Effect of lag screw and support plate through axillary approach for the treatment of Ideberg typeⅡscapular pelvis fracture / 中国骨伤

OBJECTIVE@#To analyze the effect of lag screw and support plate through axillary approach for the treatment of Ideberg typeⅡscapular pelvis fracture.@*METHODS@#From January 2016 to June 2021, 26 patients with Ideberg typeⅡglenoid fractures were treated with trans-axillary lag screw combined with supporting plate, including 15 males and 11 females. The age ranged from 21 to 75 years, with an average of (43.12±6.56) years old. The Constant-Murley Shoulder joint Scale and University of California at Los Angeles (UCLA) score were used to evaluate the function and clinical efficacy of shoulder joint.@*RESULTS@#All patients were followed up, and the duration ranged from 19 to 42 months, with an average of (30.6±10.5) months. One year after surgery, the Constant-Murley score increased from preoperative 34.9±2.5(ranged, from 28 to 47) to 87.2±6.8(ranged, from 70 to 95). The UCLA score improved from preoperative 17.9±1.7(9 to 25) to 33.1±2.3(29 to 35). Seventeen patients got an excellent result, with 7 good, and 2 fair. None of the patients had infection, screw, and plate loosening, fracture, and other complications after surgery. Two patients had different degrees of Chronic pain in the shoulder during the follow-up period.@*CONCLUSION@#The treatment of Ideberg typeⅡscapular glenoid fractures through axillary approach with lag screws and supporting steel plates has the advantages of convenient exposure, direct visual restoration of the normal anatomical shape of the scapular glenoid, selection of suitable positions for screw and steel plate placement, achieving better treatment results, and fewer complications. It is an effective and reliable surgical method.

Modified application of interface screw in femoral side during anterior cruciate ligament reconstruction / 中国骨伤

OBJECTIVE@#To compare clinical effects of the improved interface screw fixation of femoral end of anterior cruciate ligament with classic femoral lateral loop plate fixation.@*METHODS@#A retrospective analysis of 65 patients who underwent arthroscopic anterior cruciate ligament reconstruction from January 2019 to September 2021 were performed. According to the different fixation methods of the femoral side, 35 patients were divided into loop plate fixation(loop plate group), including 27 males and 8 females, aged from 18 to 50 years old with an average of (35.00±7.60) years old;30 patients in interface screw fixation(interface screw group), including 20 males and 10 females, aged from 18 to 50 years old with an average of (32.00±8.50) years old. Hospital stay, hospital expenses, operation time, complications, C-reactive protein at 1, 3, 6 days after operation, and postoperative Lysholm score and International Knee Documentation Committee(IKDC) score at 18 months were compared between two groups.@*RESULTS@#All patients were successfully operated, and obtained follow-up from 18 to 36 months with an average of (25.16±4.50) months. Anterior drawer test and Lachman test of all patients turned to negative. There were no statistical differences in hospital stay, hospital expenses and complications between two groups(P>0.05);operation time in loop plate group was (74.00±6.84) min, and (91.67±6.34) min in interface screw group, and had difference between two groups(P<0.05). C-reactive protein on the 1st and 3rd day after operation was (40.00±10.10), (20.00±8.23) mg·L-1 in loop plate group, and (60.00±8.93), (30.00±8.66) mg·L-1 in interface nail group, had statistical difference between two groups (P<0.05);while there was no difference in C-reactive protein on the 6th day after operation(P>0.05). At 18 months after operation, Lysholm and IKDC scores showed no significant difference between two groups (P>0.05). In loop plate group, medullary enlargement on coronal and sagittal views were (2.75±0.19) mm, (1.55±0.25) mm, and (2.81±0.22) mm, (1.61±0.20) mm in interface screw group, and had statistical difference between two groups(P<0.05).@*CONCLUSION@#In the reconstruction of anterior cruciate ligament, the common interface screw on the femoral side is changed to the sheath interface screw, and intramedullary screw is changed to the compression and fixation of tendon from outside to inside of joint. Although the operation procedure is relatively complicated and operation time is slightly longer, it has advantages of no residual metal foreign body after operation, and clinical effect is no different from classical loop plate suspension fixation, which is still a good choice.

