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Objective To investigate the clinical efficacy of semi-open cancellous bone grafting for infected bone defect combined with soft tissue defect of lower limb.Methods A retrospective case control study was conducted to analyze the clinical data of 26 patients with infected bone defect combined with soft tissue defect of lower limb admitted to the Third Hospital of Hebei Medical University from March 2010 to August 2017.There were 16 males and 10 females,aged 16-65 years [(39.6 ± 12.8)years].The bone defect area before bone grafting was 1.4-6.0 cm [(3.3 ± 1.2) cm].The surface soft tissue defect of bone graft granules was 2.3 cm × 1.1 cm-8.5 cm × 5.0 cm after bone grafting.If the defect was segmental defect of more than 6 cm,the defect was firstly reduced by bone transport.When the defect was near the docking point,the bone defect was repaired by open bone grafting.If the defect was located at the metaphyseal end of the calcaneus or tibia,stage Ⅰ or stage Ⅱ open bone grafting was performed after debridement.After bone grafting,antibiotic-containing cement sheets were used to cover the wound in 14 patients (semi-open group),and vacuum sealing drainage (VSD) devices were used to cover the wound in 12 patients (VSD group).The time of granulation tissue covering bone graft granules,wound healing time,bone defect healing time,material cost and complications (wound infection and necrosis of bone graft granules) were compared between the two groups.The limb function was evaluated according to Paley score.Results All patients were followed up for 12-40 months [(19.3 ±7.2) months].In the semi-open group and VSD group,the time of granulation tissue coverage was 22.2 days (15.0-44.0) days and 20.2 days (15.0-44.0) days (P ＞ 0.05);wound healing time was 3.1 months (1.5-5.5) months and 3.1 months (1.5-6.5) months (P ＞ 0.05);bone defect healing time was (5.5 ± 2.2) months and (5.9 ± 2.4) months (P ＞ 0.05);the cost of covering wound materials was (2 056.1 ± 23.4) yuan and (5 555.3 ± 1 105.5) yuan respectively (P ＜ 0.05).No wound infection occurred in either group.Two patients in the semi-open group and one patient in the VSD group had bone graft granules surface necrosis (P ＞0.05).According to Paley's functional score,the results were excellent in 12 patients and good in two in the semiopen group,compared with excellent in 11 and good in one in the VSD group (P ＞ 0.05).Conclusion For infected bone defect combined with soft tissue defect of lower limb,semi-open bone grafting can simplify the nursing of wound,prevent wound infection,promote wound healing and fracture healing.It has similar therapeutic effect with VSD,but its treatment cost is significantly reduced.
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Objective To assess the efficacy of using reaming and antibiotic cement beads/rod for intramedullary nail associated infection.Methods Data of 12 patients with intramedullary infection of tibia or femur following intramedullary nailing from October 2014 to April 2016 were retrospectively analyzed.There were 10 men and 2 women aged from 19 to 63 years old with an average age of 39.2 years.In 5 cases the disease was localized in the femur with one case of nonunion,and in other 7 cases the disease was localizedin the tibia with two cases of nonunion.The initial injury included closed fracture in 8 patients and open fracture in 4 patients which were all Gustilo-Anderson Ⅱ.According to the Cierny-Mader classification of adult osteomyelitis,6 cases were type Ⅰ (medullary osteomyelitis),4 cases were type Ⅰ combined with type Ⅲ (medullary.and localized osteomyelitis),and 2 cases were type Ⅰ combined with type Ⅳ (medullary and diffuse osteomyelitis).Surgical technique included removal of the intramedullary nailand reaming and irrigation of the medullary canal to remove intramedullary debris.The drainage sinus and soft tissues abscess were excised if existed.An local or enbloc resection for the infected or necrotic bone was performed if there was local or diffuse infection in the fracture sites.Ilizarov technique was performed for segment bone defect.The bone union was observed in nine patients and stable nonunion in one.Antibiotic PMMA beads were inserted into intramedullary canal for these ten cases after debridement,and the antibiotic beads were removed approximately 12-14 days after implantation.The antibiotic cement rod was inserted into the medullary canal to provide stabilization in the other 2 cases.All the patients received intravenous antibiotics systemically for three weeks,and followed by three weeks of oral antibiotics.Results At a mean follow-up period of 23.5 months (range,15-33 months),no recurrence of infection was observed.There were 3 cases of nonunions.One case of tibial nonunion had been achieved union 10 months after insertion of an antibiotic cement rod.One with stable nonunion of tibia was treated with antibiotic PMMA beads,and enbloc resection for the infected bone was performed after the extension of infection had been narrowed at the nonunion.6 cm of bone defect was treated with bone transport and then union was obtained 16 months after operation.The third case was infected nonunion in the femur with 4 cm bone defect after debridement.The femur was shortened and temporarily stabilized with the intramedullary antibiotic cement rod.The rod was removed three months after the operation,and then the femur was lengthened.The docking site and the regeneration area were healed 12 months after the lengthening operation.Conclusion The clinical results shows that reaming and antibiotic cement beads/rod appears an effective and safe alternative for management of intramedullary nail associated infection of the tibia and femur.
