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Objective To investigate the clinical efficacy of microsurgical repair of soft tissue necrosis after beak-type calcaneal fracture.Methods From January,2012 to March,2017,surgically flaps were used to repair wounds in 8 patients with soft tissue necrosis after calcaneal beak fracture.Five patients underwent sural neurovascular flap in the first stage of repair,2 patients were treated with peroneal perforator propeller flap,and 1 patient was treated with posterior tibial artery perforator propeller flap.The donor sites of 3 flaps were directly closed,and donor areas of the remaining 5 were covered with medium-thickness skin grafts without being sutured directly.The size of flap was 5.0 cm× 3.0 cm-7.0 cm × 5.0 cm.Through postoperative outpatient and WeChat follow-up.The patient's flap survival,infection,flap shape,sensation and ankle function were evaluated.Results All flaps and skin grafts survived post-operatively.All patients were followed-up for 6-12 (mean,8.4) months.All patients had good flap survival and no complications such as soft tissue and calcaneal infection.The flaps were good in texture,shape and function of ankle.At the last follow-up,according to the British Medical Research Institute (BMRI),the sensory function was divided into 6 levels.The flap sensory function recovered to S2 in 3 cases,and the remaining 5 cases was S1.According to the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-hindfoot Scale (AHS),the results were excellent in 5 cases,and good in 3 cases.All patients had good clinical results and satisfaction at the last followedup.Conclusion The treatment of soft tissue necrosis after calcaneus beak fractures can be completed in one stage by using flaps,which avoided the occurrence of calcaneal osteomyelitis.It is easy to perform early rehabilitation exercise and the ankle function is well restored.
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Objective To report a new self-designed locking plate assembly suitable for treatment of displaced calcaneal fractures of Sanders types Ⅱ &Ⅲ via sinus tarsi approach.Methods We designed a new locking plate assembly suitable for treatment of displaced calcaneal fractures of Sanders types Ⅱ & Ⅲ via sinus tarsi approach.Its biomechanical performance was tested by standard electronic and mechanical devices.From March 2014 to October 2015,18 patients with displaced calcaneal fracture were treated with our self-designed new locking plate assembly.They were 14 men and 4 women,aged from 32 to 66 years (average,50.4 years).All the fractures were unilateral closed ones,with 7 cases of the left side and 11 ones of the right side.By the Sanders classification,14 cases belonged to type Ⅱ (8 to type Ⅱa,4 to type Ⅱb and 2 to type Ⅱc) and 4 to type Ⅲ (2 to type Ⅲab,one to type Ⅲac and one to type Ⅲbc).The B(o)hler angle,Gissane angle,and height,width and length of the calcaneus were measured and compared at preoperation,postoperative 3 months and final follow-ups.The clinical outcomes were evaluated using Maryland foot score system atfinal follow-ups.Results This new locking plate assembly could tolerate a maximum vertical load of 1,396.03 N and a maximum horizontal anti-bending load of 427.15 N.It broke after it had been subjected to 93,003 loadings in a repeated 500 N stress test.All the 18 patients were followed-up for an average of 9.3 months (from 6.0 to 13.5 months).Follow-ups at 3 months postoperation showed significant improvements in B(o)hler and Gissane angles and calcaneal height,width and length compared with pre-operative parameters (P ＜ 0.05),but no significant differences were observed in the above parameters between 3 and final follow-ups postoperation (P ＞ 0.05).Maryland foot scores demonstrated 12 excellent cases,3 good ones and 3 fair ones.No incision infection,implant failure,nonunion or malunion happened in this series.Conclusions This new locking plate assembly suitable for sinus tarsi approach can be used in clinic because it has advantages of easy placement,rigid fixation,satisfactory functional recovery of the foot and limited complications.