Efficacy of micro steel plate and Kirschner needle oblique and transverse internal fixation of adjacent metacarpal bone in the treatment of metacarpal diaphyseal oblique fracture / 中国骨伤

OBJECTIVE@#To compare the clinical efficacy of micro steel plate and Kirschner needle oblique and transverse internal fixation of adjacent metacarpal bone in the treatment of metacarpal diaphyseal oblique fracture.@*METHODS@#Fifty-nine patients with metacarpal diaphyseal oblique fractures admitted between January 2018 and September 2021 were selected as the study subjects and divided into the observation group (29 cases) and the control group (30 cases) based on different internal fixation methods. The observation group was treated with Kirschner wire oblique and transverse internal fixation of adjacent metacarpal bones, while the control group was treated with micro steel plate internal fixation. Postoperative complications, operation time, incision length, fracture healing time, treatment cost, and metacarpophalangeal function were compared between the two groups.@*RESULTS@#No incision or Kirschner wire infections occurred in the 59 patients, except for one in the observation group. No fixation loosening, rupture, or loss of fracture reduction occurred in any of the patients. The operation time and incision length in the observation group were (20.5±4.2) min and (1.6±0.2) cm, respectively, which were significantly shorter than those in the control group (30.8±5.6) min and (4.3±0.8) cm (P<0.05). The treatment cost and fracture healing time in the observation group were (3 804.5±300.8) yuan and (7.2±1.1) weeks, respectively, which were significantly lower than those in the control group (9 906.9±860.6) yuan and (9.3±1.7) weeks (P<0.05). The excellent and good rate of metacarpophalangeal joint function in the observation group was significantly higher than that in the control group at 1, 2, and 3 months after operation (P<0.05), but there was no significant difference between the two groups at 6 months after operation (P>0.05).@*CONCLUSION@#Micro steel plate internal fixation and Kirschner wire oblique and transverse internal fixation of adjacent metacarpal bones are both viable surgical methods for treating metacarpal diaphyseal oblique fractures. However, the latter has the advantages of causing less surgical trauma, shorter operation time, better fracture healing, lower cost of fixation materials, and no need for secondary incision and removal of internal fixation.

Treatment with a proximal femoral locking plate versus a proximal femoral anti-rotation intramedullary nail for femoral intertrochanteric fractures in older adult patients / 中国基层医药

Objective:To investigate the efficacy of a proximal femoral locking plate (LPFP) versus a proximal femoral anti-rotation intramedullary nail (PFNA) in the treatment of femoral intertrochanteric fractures in older adult patients. Methods:A total of 130 older adult patients with femoral intertrochanteric fractures who received treatment in Linghu People's Hospital of Huzhou from May 2017 to June 2020 were included in this study. They were randomly assigned to undergo treatment with either a PFNA (observation group, n = 65) or an LPFP (control group, n = 65). Intraoperative blood loss, incision length, operative time, and time to fracture healing were determined in each group. At 1, 3, and 6 months after surgery, the Harris hip score was used to evaluate hip joint recovery. Coxa vara, incision infection, and internal fixation loosening were compared between the two groups. Results:Intraoperative blood loss in the observation group was less than that in the control group [(189.26 ± 48.15) mL vs. (96.47 ± 40.21) mL, t = -11.93, P < 0.001]. Incision length, operative time, and time to fracture healing in the observation group were significantly shorter than those in the control group [(4.03 ± 1.48) cm vs. (12.16 ± 1.55) cm, (72.13 ± 28.75) minutes vs. (120.34 ± 29.01) minutes, (9.89 ± 1.52) weeks vs. (13.63 ± 1.74) weeks, t = -30.59, -9.52, -13.05, all P < 0.001]. At 1 month after surgery, there was no significant difference in Harris hip score between the two groups ( t = 1.28, P > 0.05). At 3 and 6 months after surgery, the Harris hip score gradually increased in the control and observation groups ( F = 13.44, 8.26, both P < 0.001). At 3 and 6 months after surgery, Harris hip scores in the observation group were significantly higher than those in the control group [(85.17 ± 4.29) points vs. (79.50 ± 4.12) points, (95.30 ± 1.04) points vs. (87.69 ± 1.25) points, t = 7.69, 37.73, both P < 0.001]. The incidence of complications in the observation group was significantly lower than that in the control group [1.54% (1/65) vs. 10.77% (7/65), χ2 = 4.80, P = 0.029). Conclusion:Compared with LPFP, PFNA can effectively reduce intraoperative blood loss in older adult patients with femoral intertrochanteric fractures, accelerate the progress of fracture healing, promote the recovery of the hip joint, and has fewer complications. Therefore, PFNA is worthy of popularization.

Meta-analysis of the effect of double endobutton and clavicular hook plate on the treatment of acromioclavicular dislocation / 中国组织工程研究

