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.

Surgical treatment for open tarsometatarsal joint injury / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the surgical method and clinical efficacy for open tarsometatarsal joint injuries.</p><p><b>METHODS</b>From March 2011 to January 2015, 21 patients with open tarsometatarsal joint injuries were treated with stage-surgery method, including 14 males and 7 females with an average age of 45.6 years old ranging from 20 to 75 years. Injury site occurred in the left foot of 13 cases and right foot of 8 cases. Traffic injury was in 5 cases, crush injury in 6 cases, heavy crushing was in 10 cases. According to Myerson to classify for tarsometatarsal joint injury, 5 cases were type B2, 9 cases were type C1, and 7 cases were type C2. And according to Gustilo to typing for soft tissue injury, 5 cases were type IIB, 10 cases were type IIIA, 6 cases were type IIIB. Fracture healingand complications were observed after operation and clinical effects were evaluated according to the midfoot score of AOFAS.</p><p><b>RESULTS</b>All the patients were followed up from 11 to 40 months with an average of 16.2 months. The fracture healing time was from 10 to 16 weeks with an average of 12.3 weeks. No complications such as deep infection, nonunion and osteomyelitis were found. Midfoot score of AOFAS at last follow-up was 83.0±14.9, 9 cases got excellent results, 8 good, 2 fair, 2 poor. Two patients complicated with severe traumatic arthritis once again underwent tarsometatarsal arthrodesis.</p><p><b>CONCLUSIONS</b>For the treatment of open tarsometatarsal joint injury, reasonable debridement, comprehensive assessment for the soft tissue injury, correctly grasp the surgical indications and time of internal fixation, can reduce the incidence of deep infection and osteomyelitis.</p>

Iindividual choice of distal fibula internal fixation for ankle fractures in elderly / 中国骨伤

<p><b>OBJECTIVE</b>To explore individual choice and therapeutic effect of distal fibula internal fixation in treating ankle fractures in elderly.</p><p><b>METHODS</b>From May 2012 to April 2015, 68 elderly patients with ankle fractures were treated by surgical operation, included 37 males and 31 females with an average of 69.2 years old ranging from 62 to 81 years. According to Danis-Weber classification, there were 19 cases belong to type A, 31 cases belong to type B, and 18 cases belong to type C. According to Lange-Hanson classification, 22 cases were supinatio-extorsion, 18 were pronate-extorsion, 19 were supinatio-adduction, and 9 were pronate-abduction. All patients were performed individyually with different internal fixation methods for the treatment of distal fibula fracture according to different types of fracture. Clinical results were evaluated based on clinical examination, radiographic evaluation and AOFAS score.</p><p><b>RESULTS</b>Twelve patients were treated with Herbert screw, 7 cases with Kirschner wire tension band, 5 cases with 1/3 tube plate, 6 cases with reconstruction plate, 17 cases with fibular end dissection steel plate composite, and 21 cases with distal fibula anatomic locking plate. All patients were followed up from 12 to 26 months with an average of 17.7 months. The operative incision of all patients were primary healed. And there was no bone nonunion, ankle instability, internal fixation loosening and fracture occurred. Fracture healing time ranged from 2.7 to 4 months with an average of 3.2 months, and had significant differences among different groups(<0.05). There were no statistical differences in AOFAS score, VAS score and motion of ankle joint among different internal fixation groups(>0.05). Dorsal stretch was 6° to 18° with an average of 15°, plantar flexion ranged from 26°to 47° with an average of 37°. AOFAS score at the latest following-up was 88.4±4.3, 34 patients got an excellent result, 30 good and 4 fair.</p><p><b>CONCLUSIONS</b>Good clinical results could be obtained by using individualized internal fixation for distal fibula fracture for the treatment of the ankle fractures in elderly.</p>

Surgical staging applications with antibiotic graft bone for the treatment of open calcaneal fractures / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the effect of surgical staging and using craft bone with vancomycin for the treatment of calcaneal fractures.</p><p><b>METHODS</b>From January 2006 to December 2012,13 patients with open calcaneal fractures were treated including 9 males and 4 females with an average of 35.2 years old ranging from 23 to 66. All cases were emergency cases. According to Sanders classification of calcaneal fractures, 2 cases were type II, 7 cases were type III, 4 cases were type IV. According to Gustilo-Anderson soft tissue injury classification, 8 cases were type II, 2 cases were type III A, 2 cases were type III B, 1 case were type III C. Firstly a thorough debridement or VSD procedures were applied,secondly calcaneal fracture were treated with open reduction, plate fixation and bone graft complex with antibiotics. Based on clinical examination, radiographic evaluation, and American Foot and Ankle Surgery Society (AOFAS), ankle function were evaluated after operation.</p><p><b>RESULTS</b>Open wounds were headed after dressing and repairing,, lateral calcaneal wound were healed during the first period. All patients were followed up for 6 to 36 months (means 14.5 months). Fracture healing time was 14 to 20 weeks (means 16.2 weeks). Last follow-up AOFAS ankle-hindfoot score was (80.0 +/- 7.4) ranging from 55 to 95.</p><p><b>CONCLUSION</b>For patients with open fractures, through reasonable clinical evaluation, staging operation, using bone graft with antibiotics can reduce the incidence of postoperative wound infection and promote fracture healing.</p>

