusion postoperatively and no iatrogenic ulnar nerve injury happen.</p><p><b>CONCLUSION</b>The technique is a stable and reliable methods for unstable supracondylar fracture and the iatrogenic injury ulnar nerve can be avoided completely.</p>