OBJECTIVE: Because the double Endobutton plate has more advantages than the clavicle hook plate in the treatment of acromioclavicular joint dislocation, and the trauma is small; it does not need to be removed through secondary surgery. Thus, it has been widely used in clinical practice in recent years. Meta-analysis was used to investigate whether there were differences in the treatment of acromioclavicular dislocation between double Endobutton plate and clavicle hook plate so as to provide effective guidance for clinical treatment. METHODS: The database Cochrane library, PubMed, EBSCO, CNKI, VIP and Wanfang were searched from the database inception to January 2020. All the literatures related to the treatment of acromioclavicular dislocation with double Endobutton plate and clavicle hook plate were collected. The literatures were selected according to the inclusion and exclusion criteria to extract the data and to carry out the relevant analysis. The literatures that meet the requirements were screened out. The quality of the selected relevant literatures was assessed. All outcome indicators were analyzed by RevMan 5.3 software. RESULTS: (1) A total of 38 articles were included, and the total number of cases was 2 199, of which 1 035 cases were in the double Endobutton plate group and 1 164 cases were in the clavicle hook plate group. (2) The results showed that the double Endobutton plate group was superior to the clavicle hook plate group in the excellent and good rate [RR=1.19, 95%CI(1.13, 1.26), P < 0.000 01], operation time [MD=10.54, 95% CI(6.09, 15.00), P < 0.000 01], intraoperative blood loss [MD=-14.83, 95%CI(-20.54,-9.13), P < 0.000 01], hospitalization time [MD=-1.44, 95%CI(-2.65,-0.23), P=0.02], incision length [MD=-2.87, 95%CI (-3.60, -2.14), P < 0.000 01], hospitalization cost [MD=-2 442.10, 95% CI(-4 466.34, -417.86), P=0.02], shoulder pain after operation [RR=0.34, 95%CI(0.22, 0.53), P < 0.000 01], visual analogue scale score [MD=-0.85, 95% CI(-1.28, -0.41), P=0.000 2], final Constant-Murley score at 6 months postoperatively [MD=8.82, 95%CI(1.91, 15.72), P=0.01; MD=6.66, 95%CI(4.46, 8.86), P < 0.000 01]CONCLUSION: The treatment of Rockwood III type and above acromioclavicular joint dislocation with double Endobutton plate is superior to that clavicular hook plate. It has the advantages of short operation time, less intraoperative blood loss, less trauma, short hospitalization time and less cost, and good functional recovery of shoulder joint after operation.

Intramedullary nail fixation versus plate fixation in the treatment of displaced midshaft clavicular fractures in adults: A meta-analysis / 中国组织工程研究

OBJECTIVE: At present, many studies have proved that intramedullary nail and steel plate internal fixation is a better way to treat displaced midshaft clavicular fracture. However, there are relatively few comparative studies on the advantages and disadvantages of the two methods, and there are still many controversies. Through the meta-analysis of related literature, the efficacy and safety of intramedullary nail and steel plate in the treatment of adult displaced midshaft clavicular fracture were systematically evaluated. METHODS: Through computer retrieval of PubMed, Embase, Cochrane Library, CNKI, Wanfang and VIP databases from the inception to January 2020, the literature of randomized controlled trials meeting the inclusion and exclusion criteria of intramedullary nail and steel plate in the treatment of adult displaced midshaft clavicular fracture was collected and screened, and the quality evaluation and data extraction were carried out. The operation time, incision length and upper limb function score, Constant-Murley score, and fracture healing time were used as the evaluation indexes of meta-analysis. Meta-analysis was performed using ReMan 5.3 software. RESULTS: (1) Eight valuable articles were retrieved, among which 283 patients were treated with intramedullary nail and 271 patients were treated with steel plate internal fixation. (2) The meta-analysis results showed that the intramedullary nail group was superior to the steel plate group in terms of operation time [MD=-19.63, 95%CI(-22.72,-16.54)], incision length [MD=-3.31, 95%CI(-5.78,-0.85)], and fracture healing time [MD=-1.53, 95%CI(-2.73,-0.33)]. (3) No significant difference was found in upper limb function score [MD=-1.91, 95%CI(-5.48, 1.66)] and Constant-Murley score [MD=-0.58, 95%CI(-4.63, 3.47) between the intramedullary nail group and the steel plate group after surgery. CONCLUSION: The results of meta-analysis showed that intramedullary nail was superior to steel plate in the operation time, incision length and fracture healing time in the treatment of displaced midshaft clavicular fracture. The above results can provide evidence for clinical use of intramedullary nail instead of steel plate internal fixation in the treatment of displaced midshaft clavicular fracture.

Intramedullary fixation versus plate fixation in the treatment of displaced mid-shift clavicle fractures: A meta-analysis / 中国组织工程研究