Clinical application of free vascularized flaps based on the wrist cutaneous branch of ulnar artery in repairing finger soft tissue defect / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the methods and clinical effects of repairing finger soft tissue defect with free vascularized flaps based on the wrist cutaneous branch of ulnar artery.</p><p><b>METHODS</b>From February 2010 to December 2012, 16 patients with finger soft tissue defects were repaired by free vascularized flaps based on the wrist cutaneous branch of ulnar artery, including 10 males and 6 females with an average age of 38.2 years old ranging from 18 to 52 years. Among them, 5 cases caused by hot crush injury, 8 cases caused by machine crush injury, 3 cases caused by firecracker burst injury. The defect area varied from 1.3 cm x 2.3 cm to 2.6 cm x 5.0 cm. The flap area varied from 1.5 cm x 2.5 cm to 2.8 cm x 5.2 cm. The appearance and two-point discrimination of flap were observed after operation.</p><p><b>RESULTS</b>All flaps survived and wounds healed primarily. No wound infection and skin necrosis were found in donor site and recipient site. Among repair methods, direct suture in forearm donor site had 11 cases and skin graft had 5 cases. All patients were followed up from 6 to 24 months with an average of 10.8 months. The appearance of flap was not fat or clumsy, texture and color were similar to the recipient site, the sensation were good, two-point discrimination was 6 to 9 mm. The appearance of donor site were well complicated with mild scarring without dysfunction obviously.</p><p><b>CONCLUSION</b>The free vascularized flaps based on the wrist cutaneous branch of ulnar artery has the advantages of vascular anatomy constant,thickness moderate and carry sensory nerves, etc, which is effective way to repair finger soft tissue defects.</p>

Staple fixation for the treatment of hamate metacarpal joint injury / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effcacy of the staple fixation for the treatment of hamate metacarpal joint injury.</p><p><b>METHODS</b>From May 2009 to November 2012,16 patients with hamate metacarpal joint injury were treated with staple fixation including 10 males and 6 females with an average age of 33.6 years old ranging from 21 to 57 years. Among them, 11 cases were on the fourth or fifth metacarpal base dislocation without fractures, 5 cases were the fourth or fifth metacarpal base dislocation with avulsion fractures of the back of hamatum. Regular X-ray review was used to observe the fracture healing, joint replacement and position of staple fixation. The function of carpometacarpal joint and metacarpophalangeal joint were evaluated according to ASIA (TAM) system evaluation method.</p><p><b>RESULTS</b>All incision were healed well with no infection. All patients were followed up from 16 to 24 months with an average of (10.0 +/- 2.7) months. No dislocation recurred, the position of internal fixator was good,no broken nail and screw withdrawal were occurred. Five patients with avulsion fracture of the back of hamatum achieved bone healing. The function of carpometacarpal joint and metacarpophalangeal was excellent in 10 cases,good in 5 cases, moderate in 1 case.</p><p><b>CONCLUSION</b>The application of the staple for the treatment of hamatometacarpal joint injury has the advantages of simple operation, small trauma, reliable fixation, early postoperative function exercise and other advantages, which is the ideal operation mode for hamatometacarpal joint injury.</p>

Difference of adherence, proliferation and osteogenesis of mesenchymal stem cells cultured on different HA/ZrO2 composites / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study the adherence, proliferation and osteogenesis of mesenchymal stem cells (MSCs) cultured on different HA/ZrO2 composites.</p><p><b>METHODS</b>The simplex and graded HA/ZrO2 compo-sites were prepared using dry-laid method. The surface topography of the composites was observed by scanning electron microscope (SEM). The MSCs were isolated from rabbits and cultured on experimental groups (simplex HA/ZrO2 composite, graded HA/ZrO2 composite, pure HA or pure ZrO2 coatings respectively) and control group (ordinary culture plate). Then, we observed the adherence, proliferation and osteogenesis of the MSCs, detected the cellular alkaline phosphatase (ALP) activities, extracted total RNA and detected the mRNA expression of collagen I, osteocalcin and osteopontin using the reverse transcription and polymerase chain reaction (RT-PCR) method.</p><p><b>RESULTS</b>The SEM images confirmed that the surface of the simplex HA/ZrO2 composite was coverd by discon-tiguous HA layer with clear visualization of the partial ZrO2 matrix, while the surface of the graded HA/ZrO2 composite was fairly rough with porosity. X-ray diffraction showed that after high temperature sintering, the ZrO2 phase still remained, while the HA phase was transformed to beta-Ca3(PO4)2 , alpha-Ca3(PO4)2 and CaZrO3 phases on the surface of both composites. Cell culture indicated that the HA/ZrO2 composites supported cell attachment. Neither ALP expression nor mRNA expression of collagen I, osteocalcin or osteopontin from RT-PCR results showed significant deviation among four groups.</p><p><b>CONCLUSION</b>Among these four composites, the graded HA/ZrO2 composite promotes the MSCs proliferation and the osteogenic differentiation to a certain extent.</p>