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Objective Trauma-induced coagulopathy (TIC)is an acute coagulopathy in which coagulation,fibrinolysis,and anticoagulant pathways are activated after trauma due to massive hemorrhage and tissue damage.TIC is caused by hypothermia,acidosis,blood dilution,hyperfusion,tissue injury,etc.To diagnose TIC,we mainly rely on traditional coagulation function analysis and thrombelastogram (TEG).At present,the key to treat TIC is quick hemostasis.The basic treatment procedure includes transfusion of packed red blood cells and fresh frozen plasma by appropriate proportion,and timely infusion of platelets and coagulant material so as to stabilize blood pressure and reconstruct the blood coagulation mechanism.In this paper,we reviewed recent advances in the pathophysiological and treatment of TIC in order to provide references for further research in related fields.
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Objective To explore the clinical efficacy of rectangle advancement flaps used in the reconstruction of skin defects around the Achilles tendon in children.Methods From May 2014 to June 2015,7 children with skin defects around the Achilles tendon were admitted to our trauma center.The areas of skin defect ranged from 3.4 cm × 2.7 cm to 5.5 cm × 4.0 cm.The integrity of Achilles tendon was preserved in 6 cases but the tendon insertion was partly disrupted in one case.The skin defects were reconstructed with self-designed rectangle advancement flaps after debridement.In the one case with the Achilles tendon partly disrupted,the contaminated tendon ends were excised before wound closure.The injured ankles were immobilized in plantar flexion with one 1.5 mm K-wire and plaster splint to decrease the postoperative tension of the flap.Results All the flaps survived completely by primary intention but local infection occurred in 2 wounds which was cured by second intention of dressing change.The follow-up periods ranged from 8 to 12 months (average,11.5 months).The scar around the flap was remarkable in 2 cases,but the flaps in the other cases appeared normal in terms of color and texture.The ankle function was satisfactorily normal in all the cases.Conclusion Our self-designed rectangle advancement flaps provide a simple,safe and reliable way to repair skin defects around the Achilles tendon in children.
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Objective To assess the efficacy of using the Ilizarov bone transport combined with open bone grafting and vacuum sealing drainage (VSD) to treat infected tibial bone defect.Methods A retrospective case series study was made on 8 patients sustaining posttraumatic infectious tibial bone defect treated between March 2010 and May 2015.There were 7 male and 1 female patients between 22 and 51 years (mean,39.4 years).All patients underwent radical resection of the infected/necrotic bone and debridement of the soft tissue.Length of bone defects after debridement averaged 8 cm (range,3.5-13.5 cm) and wound size averaged 4.8 cm ×2.5 cm (range,2.3 cm× 1.1 cm-8.5 cm ×6.0 cm).Stabilization was finished with Ilizarov circular external frame in all patients.Six patients were candidates for single-or double-level bone transport,and the cancellous bone autograft was placed openly within the butterfly defect after docking.Other 2 patients were treated with one-stage shortening of the fracture ends and open cancellous bone grafting,and the bone lengthening was performed.Then the grafted wounds were covered by VSD.Data were recorded including the bone transport or lengthening time,wound healing time,union time of docking sites,consolidation time of regenerate zones,external fixation time and external fixation index.Bone results and functional results were evaluated according to the criteria given by association for the study and application of the method of Ilizarov (ASAMI).Results Duration of follow-up was 10.2-36.4 months (mean,12.2 months).All the wounds achieved successful healing and eradication of infection.Mean bone transport time was 50 days (range,30-69 days).Seven patients showed selfhealing wounds,and mean healing time was 3.4 months (range,1.2-6 months).One patient experienced wound closure by skin grafting.Union and consolidation were achieved in all docking sites and regenerate zones.Mean union time of docking sites after bone grafting was 6.8 months (range,5.3-10 months).Mean consolidation time of regenerate zones was 6.2 months (range,4.8-8.5 months).Mean external fixation time was 8.6 months (range,6.5-11.5 months) with a mean external fixation index of 1.2 months/cm(range,0.7-1.9 months/cm).According to the criterion of ASAMI,bony results were excellent in 7 patients and poor in 1 patient,and functional results were excellent in 4 patients and good in 4 patients.Conclusion Ilizarov bone transport technique combined with open bone grafting and VSD for infectious tibial bone defect can accelerate bone union and wound healing at docking sites and reduce external fixation time.