BACKGROUND: Elastic intramedullary nail and steel plate are two commonly used instruments for clavicle fracture, However, there are few comparative studies on the advantages and disadvantages of them. OBJECTIVE: To systematically evaluate the treatment effects of intramedullary fixation or plate fixation for displaced mid-shift clavicle fractures. METHODS: Articles about the treatment effects of intramedullary fixation or plate fixation for displaced mid-shift clavicle fractures were searched in PubMed, Embase, Science Direct and Cochrane Library, CNKI, WanFang and VIP databases from inception to March 2017. Two reviewers independently screened the articles, extracted data and evaluated the bias risk in the included studies according to the inclusion and exclusion criteria. Meta-analysis was performed using ReMan 5.3 software. RESULTS AND CONCLUSION: (1) A total of 21 studies were included, with 859 patients in the intramedullary fixation group and 831 patients in the plate fixation group. (2) The result of meta-analysis showed that the operation time [MD=-18.62, 95%CI (-20.75, -16.49)], blood loss [MD=-56.23, 95%C/(-68.02, -62.44)], incision length [MJ=-5.53, 95%C/(-6.56, -4.49)], hospitalization time [MD=-1.01, 95%C/(-1.13, -0.89)], and healing time [MD=-1.39, 95%C/ (-1.98, -0.80)] in the intramedullary fixation group were better than those of the plate fixation group. (3) At 6 months after surgery, the Disabilities of the Arm, Shoulder and Hand scores in the intramedullary fixation group were better than those in the plate fixation group (F < 0.05). The scores showed no significant difference between two groups at 12 months after surgery. Major complications [OR=0.61, 95%C/ (0.39, 0.93)] in the intramedullary fixation group were less than those in the plate fixation group. Minor complications and implant removal were similar between two groups. (5) Meta-analysis results imply that elastic intramedullary nail fixation for treating displaced mid-shift clavicle fractures is superior to plate fixation in surgery-related indexes, functional recovery and fracture healing, which can provide effective evidence for its clinical application.

Treatment of ulnar coronoid process fractures in complex elbow injury with plate fixation through an anterior approach / 中国组织工程研究

BACKGROUND: Ulnar coronoid process has special anatomy and it is adjacent to vascular nerve. It is characterized by weak fixation, unstable recurrence, postoperative elbow joint stiffness and pain. These make the treatment of ulnar coronoid process fracture, in particular in complex elbow joint injuries, challenged. OBJECTIVE: To investigate the efficacy of internal fixation with steel plate through an anterior approach on ulnar coronoid process Regan-Morrey type II or type III fracture in complex elbow injury METHODS: Sixteen patients with complex elbow injury and ulnar coronoid process fractures who underwent open reduction and internal fixation were followed up between September 2012 and May 2017. Among these patients, 11 patients had Regan-Morrey type II fracture, 5 patients had Regan-Morrey type III fracture, 14 patients had humeral head fracture, and 2 patients had ulnar olecranon fracture. All patients provided written informed consent. This study was approved by the Medical Ethics Committee of Hong Hui Hospital, China. Ulnar coronoid process fractures were reduced and fixed with steel plate through the space between the median nerve and the radial artery using an anterior approach. At the same time, all radial humeral head and olecranon fractures were treated by internal fixation. RESULTS AND CONCLUSION: All patients acquired acceptable reduction and firm fixation of fractured fragments. All of them were followed up for 13-28 months. At the final follow-up, solid osseous union was confirmed for all coronoid fractures. The average time to radiologic union was 16.5 weeks. The mean flexion-extension arc was 113.4°, the flexion contracture was 13.8°, and further flexion was 127.2°. The mean pronation arc was 72.5°. The mean supination arc was 74.7°, and the mean forearm rotation arc was 146.9°. 11 patients achieved functional arc of motion. All patients were satisfied with the treatment with the mean Mayo Elbow Performance score of 90.3 points. 11 patients achieved excellent elbow performance and 5 patients achieved good elbow performance. These results suggest that ulnar coronoid process fractures in complex elbow injury can be treated successfully with an anterior surgical approach. This approach allows for accurate and rigid internal fixation with steel plate and early functional exercise, resulting in a reasonable outcome.

Stability of the femoral neck and internal fixation with bone cement and steel plate after curettage for benign proximal femoral lesions / 中国组织工程研究

BACKGROUND: For benign bone tumor patients, the life cycle is long. To reduce the incidence of complications and improve the quality of life after surgery through surgery is the common goal of physicians. The quality of life of patients can be increased through discussing the operation mode and prognosis of benign tumor patients, choosing the reasonable operation mode, predicting and reducing the risk of secondary fracture. OBJECTIVE: To analyze the femoral neck force after different surgical methods using finite element technique in the analysis of benign proximal femoral lesions, and to assess the stability of the femoral neck and the risk of fracture after different surgical procedures for cases with a wide range of lesions. METHODS: According to preoperative CT data of lesion sites in 10 subjects with benign tumor of proximal femur, three-dimensional model of internal fixation with bone cement and steel plate after focal curettage (group A) and three-dimensional model of treating with bone cement after focal curettage (group B) were set in this study. Finite element technique was used to simulate the maximum force of the femoral neck when walking. The stress peaks of the femoral neck were compared after surgery between the two groups. The risk of fracture at this location was assessed. Patients signed the informed consent. This study was approved by the Ethics Committee of Chengde Medical College. RESULTS AND CONCLUSION: (1) The stress was significantly lower in the group A than in the group B (P=0.007 < 0.05). (2) The local stress of the model was reasonable in the group A. Ten patients were operated with the protocol of the group A. An additional 17 patients with proximal femur benign lesions who met the requirements but refused to enter the finite element experiment were treated with the surgical program of the group A. (3) The patients were followed up for 14-42 months. During the follow-up, no new fracture was found in the operation area, and the internal fixation device was firm without fracture. At 12 months postoperatively, the mean Musculoskeletal Tumor Society score of all patients was (26.12±2.28). (4) The finite element technology for simulating the stress evaluation and postoperative follow-up verified that the treatment of proximal femur benign tumor with bone cement and steel plate internal fixation after curettage is more reasonable and effective. The scheme can effectively reduce the risk of secondary fracture and enhance the stability in the surgical area.

