Posterior malleolar fracture: technique and clinical experience of the posterolateral approach / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To introduce the postero- lateral surgical approach to the posterior malleolar fracture and report its clinical outcomes in 32 cases.</p><p><b>METHODS</b>This study consisted of 32 cases, 22 males and 10 females with the mean age of 48 years (range, 21-63 years), suffering from posterior malleolar fracture. All cases were treated with the posterolateral surgical approach to the ankle. The average follow-up period was 28 months (range, 24-35 months). The clinical outcomes of these cases were evaluated on the basis of the Olerud-Molander Ankle (OMA) score and plain radiographs.</p><p><b>RESULTS</b>All cases showed radiological evidence of bony union at follow-up. The average OMA score was 82 points; 21 cases had excellent scores (90-100 points), 9 good (61-90 points), and 2 fair (31-60 points). The excellent-to-good rate was 93.8%. Although most cases did not show any wound dehiscence or necrosis, one patient had a superficial infection which healed after using antibiotic dressing and one had sural cutaneous nerve injury that underwent spontaneous remission without any treatment after three months. In addition, one presented with mild symptoms of peroneal tendonitis that disappeared after plate removal.</p><p><b>CONCLUSION</b>The posterolateral approach offers an effective technique for fracture reduction and fixation of large posterior malleolar fragments.</p>

Clinical investigation of the minimal invasive osteotomy for the treatment of hallux valgus combined with tailor's bunion / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effects of the minimal invasive osteotomy treatment for hallux valgus combined with tailor's bunion deformity.</p><p><b>METHODS</b>From May 2007 to May 2009, Forty-nine feet of 32 patients (a mean age of 57 years old) of hallux valgus combined with tailor's bunion deformity were reviewed retrospectively, including 2 males(2 feet) and 30 females (47 feet). All patients were treated by the minimal invasive osteotomy. The axial and lateral films of all feet with loading were taken before and after operation. The hallux abducto valgus angle(HAV),intermetatarsal angle(IM), fourth-fifth intermetatarsal angle (IM 4 to 5), modified fourth-fifth intermetatarsal angle (MIM 4 to 5), Metatarsophalangeal-fifth angle (MPA) and lateral deviation of the fifth matatarsal angle (LDA) were compared before and after operation. Therapeutic effects of all the patients were observed after operation, the item including AFAS score and WEN Jian-min's therapeutic effects standard.</p><p><b>RESULTS</b>The average operating time was 40 minutes. All the patients were followed up,and the duration ranged from 6 to 24 months. The HAV angle, IM angle, IM 4 to 5 angle, MIM 4 to 5 angle,MPA angle and LDA angle significantly decreased after operation. The AFAS score significantly raised after operation. According to the criteria, 33 feet got an excellent result, 15 good and 1 fair.</p><p><b>CONCLUSION</b>The minimal invasive osteotomy treatment for hallux valgus combined with tailor's bunion is effective and safe. This method is mini-trauma,less pain and it can make a very soon rehabilitation. This method has widely clinical value.</p>

Experiment study of alendronate in the prevention and treatment of aseptic loosening of prosthesis / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effect of alendronate on the prevention and treatment of aseptic loosening of prosthesis.</p><p><b>METHODS</b>A rat model of particle-induced osteolysis was used. Thirty-xis SD rats were divided into three groups: negative control group, positive control group and experiment group. Alendronate was administered by ig in experiment group. Positive control group and experiment group received intro-articular injections of ultrahigh molecular weight polyethylene (UHMWPE) particles at 4, 6, 8, 10 weeks postoperatively. Negative control group was received injection with mixture solution of mouse serum and PBS only. All animals were sacrificed at 12 weeks after operation for histologic examination. In vitro human peripheral blood mononuclear (PBMC)were separated and cultured and divided into five groups as group A: PBMC group, group B: PBMC and particles,group C:PBMC and particles with 10(-4) mol/L alendronate, group D:PBMC and particles with 10(-5) mol/L alendronate, group E: PBMC and particles with 10(-6) mol/L alendronate. The production of IL-1beta, IL-6, TNF-alpha in each group were tested.</p><p><b>RESULTS</b>Alendronate could prevent particle-induced osteolysis. The production of IL-1beta, IL-6, TNF-alpha was inhibited when alendronate was used.</p><p><b>CONCLUSION</b>Alendronate can inhibit bone absorptive factors expression induced by wear particles and may be used in the prevention and treatment of aseptic loosening of prosthesis.</p>

Treatment of the ununited lower limb fracture with reamed intramedullary interlocking nail / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical effect of the treatment of the ununited lower limb fracture with reamed intramedullary interlocking nail.</p><p><b>METHODS</b>Fifty-two patients with ununited lower limb fracture were treated with intramedullary interlocking nail (femur 36, tibia 16). The main cause of nonunion was interternal fixation loosening or fracture (41 cases, 78.8%), other reasons included bone defection, bone infection or too much traction of fracture (11 cases, 21.2%). According to X-ray classification: 41 cases in type hypertrophy, 11 cases in type atrophy. All these patients need operation to remove the primary implant, clean the hard bone, ischemia bone and scar, manual ream and fix by intramedullary interlocking nail, then bone graft were done around the fracture site. With the knee joint stiffness, relax it by manipulate or operation.</p><p><b>RESULTS</b>Beside 3 superficial infection (2 delayed healing and 1 healing after debridement), other 49 wounds healed on time. All cases were followed up for an average of 25.2 months, ranging from 12 months to 39 months. All the ununion healed from 5 to 11 months, mean union time were 6.1 months. Deep tissue infection, fat embolism, implant loosening, nail broken or nonunion were not found in this series. According to judet standard on the movement of knee, the excellent-good rate was 82.7%.</p><p><b>CONCLUSIONS</b>Intramedullary interlocking nail is effective to treat nonunion of lower limb fracture.</p>

Analysis of factors related to prognosis of femoral neck fracture / 中华创伤骨科杂志

Objective To find out factors related to avascular necrosis (AVN) of femoral head through a retrospective study of patients with femoral neck fractures treated with cannulated screws.Methods Two hundred and thirty cases of femoral neck fracture whn had been treated with cannulated screws in our department from August 1994 to October 2003 were analyzed statistically.Six factors of patient,age,gender,fracture type (Garden clas- sification),reduction method (close or open),the quality of reduction (Garden Index) and time interval from injury to surgery were analyzed statistically with rank sum test and logistic multiple regression.Results Factors that might have an impact on avascular necrosis of femoral head were ranked in the following likelihood sequence: fracture type,quality of reduction,reduction method,time interval from injury to surgery and age.Gender was found to have little impact on the prognosis of femoral neck fracture (P＞0.05).Conclusions Fracture displacement is the most critical factor that influences the prognosis.Anatomical reduction (close or open) must be achieved to re- duce the risk of AVN.Timing of surgery shows its importance.High age will not lead to an increased incidence of AVN.