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Objective To assess the efficacy of double-level bone transport for treatment of extensive post-infectious tibial bone defects.Methods From January 2010 to May 2014,12 consecutive patients suffering from massive postinfectious tibial bone defects were treated by the Ilizarov technique of double-level bone lengthening.The study population included 8 males and 4 females,with mean 40.9 years (range,16-65 years).Mechanisms of initial injury included motor-vehicle injury in eight patients,explosive injury in two and crush-related injury in two.After bony resection for infection,skin defect was 8.7 cm ×5.8 cm (range,4.5 cm × 2.0 cm-20.0 cm × 10.0 cm) and bone defect averaged 11.0 cm (range,6.0-20.0 cm).All patients were treated with a double-level transport (three distal-to-proximal,six both-ends-to-center and three proximal-to-distal).Three patients were candidates for flap coverage before bone transport because of large wounds,one patient had direct closure of the wound after tibial partly shortening,and the remaining patients kept the wound open during bone transport.Bone and functional results were evaluated according to the criteria given by Association for the Study and Application of the Method of Ilizarov (ASAMI).Results After removal of the apparatus,follow-up was (30.0 ±5.6) months (range,12-36 months).All patients achieved complete union and successful eradication of infection.Mean bone transport time was (55.4 ± 26.2)d (range,30-125 d),with the lengthening index of (5.0 ± 0.6) d/cm (range,3.9-6.3 d/cm).Wound union time was (3.6 ± 1.4) months (range,1.5-6.0 months).Mean consolidation time of the distraction gap was (10.9 ± 3.8)d (range,4.0-18.0 d).Mean union time of the docking site was (8.4 ± 3.8)months (range,3-16.5 months).Mean external fixation time was (12.5 ±4.1)months (range,5-18 months),and mean external fixation index was (1.2 ± 0.3) months/cm(rang,0.8-2 months/cm).According to the ASAMI,bony results were excellent in seven patients (58％) and poor in five (42％);functional results were excellent in nine patients (75％) and good in three (25％).Conclusion Double-level bone transport is an effective method that can reduce bone transport time and external fixation time.
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Objective To determine the curative effect of stabilizing unstable pelvic ring fracture using the anterior subcutaneous internal fixator (INFIX).Methods From July 2013 to June 2014,15 cases who suffered from anterior pelvic ring fracture were treated with the device.There were 11 males and 4 females,with mean age of 38.5 years (range,23-65 years).Eight cases sustained fracture in traffic accidents,4 in high falls,and 3 in crush injury.According to the Young-Burgess and AO/OTA classification systems,type APC2 or 61-B1 was noted in one case,LC1 or 61-B2.1 in 4 cases,LC2 or 61-B2.2/61-B2.3 in 6 cases,and VS or 61-C1/61-C2 in 4 cases.Basic method in anterior ring fixation was one pedicle screw was respectively inserted into the area between the anterior superior iliac spine and anterior inferior iliac spine of both sides.The precontoured rod was then tunneled subcutaneously from one screw to the other.For the stable posterior injury in pelvic ring fracture,the anterior pelvic ring was stabilized only using the technique.For the unstable posterior injury in pelvic ring fracture,the anterior and posterior ring were both fixed using the technique.During follow-up visits,patients' tolerance to the device,wound infection,myositis ossificans,internal fixation lessening,and lateral femoral cutaneous nerve injury were evaluated.Results Follow-up ranged from 6-12 months (mean,7.5 months).The device was well tolerated by the patients for comfort.None had surgical site infection and internal fixation loosening.Injuries healed without loss of reduction at the 3-month follow-up.Injury of the lateral femoral cutaneous nerve at the both side was reported in 4 cases and at one side in 2 cases,but all restored 3 month after operation.Conclusion The reported technique is minimally invasive with few complications and reliable results,hinting an ideal method to stabilize the anterior pelvic ring fracture.