Finite element analysis to verify the rationality of bone cement combined with plate internal fixation for benign proximal femoral lesions / 中国组织工程研究

BACKGROUND: For the patients with benign osteopathy, the patients usually get a good life cycle after surgical treatment. Through continuous improvement of the operation mode, the stress of the proximal femur after the operation of benign osteopathy is studied by using the finite element analysis. The risk of pathological fracture and secondary fracture is predicted and reduced. To explore the best operation and prognosis is of great significance for prolonging and improving the quality of life of patients. OBJECTIVE: Three-dimensional finite element technique was used to analyze the different surgical models of benign proximal femoral lesions. The differences of different surgical models were compared and the rationality and effectiveness of internal fixation were verified. The reliability of the finite element model was verified in the follow-up of patients after operation. METHODS: Preoperative CT examination was conducted in 10 patients with benign proximal femoral lesions who met the inclusion criteria. Three models of limbs scraping (group A), cavity internal nail re-infusion bone cement (group B) and intracavitary bone cement joint plate screw (group C) were established by MIMICS. The maximum stress values of the left and right side windows of the cortical model of group A, B and C were measured under simulated conditions, and the stress values of the three groups were compared. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. RESULTS AND CONCLUSION: (1) The comparison of the maximum stress values of the anterior and posterior sides of the cortical fenestration in the three groups of models was group A > group B > group C (P < 0.05). The risk of fracture was high in group A, and the risk of fracture in group B was large. The stress in group C was controlled within a reasonable range, and the risk of fracture was low. (2) Therefore, 10 subjects underwent the treatment in group C. The prognosis was good and there were no secondary fractures. The Musculoskeletal Tumor Society score was 27-30 points 1 year after surgery. (3) The model stress is prone to increase the local stress after opening the window. After adding bone cement and steel plate, the stress value of the model window is significantly reduced. After the benign lesions of the proximal femur are scraped, the stress of the fenestration can be effectively reduced by placing the bone cement and the steel plate, and the fracture probability at the surgical site is significantly reduced. Steel plate placement is reasonable.

Anatomic progress of pubic symphysis and biomechanical characteristics of internal fixation / 中国组织工程研究

BACKGROUND: The separation injury of pubic symphysis is most commonly associated with severe pelvic fracture injuries. Because the anatomical position of the pubic symphysis is deep, and the curative effect is often unsatisfactory. Anatomical and biomechanical studies are necessary to better guide clinical diagnosis and treatment. OBJECTIVE: To summarize and analyze the anatomical characteristics and biomechanical research status of pubic symphysis, and to provide some benefits for the clinical treatment of pubic symphysis separation. METHODS: The authors retrieved CNKI, VIP, and PubMed with the key words of “separation of pubic symphysis” and “biomechanics” for articles published from April 1984 to February 2020. Relevant literature was selected by title and abstract, and the titles and abstracts of the references were read. The related literatures were selected again and the duplicate literatures were eliminated. RESULTS AND CONCLUSION: There were 57 eligible literatures, and 33 were finally included. (1) The present anatomical study mainly focuses on the structure of pubic symphysis and its adjacent ligaments. (2) Because of the position of pubic symphysis, no further study was carried out. The precise distribution of the starting and ending points of the peripheral ligaments and muscles, and the precise nerve and blood distribution need further study. (3) There have been relatively few studies of pubic symphysis biomechanics, and they vary widely. It needs to be deeply studied and agreed upon. (4) With the development of finite element, the biomechanics focus on the treatment of pubic symphysis. (5) Due to good mechanical stability, the reconstructed plate and the hollow screw are used as common fixation for pubic symphysis separation. However, percutaneous hollow screw fixation has become the trend in the future because of its minimal invasion.