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Objective To report a new self-designed locking plate assembly suitable for treatment of displaced calcaneal fractures of Sanders types Ⅱ &Ⅲ via sinus tarsi approach.Methods We designed a new locking plate assembly suitable for treatment of displaced calcaneal fractures of Sanders types Ⅱ & Ⅲ via sinus tarsi approach.Its biomechanical performance was tested by standard electronic and mechanical devices.From March 2014 to October 2015,18 patients with displaced calcaneal fracture were treated with our self-designed new locking plate assembly.They were 14 men and 4 women,aged from 32 to 66 years (average,50.4 years).All the fractures were unilateral closed ones,with 7 cases of the left side and 11 ones of the right side.By the Sanders classification,14 cases belonged to type Ⅱ (8 to type Ⅱa,4 to type Ⅱb and 2 to type Ⅱc) and 4 to type Ⅲ (2 to type Ⅲab,one to type Ⅲac and one to type Ⅲbc).The B(o)hler angle,Gissane angle,and height,width and length of the calcaneus were measured and compared at preoperation,postoperative 3 months and final follow-ups.The clinical outcomes were evaluated using Maryland foot score system atfinal follow-ups.Results This new locking plate assembly could tolerate a maximum vertical load of 1,396.03 N and a maximum horizontal anti-bending load of 427.15 N.It broke after it had been subjected to 93,003 loadings in a repeated 500 N stress test.All the 18 patients were followed-up for an average of 9.3 months (from 6.0 to 13.5 months).Follow-ups at 3 months postoperation showed significant improvements in B(o)hler and Gissane angles and calcaneal height,width and length compared with pre-operative parameters (P ＜ 0.05),but no significant differences were observed in the above parameters between 3 and final follow-ups postoperation (P ＞ 0.05).Maryland foot scores demonstrated 12 excellent cases,3 good ones and 3 fair ones.No incision infection,implant failure,nonunion or malunion happened in this series.Conclusions This new locking plate assembly suitable for sinus tarsi approach can be used in clinic because it has advantages of easy placement,rigid fixation,satisfactory functional recovery of the foot and limited complications.
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Objective To explore the effect of percutaneous kyphoplasty (PKP) combined with Xianling Gubao capsule on treatment of osteoporotic vertebral compression fractures(OVCF).Methods 118 postmenopausal women diagnosed as OVCF and meeting the standard were collected from Mar.2012 to Jul.2016 in our hospital.They were randomly divided into two groups:observation group and the control group.General information of the two groups were comparable.The patients of the control group received PKP combined with traditional anti-osteoporosis therapy.The patients of observation group received Xianling Gubao capsule on the basis of the control group.The lumbar bone density (BMD,greater trochanter BMD,femoral neck BMD,Ward triangle BMD,the Japanese orthopaedic association(JOA)score,the visual analogue score (VAS) score,the serum levels of osteoprotegerin (OPG),receptor activator of nuclear factor-κB ligand (RANKL)and adverse reactions were recorded during the treatment.Results The lumbar BMD,greater trochanter BMD,femoral neck BMD,Ward triangle BMD of observation group at 6-month after operation were higher than those before operation and those of control group (P＜0.05).The VAS score and JOA score of the observation group were superior to those of the control group at 6-month after operation (P＜0.05).The serum levels of OPG of observation group were higher than those of control group,while the serum levels of RANKL of observation group were lower than those of control group at 6-month after operation (P＜0.05).No severe adverse reactions occurred in the two groups during the treatment.Conclusion Xianling Gubao capsule can significantly improve bone metabolism of postmenopausal women with osteoporotic vertebral compression fractures after percutaneous kyphoplasty,increasing BMD,improving lumbar function,relieving pain,without increasing complication rates.
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Objective To evaluate a new self-designed device to assist closed reduction of femoral shaft fracture.Methods From January 2012 to June 2014,18 cases of femoral shaft fracture received closed reduction and internal fixation with anterograde intramedullary nails on a popular fluoroscopic orthopedic table.The new self-designed distraction reduction device was used during the operation.The patients contained 14 males and 4 females,aged from 21 to 48 years (mean,33.6 years).Fracture AO classification was type 32A2 in 8 cases,32A3 in 5 cases,32B1 in 3 cases and 32B2 in 2 cases.Mean pre-operation time was 5.5 days (range,3-10 days).Results Operation time ranged from 85 to 130 minutes (mean,96 minutes).Intraoperative bleeding ranged from 120 to 180 ml (mean,150 ml).X-ray fluoroscopy time ranged from 20 to 40 seconds (mean,25 seconds).Frequency of nailing into the distal fracture end was 1 to 3 times (mean,1.5 times).One case had additional small incision for open reduction.Fourteen cases experienced external rotational deformity of the femur from 2° to 6° (mean,3.6°) after surgery,and four cases were free of rotational deformity.All patients were followed up for 6 to 20 months (mean,12.8 months).All patients had fracture healing in a period of 4.5 to 8.5 months (mean,5.5 months).No iatrogenic fracture,infections,nail breakage or other complications occurred.At the final follow-up,knee score according to the system of hospital for special surgery (HSS) was found to be excellent in 12 cases,good in 4,and fair in 2,giving an excellent-togood rate of 89％.Conclusion The new self-designed distraction device is an easy-to-operate instrument that is useful in assisting distraction and reduction of the femoral shaft fracture diffictlt to be fixed with routine methods as well as intramedullary nailing just on a popular fluoroscopic orthopedic table.