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Objective To compare the therapeutic results between low-molecular-weight heparin therapy and combined therapy of low-molecular-weight heparin and Shuxuetong for deep venous thrombosis (DVT) after lower extremity fracture.Methods Forty-two patients with DVT from 1,037 patients with lower extremity fracture treated from December 2010 through November 2012 were included in the study.There were 31 males and 11 females,aged from 26 to 82 years (mean,63 years).The patients were assigned to administration of 4,250 IU low-molecular-weight heparin subcutaneously,twice daily (Group A,n =19)and 4,250 IU low-molecular-weight heparin subcutaneously,twice daily plus shuxuetong to 6 ml intravenously,once daily (Group B,n =23) according to the random number table.A period of treatment was a week.Color Doppler sonography was performed to detect DVT.Results Longest course of treatment was 3 weeks.In Group A,the results were recanalization in 2 patients with mean time of 2.50 weeks,significantly effective in 3 patients with mean time of 2.67 weeks,effective in 7 patients with mean time of 3 weeks,and invalid or worse in 7 patients with mean time of 3 weeks.Whereas in Group B,the results were recanalization in 7 patients with mean time of 1.86 weeks,significantly effective in 12 patients with mean time of 1.83 weeks,effective in 3 patients with mean time of 3 weeks,and invalid or worse in 1 patient with mean time of 3 weeks (P ＜ 0.05).Conclusion Low-molecular-weight heparin plus Shuxuetong is effective in treatment of DVT after lower extremity fracture and hence can be as an option in clinical application.
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Objective To evaluate the effect of internal iliac artery or abdominal aorta blockade on the pressure of internal iliac artery net in order to provide theoretical basis for reasonable option of arterial blockade in management of arterial bleeding of pelvic fractures.Methods Five goats were included in the study.The measurement of the pressure of internal iliac artery net was made in the following steps:( 1 ) measurement of the pressure of normal internal iliac artery,(2) measurenent of the pressure following blockade of unilateral internal iliac artery,(3) measurement of the pressure following blockade of bilateral internal iliac arteries,(4) measurement of the pressure following blockade of abdominal aorta and bilateral internal iliac arteries simultaneously,(5) measurement of the pressure following blockade of abdominal aorta only.Results The normal internal iliac artery pressure was ( 57.84 ± 13.46 ) mm Hg.The pressures following the blockade of unilateral internal iliac artery,bilateral internal iliac arteries,abdominal aorta and bilateral internal iliac arteries sinultaneously,and abdominal aorta only were (38.40±17.39) mm Hg,(29.70 ± 12.16) mmHg,(32.80 ± 17.02) mm Hg and (29.20 ± 18.52) mm Hg,respectively.All the blocking designs had obvious effect on the pressure of normal internal iliac artery ( P ＜ 0.05 ),while the various blockade modes themselves showed no statistical differences (P ＞ 0.05). Conclusion The upper described four modes of blockade are similar in decreasing the pressure of the internal iliac artery net.Thereby,only one of them is enough in management of artery hemorrhage following pelvic fractures.