Establishment and mechanical analysis of the finite element model of the type frykman VIII fracture of the distal radius with steel plate fixation / 中国组织工程研究

BACKGROUND: Generally, the treatment of distal radius fractures or joint dislocations is generally valued in clinical practice, but little attention is paid to the ulnar styloid fracture, and whether the ulnar styloid fracture needs to be fixed is controversial. In the study of orthopedic biomechanics, the selection of cadaver model may encounter some problems, such as different selection criteria of cadaver model and different mechanical measurement methods. OBJECTIVE: Based on Mimics software, the finite element simulation model of type Frykman VIII fracture of the distal radius fixed by plate and screw was constructed using finite element analysis. The working condition and load were set for mechanical analysis. It is hoped to provide a reference for the choice of the repair plan of this kind of fracture. METHODS: A three-dimensional finite element model of normal wrist joint was established based on the forearm and wrist CT images of a healthy volunteer. After debugging the model, Von Mises stress of the distal radius was obtained by loading the 100 N stress in the axial direction, and the validity of the model was verified by comparing with the experimental data in the literature. Two kinds of finite element models of Frykman VIII fracture with ulnar styloid type I and type II fractures were established by using finite element software to divide the mesh, cut and mold, and the model of plate and screw fixation of distal radius was assembled. Setting load under rotating working conditions, we analyzed the changes of the stress distribution of the steel plate unit in two models, and the relative displacement of the distal radioulnar joint as well as the ulnar styloid fracture broken end. RESULTS AND CONCLUSION: (1) A three-dimensional finite element model of normal wrist joint was established and validated, and the other two models of type Frykman VIII fracture of the distal radius with ulnar styloid type I and type II fractures fixed by plate and screw were established based on this model. (2) Under the same rotating load, this study showed that the stress and stress distribution of the steel plate unit in the steel plate fixation model of Frykman VIII fracture of the distal radius combined with ulnar styloid type I fracture were smaller than those of the fracture model combined with type II fracture of styloid process of ulna; the relative displacement values of the distal radioulnar joint and the ulnar styloid fracture broken end were smaller than the latter too. (3) The three-dimensional finite element model of wrist joint constructed in this study can be used to analyze the mechanical mechanism of wrist fracture. The results of finite element analysis showed that the fracture of styloid process of ulna in Frykman VIII fracture of the distal radius would affect the stability of the distal radioulnar joint, especially in the case of ulnar styloid type II fracture, which can provide a certain clinical reference for the selection of operation scheme of such fracture.

Treatment of old femoral neck fracture in adults with sartorius pedicle iliac bone flap and proximal femoral locking plate / 中国组织工程研究

BACKGROUND: The fracture of femoral neck in adults is very common. Most of them can be cured by operation or conservative treatment, but a few can develop into old fracture. At present, there is no clear and effective treatment for old fracture of femoral neck in adults. OBJECTIVE: To explore the clinical effect of sartorius pedicle iliac bone flap combined with proximal femoral locking plate in the treatment of old femoral neck fracture in adults. METHODS: Twelve adult patients with old femoral neck fracture were treated with sartorius pedicle iliac bone flap combined with proximal femoral locking plate, 9 males and 3 females, aged 18-47 years, with an average age of 33. 5 years. Garden classification: Type I in 0 cases, type II in 1 case, type III in 7 cases, and type IV in 4 cases. All of them were incised by Smith Petersen (S-P) approach. The 2/3 sartorius pedicle iliac bone flap of the anterior superior iliac spine was chiseled with a bone knife, about 4. 0 cm×1. 0 cm×1. 0 cm in size. After reduction, the proximal femur was fixed with steel plate and screw. Finally, the sartorius pedicle iliac bone flap was implanted into the defect of the femoral neck and fixed. At 3, 6, 12, and 24 months after the operation, X-ray films were reexamined to evaluate the fracture healing and Harris score of hip joint was used to evaluate the recovery of hip joint function. RESULTS AND CONCLUSION: (1) Twelve patients were followed up for at least 24 months. (2) Harris scores of hip were significantly higher at 3, 6, 12, and 24 months after surgery (54. 4±6. 4, 68. 7±6. 8, 82. 3±4. 2, 90. 3±4. 6) than those before surgery (46. 3±6. 1) (P < 0. 05). (3) There were no complications, such as wound nonunion, infection, or venous thrombosis. Finally, 11 patients finally achieved bony healing at the fracture site. One patient had nonunion at 28 months postoperatively with avascular necrosis of the femoral head (ARCO stage IV), followed by artificial hip replacement. Harris score before operation was 38, and Harris score at 3 months postoperatively was 98. (4) The results show that the combination of sartorius pedicle iliac bone flap and proximal femoral locking plate is a good method for the treatment of old femoral neck fracture in adults, with high healing rate and low necrosis rate of femoral head.

Advantages and disadvantages of internal fixation with suture anchors and locking plate in the treatment of the greater tuberosity fracture / 中国组织工程研究

BACKGROUND: Open reduction and internal fixation with locking plate is wildly used in treatment of the greater tuberosity fracture, but certain disadvantages still existed. OBJECTIVE: To compare the effects of open reduction and internal fixation with suture anchors and locking plate in the treatment of the greater tuberosity fracture. METHODS: A retrospective review of 33 patients with greater tuberosity fracture treated with open reduction and internal fixation between January 2016 and December 2018 was conducted. According to internal fixation method, the patients were divided into anchor group (n=7) and plate group (n=26), which received open reduction + suture anchor fixation and open reduction + locking plate fixation. Operation time, incision length, intraoperative blood loss, postoperative displacement of fracture mass, and Constant-Murley score 1 and 3 months after surgery and in final follow-up were compared between the two groups. Adverse reactions were recorded in the two groups. RESULTS AND CONCLUSION: (1) Operation time was shorter in the anchor group (73.1±10.5 minutes) than in the plate group (98.2±11.9 minutes). Incision length was shorter in the anchor group (7.3±1.1 cm) than in the plate group (14.9±1.7 cm). Intraoperative blood loss was less in the anchor group (45.0±7.1 mL) than in the plate group (141.0±25.9 mL) (P 0.05). (4) All results suggest that compared with locking plate fixation, suture anchor fixation is easier to be operated with small trauma in the treatment of the greater tuberosity fracture.

Finite element analysis of intervention of splint to ulnar column in the treatment of type frykman viii fracture of distal radius / 中国组织工程研究

BACKGROUND: Through clinical research, we found that in the treatment of distal radius fracture combined with ulnar styloid process fracture, the proportion of complications of ulnar column after manual reduction and splint fixation was smaller than that of patients who only received open reduction and internal fixation of distal radius. We deemed that the wrist joint was treated as a whole in the treatment cycle, the splint as elastic fixation could provide the relative stability of the ulnar column and reconstruct the stability of the three columns of the wrist. OBJECTIVE: To explore the biomechanical mechanism of splint intervention on the ulnar column after type Frykman VIII fracture of the distal radius by finite element analysis. METHODS: A three-dimensional finite element model of normal wrist joint was established based on the forearm and wrist CT images of a healthy volunteer. Two kinds of finite element models of type Frykman VIII fracture of the distal radius with ulnar styloid type I and type II fractures were established by using finite element software to divide the mesh, cut and mold. On this basis, four wrist joint finite element models with splint fixation and steel plate fixation for type Frykman VIII fracture of the distal radius were established. Under axial compression, lateral extension, pronation and supination working conditions, stress distribution and relative displacement of the distal radioulnar joint, displacement and direction of the ulnar styloid fracture broken end were analyzed. RESULTS AND CONCLUSION: (1) The stress values of the ulnolunate ligament, ulnotriquetral ligament, and the palmar dorsal radioulnar ligament in the model of type Frykman VIII fracture of the distal radius with ulnar styloid type I fracture after splint intervention were lower than those in the model after plate intervention in the lateral tension, pronation and supination conditions. (2) In the pronation and supination conditions, the relative displacement values of the distal radioulnar joints in type Frykman VIII fracture of the distal radius models with ulnar styloid type I and type II fractures after splint intervention were smaller than those in the models after plate intervention. (3) In the lateral tension, pronation and supination conditions, the relative displacement values of the ulnar styloid fracture broken end in type Frykman VIII fracture of the distal radius models with ulnar styloid type I and type II fractures after splint intervention were smaller than those in the models after plate intervention. (4) The finite element study shows that distal radioulnar joint stability becomes worse after type Frykman VIII fracture of the distal radius, which is more obvious in the model with ulnar styloid type II fracture. In the treatment of this kind of fracture, compared with the simple internal fixation of distal radius fracture, the splint as elastic fixation takes the wrist joint as a whole in the treatment cycle and provides the relative stability of the ulnar column, thus further revealing the advantages of the splint elastic fixation.

Clinical application of Taylor spatial frame in adjustment of lower extremity force line of knee medial compartmental osteoarthritis / 中国修复重建外科杂志

Objective: To explore the safety and effectiveness of Taylor spatial frame (TSF) in the treatment of medial compartmental osteoarthritis (MCOA) of the knee and the adjustment of the lower extremity force line at the same time. Methods: The clinical data of 30 patients with MCOA who underwent high tibial osteotomy (HTO) between October 2016 and April 2017 were retrospectively analyzed. According to the different fixation methods, they were divided into external fixation group (TSF external fixation, 16 cases) and internal fixation group (locking steel plate internal fixation, 14 cases). There was no significant difference between the two groups in gender, age, side, disease duration, mechanical femur tibia angle (MFTA), and other general data ( P>0.05). The operation time and intraoperative blood loss of the two groups were recorded and compared; MFTA was used to evaluate the recovery of the lower extremity force line at last follow-up; Hospital for Special Surgery (HSS) score was used to evaluate the clinical effecacy before operation and at 2 weeks, 1 month, and 3 months after operation. Results: The operation time and intraoperative blood loss of external fixation group were significantly less than those of internal fixation group ( P0.05). Conclusion: TSF has unique advantages in HTO treatment of MCOA patients and correction of lower extremity force line, such as shorter operation time, less bleeding, firm fixation, and less complications. It can accurately adjust the lower extremity force line after operation and has good effectiveness. It is an effective and safe fixation method.