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Objective To determine safe zones at the medial and lateral calcaneus for percutaneous pin placement in Chinese patients.Methods Fourteen cadaveric specimens of normal Chinese adult foot and ankle joints were dissected in this study.At the medial calcaneus of each foot, the most medial and posteroinferior point, the most inferior medial malleolus and the navicular tuberosity were identified and labeled as points A, B and C respectively.The medial calcaneal nerve, the most posterior branch of the lateral plantar nerve, the lateral plantar nerve, the medial plantar nerve, the posterior tibial artery, the lateral plantar artery and the medial plantar artery were carefully dissected and identified.A relative safe zone at the medial calcaneus was marked off according to where the neurovascular structures crossed lines AB and AC.At the lateral calcaneus, the most lateral and posteroinferior point and the inferior lateral malleolus were identified and labeled as points D and E respectively.The lateral calcaneal nerve, the sural nerve and the trunk of the small saphenous vein were carefully dissected and identified.A relative safe zone at the lateral calcaneus was marked off in the same way as that at the medial calcaneus.Results At the medial calcaneus, the medial calcaneal nerve, the most posterior branch of the lateral plantar nerve, the lateral plantar nerve, the medial plantar nerve and the posterior tibial artery crossed line AB respectively at posteroinferiorly 22%, 50%,56%, 64% and 58% of the line.The medial calcaneal nerve, the most posterior branch of the lateral plantar nerve, the lateral plantar nerve, the medial plantar nerve, the lateral plantar artery and the medial plantar artery crossed line AC respectively at posteroinferiorly 14%, 39%, 49%, 63%, 41% and 57% of the line.At the lateral calcaneus, the lateral calcaneal nerve, the sural nerve and the trunk of the small saphenous vein crossed line DE respectively at posteroinferiorly 19%, 65% and 61% of the line.Conclusions At the medial calcaneus, the circular region posterior to the 1/2 of line AB and to the 1/3 of line AC may be considered as a relative safe zone for percutaneous pin placement; at the lateral calcaneus, the region posterior to the perpendicular at the midpoint of line DE may be considered as a relative safe zone for percutaneous pin placement.
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Objective The tissue engineering technique and the microsurgery technology is combined to construct the uncellular tissue engineering complex with vascularization and membrane guided dual effect. Through comparing study of using the simple biomembrane guided bone regeneration technique to construct the uncellular tissue engineering complex to repair the large segment bone defect in the animal body,the bone reparative effect of the tissue engineering bone wrapped by pedical fascial flap with vessels and that wrapped by the simple biomembrane was compared, thus to provide experimental evidence for the clinical application. Methods Twenty-four Newzland 5-month-old rabbits were used to build the bilateral periosteumincluded bone defect modelsin the middle piece of the ulna and the length of the defect was 1 cm. Autologous red bone marrow was implanted in the tissue engineering bone which was prepared by osteoinductive absorbing material including BMP. The prepared tissue engineering bone was implanted in the bone defect area. The right side was wrapped by the simple absorbable biomembrane, whereas the left side was wrapped by pedical fascial flap with blood supply. At the fourth, eighth, twelfth and sixteenth week after the operation each group was examined by the radiograph (x-ray), the light density measurement, gross morphology and histological inspection,bone shape measurement analysis in the repairing area and the biomechanics measurement at the twelfth week. The data was analyzed to test the difference of the bond defect repair. Results The radiograph, gross morphology and histological inspection showed the growth of vessels in the implant area, the quantity and the forming speed of the bone trabecula and, the cartilaginous tissue, the formation of the mature bone structure,remodeling of the diaphysis, recanalization of the cavum ossis and the absorption and the degradation of the implant of the group of pedical fascial flap with blood supply was superior to that of the group of the simple absorbable biomembrane. At the fourth, eighth, twelfth and sixteenth week after the operation the bone trabecula area were( 20. 35 ± 2. 41 ) %, ( 40. 21 ± 1.97 ) %, (66. 67 ± 3.44 ) % and ( 86. 47 ± 3.99) % respectively in the group of pedical fascial flap with blood supply, and were ( 7. 46 ± 2.64 ) %, ( 20. 66 ± 2. 28 ) % , ( 40. 22 ±1.84)% and(58. 18 ± 1.79) respectively in the group of the simple absorbable biomembrane. At the same time point after the operation the light density were 0. 636 ± 0. 012,0. 596 ± 0. 062,0. 552 ± 0. 009 and 0. 451 ±0. 008 respectively in the group of pedical fascial flap with blood supply, and 0. 742 ± 0. 032,0. 713 ± 0. 022,0. 655 ±0. 018 and 0. 606 ±0. 015 respectively in the group of the simple absorbable biomembrane. The units of blood vessel reproductive area in the bone repair junctional zone were ( 18.75 ± 2. 09 ) %, ( 37.41 ± 3.22 ) %,(53. 06 ±2. 18)% and (36.72 ±4. 73)% respectively in the group of pedical fascial flap with blood supply,and (5. 34 ± 1.17 ) %, (9. 48 ± 2.96) %, ( 22.43 ± 2. 21 ) % and ( 26. 27 ± 3. 14 ) % respectively in the group of the simple absorbable biomembrane. The biomechanics intension was 26.62 ± 3.96 in the group of pedical fascial flap with blood supply and 18. 38 ±0. 71 in the group of the simple absorbable biomembrane at the twelfth week after the operation. All of the differences were significant( P ＜0. 05 ). Conclusion The pedical fascial flap with blood supply has significant effect in promoting the tissue engineering bone to vascularize and promoting the bone formation by vascularization. The membrane guided bone regeneration technique restricted not only the growth of the fibrous connective tissue in the reparative process of the large segment bone defect effectively, but also the ability of fast and effective vascularization, thus the chronic creep and substitution process would be needed. Simple application of the biomembrane can compensate the shortcoming of chronic creep of the implanted material by the growth of the external callus.