Clinical curative effect of bridge combined internal fixation system and digital customized steel plate for treating complex extremity fracture / 重庆医学

Objective To compare the clinical curative effect of bridge combined internal fixation system (BCFS) and digital customized steel plate(DCSP) for treating complex extremity fracture.Methods Fortyseven cases of complex extremity fracture in this hospital from October 2012 to October 2015 were treated by BCFS and DCSP,among them,26 cases adopted BCFS(BCFS group) and 21 cases were treated by DCSP(DCSP group).Then the operation time,intraoperative blood loss volume,hospitalization time,healing time of fracture,postoperative complications and function evaluation of limbs were compared between the two groups.Results The two group were followed up for 6-15 months with an average of(13.57±1.37)months.The DCSP group was better than the BCFS group in the aspects of operation time and intraoperative blood loss volume,the difference was statistically significant(P＜0.05).The fracture healing time in the BCFS group was significantly shorter than that in the DCSP group,the difference was statistically significant(P＜0.05).The hospitalization time,postoperative complications and function evaluation of limbs had no statistical differences between the two groups(P＞0.05).Conclusion Both BCFS and DCSP can acquire good clinical curative effect in the treatment of complex extremity fracture,however BCFS has a shorter healing time of fracture.

Non-weight-bearing area osteotomy of lateral tibial condyle in treating posterior-lateral condyle fracture of tibial plateau / 重庆医学

Objective To explore the clinical curative effects of non-weight-bearing area osteotomy of anterior lateral tibial condyle in treating posterior-lateral condyle fracture of tibial plateau.Methods A retrospective analysis was carried out on 24 cases of posterior-lateral condyle fracture of tibial plateau treated by osteotomy of anterior lateral tibial condyle in this hospital from December 2012 to December 2015,including 15 males and 9 females,aged 26-59 years old with an average age of 42.2 years old.Fracture Schatker classification:type Ⅱ in 16 cases,type Ⅴ in 3 cases and type Ⅵ in 5 cases.All 24 cases adopted surgical treatment via the approach of anterior lateral tibial condyle.During operation,the non-bearing area of lateral tibial condyle was cut to expose and reset the posterior-lateral fractured condyle and fix it with lateral raft steel plate.At the time of last follow-up,the recovery of the knee joint function was evaluated according to the knee scoring system of Hospital for Special Surgery (HSS) in USA.Results Twenty-four patients were postoperatively followed up for 12-24 months,with an average of 13.1 months.The Rasmussen score for the postoperative immediate fracture reduction quality averaged (17.3 ± 0.8)points;there were 19 cases of excellent results and 5 cases of good results,with the excellent and good rate of 100 ％.Twenty-four cases had no incision infection,no internal fixation loosening or breakage.The X ray film showed that the fracture got healing,and the average healing time was (13.1 ± 1.1) weeks(12-15 weeks).No surgery related complications including blood vessel and nerve damage occurred;2 cases appeared small area of superficial necrosis at the edge of the posterior incision,which was healed after dressing.At the last follow-up,the HSS knee score was(93.0±6.4) points,excellent in 19 cases,good in 4 cases,and fair in 1 case,with the excellent and good rate of 95.8％.Conclusion For the patients with posterior-lateral condyle fracture of tibial platform,non-weight-bearing area osteotomy approach of lateral tibial condyle allows enough space to directly expose the fracture area and carry out operation;combined with lateral raft locking steel plate fixation is more reliableto fixthe fractured bone,with convenient operation positioning,good postoperative functional recovery,fewer complications,and satisfied curative effects.

Surgical treatment of 190 adults with pectus excavatum by newly modified orthopedic steel plate / 中国胸心血管外科临床杂志

@#To summarize the clinical experience of treating adults with pectus excavatum by newly modified orthopedic steel plate and Nuss procedure. Methods    The clinical data of 190 adults with pectus excavatum treated by newly modified Nuss procedure in Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine from January 2011 to June 2016 were collected. There were 151 males and 39 females aged 21.80±3.96 years ranging from 18 to 45 years. The therapeutic efficacy, Haller index and the lung function index were also analyzed. Results    All patients recovered well after the operation. Two orthopedic steel plates were implanted in 12 patients. Pneumothorax was found in 7 patients postoperatively and 2 of them was treated by puncture extraction. There were 5 patients with poor healing of incision and all of them were healed after the debridement. Other complications such as steel plate shift was found in 2 patients. Both of them recovered after the reoperation. The duration of operation was 36–65 min. The intraoperative blood loss was 5–20 ml. Postoperative hospital stay was 4–7 days. Haller and lung function index improved after the operation (P<0.001). Conclusion    It is effective and safe to treat the pectus excavatum by newly modified orthopedic steel plate and Nuss procedure in adult patients.

Application of three-dimensional printing technology in treatment of internal or external ankle distal avulsed fracture / 中国修复重建外科杂志

Conclusion: Application of 3D printing technology in treatment of internal or external ankle distal avulsed fracture is simple, safe, reliable, and effective. In particular, it is an ideal treatment for avulsed fracture.