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Objective To observe the curative effect of internal compression in the treatment of intra-articular fracture of the calcaneus by anatomical plate with compression bolt through the sinus tarsi approach.Methods Forty-nine patients with 62 calcaneal fractures treated with anatomical plate with compression bolt through sinus tarsi approach from September 2006 to May 2009 were enrolled in the study.According to Sanders classification,there were 39 patients with type Ⅱ fractures,20 with type Ⅲ fractures and three with type Ⅳ fractures.The axial and lateral view X-ray radiographs and the axial,semi-coronal and sagittal computed tomography (CT) images of the heel were taken before and after operation.The reduction of posterior articular surface of calcaneus and calcaneal shape was observed and the width,height,length,B(o)hler' s angle and Gissan' s angle were measured on the radiographs,respectively.Partial weight bearing was allowed 12 weeks after operation and full weight beating was allowed 16 weeks after operation.The anatomical plates were removed 8-15 months after operation.The Maryland hindfoot score system was applied to evaluate the function of the hindfoot postoperatively.Results All the patients were followed up for 7.5-23 months (average 10.6 months),which showed no wound infection.The reduction of the posterior facet was nearly anatomical (less than 3 mm articular displacement) in all patients and the shape of the calcaneus was satisfactory.The width,height,length,B(o)hler' s angle and Gissan' s angle were improved significantly in all patients (P ＜0.01 ).According to Maryland hindfoot scoring system,29 feet scored 90-100 points (excellent),18 feet scored 80-90 points (good),10 feet scored 70-80 points (moderate) and 5 feet scored 60-70 points (poor).A total of 40 patients (82％) were able to return to their original occupations at mean 9.1 months ( 6.0-12.9 months ) after the injury.Conclusion The anatomical plate with compression bolt internal fixation through sinus tarsi approach is an ideal method for the treatment of displaced intra-articular calcaneus fracture.
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Objective To evaluate the biomechanical effect of cortical screw support technique in fixation of the femoral neck fractures. Methods The models of subcapital femoral neck fracture were made in eight matched pairs of embamled cadaver femurs and decided into experiment group and control group (four pairs per group). The side of experiment group was fixed using three cannulated compression screws with cortical screw support and that of control group with conventional screw placement. The speci-mens in two groups were tested in aspects of torsion and axial loading. Results In axial load test at load of 600 N and 800 N, the displacements in cortical screw support group were (0.677±0.135) mm and (0.907±0.132) mm respectively, while those of femoral head in conventional screw placement group were (0.899±0.160) mm and (1.202±0.152) nun respectively (P <0.05). There was signifi-cant difference between the two groups (P < 0.05). The maximal vertical loading for failure of the fixa-tion was (2 782±228) N in cortical screw support group and (1 950±281) N in conventional screw placement group (P < 0.01). In torsibility test at 4° and 6° torsibility, the torque-moments of cortical screw support group were (10.406±1.515) Nm and (15.328 ±1.471) Nm respectively and those of conventional screw placement group (6.628±1.163) Nm and (9.072±1.570) Nm respectively, with statistical difference between two groups (P <0.01). The maximal torque-moment for failure of the fixa-tion was (25.437±5.213) Nm in cortical screw support group and (13.235±3.012) Nm in conven-tional screw placement group (P < 0.01). Conclusion Fixation of femoral neck fractures by using cortical screw support can significantly enhance anti-torsion and anti-compression of internal fixation.
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[Objective]Through the clinical investigation of the conversative treatment of undisplaced femoral necks,to analyze the occurrence of secondary displacement and femoral head necrosis.[Method]The medical records of 216 patients with undisplaced femoral neck fractures who were primarily treated conservatively from January,2000 to January,2004 were analyzed.Among that,186 cases is in accordance with the selected standard,which were consisted of 82 men and 104 women.(the average age 67.5).One hundred and forty-one fractures were given to bed rest in rotation-proof shoes,and walking on the crutches was followed after four weeks.Forty-five patients began to get out of bed with double crutches on the third day.When displacement happened,the operation was carried out.Once X-rays showed the fracture line unclearly,it is considered as bone healing.The early stage of femoral head necrosis was defined by sclerotic region or cyst in the femoral head.[Result]Sixty-eight fractures(36.6%) united and secondary considered displacement occurred in 118 cases(63.4%); the average time was 16 days (2～68 d) after injury when the displacement is found.In all primary healing patients,femoral head necrosis rate was 25%.The discovery time of necrosis was between 4 and 18 months,the most was 36 cases in the interval of 6 to 12 months.As for patients of secondary displacement,92 for closed reduction and hollow screws fixation,and the head necrosis happened in 55 patients(59.8%).The discovery time was from 4 to 18 months,the most in 6 to 12 months was 36 cases.The operation of open reduction and internal fixation with hollow screws was in 26 cases,73% of necrosis rate for it.The time was range from 3 to 12 months,11 case was the most in the period of 3 to 6 months.[Conclusion]Undispalced femoral neck fractures treated conservatively bear higher risk of secondary displacement and femoral head necrosis.In addition with more mortality and general complications,we therefore recommend primary operative stabilization of undisplaced femoral neck fractures.
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[Objective]To evaluate the effect of fibula shortening on biomechanical characters of tibiotalar joint and prescribe the most acceptable extent of fibula shortening.[Method]Six fresh cadaveric specimens were disarticulated though the knee,and the soft tissues were removed from the knee to the level of the ankle joint.The position of the ankle joint during testing simulated the single leg stance phase of gait.Every group of specimen carried out a biomechanical test in the turn of intact,fibula 2mm shortening,4mm shortening,6mm shortening.The biomechanical change of the tibiotalar joint after fibular shortening was found.[Result]The total contact area of the tibiotalar joint tended to decrease in the fibular shortening model.The contact area and contact pressure in anteromedial and posteromedial quadrant tended to decrease,while,the contact area and contact pressure in anterolateral and posterolateral quadrant tended to increase.[Conclusion]The 2 mm fibular shortening(including 2 mm) significantly alter the biomechanical characters in tibiotalar joint.
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[Objective]To observe the changes of contact characteristics of the subtalar joint after calcaneus fracture in load condition, so as to provid a theoretical basis for its clinical treatment.[Method]Six fresh speciments consisting of foots and lower legs were harvested.A specimen,including an intact foot and 15~20cm of the distal tibia and fibula prepared by removing the skin,muscle and tendons down to the level of the hindfoot and the ligaments and joint capsules were kept intact with the exception of the posterior aspect of the posterior facet and the lateralaspect of middle and anterior facets of the talocalcaneal joint.The pressure sensitive film was inserted into the posterior and anterior-middle facets of the talocalcaneal articulation,and 500-N load was applied in the neutral position.After testing of the intact foot,the calcaneus was splited into anterointernal and posterolateral compoments using microoscillating saw to simulate primary fracture of calcaneus.The test was repeated after tile posterolateral fragment was anatomically reduced and displaced 2mm,5mm and 10mm respectively in a planter direction.The changes of contact characteristics of the subtalar joint ware recorded.[Result]The average pressure area of the intact posterior facet was(275.67?46.02) mm~2,the average stress to bear the weight was(1.83?0.56) MPa.The bearing average pressure area decreased to(167.67?25.09) mm~2 when the posterolateral compoment was displaced to plantar in 2 mm,it was significantly lower(P0.05).The bearing stress the anterior and middle facets significant increased only in a 1 10mm plantar displacement of the posterolateral component(P