Great trochanteric digastric osteotomy and surgical dislocation for treatment of Pipkin Ⅳ fractures / 中华创伤骨科杂志

Objective To discuss the clinical outcomes of trochanteric digastric osteotomy and surgical hip dislocation for treatment of Pipkin Ⅳ fractures. Methods We retrospectively reviewed the 12 patients with Pipkin Ⅳ fracture who had been treated by trochanteric digastric osteotomy and surgical hip dislocation from February 2012 to June 2016. They were 10 males and 2 females, with an average age of 44. 1 years ( from 24 to 63 years ) . According to the Pipkin classification for femoral head fractures, 9 fractures were type Ⅰand 3 type Ⅱ; according to Letournel-Judet classification for acetabular fractures, 10 were posterior wall fractures ( 9 belonging to the posterior superior subgroup ) and 2 transverse plus posterior wall fractures ( one involving the posterior wall belonging to the posterior superior subgroup ) . The operation time, blood loss, complications and functional results were recorded. Results The operation time averaged 165 min ( from 150 to 195 min ); the blood loss averaged 850 mL ( from 500 to 1, 200 mL ) . A spring plate was used additionally for posterior wall fracture in 7 cases. All the 12 cases obtained an average follow-up of 19 months ( from 6 to 52 months ) . Motion function was fully recovered from 6 weeks to 4 months after operation in 2 cases of preoperative incomplete sciatic nerve injury and in one case of iatrogenic incomplete sciatic nerve injury. Anatomical reduction was achieved in all femoral head fractures. According to the Matta criteria for acetabular fractures, anatomical reduction was achieved in 9 cases, good reduction in 2 and poor reduction in one. Heterotopic ossification occurred in 4 cases ( gradeⅠin one, gradeⅡin 2 and gradeⅢin one by the Brooker grading system ) . The trochanteric osteotomy was repeated in one case. No femoral head avascular necrosis was found. According to the modified Merle d'Aubigné and Postel scoring at the final follow-ups, the functional results of the affected hip were excellent in 4 cases, good in 7 and poor in one. Conclusion Trochanteric digastric osteotomy and surgical hip dislocation is a safe and effective treatment for Pipkin Ⅳ fractures.

Fracture morphology and injury mechanisms of tibial plateau fracture: analysis of 200 cases / 中华创伤骨科杂志

Objective To classify tibial plateau fractures based on the analysis of the morphology and injury mechanisms of 200 cases of tibial plateau feature.Methods We collected the X-ray and CT images of 200 consecutive cases of tibial plateau fracture in i99 patients who had been treated at our department from January 2010 to April 2011.They were 134 males and 65 females,from 15 to 77 years of age (average,45.7 years).According to the Schatzker classification,9 cases were type Ⅰ (4.5％),105 type Ⅱ (52.5％),19type Ⅳ (9.5％),37type Ⅴ (18.5％),30type Ⅵ (15.0％),and none type m.The fracture morphology and injury mechanism of each case were analyzed to propose a new classification system.Results Fractures of tibial plateau can be classified into the following five types:(a) Lateral condylar fracture and valgus injury (100 cases,50％).The injury mechanism is the axial force on the valgus and extended knee joint.(b) Fracture-dislocation injury (24 cases,12.0％).This type includes typical Schatzker type Ⅳ,and some cases of Schatzker type Ⅵ associated with lateral subluxation.Its mechanism is a compound force of valgus,varus,rotational and axial stresses.The rotational force is the key factor leading to subluxation of the knee joint.(c) Double-condylar fracture (40 cases,20.0％).This type is caused by an axial force on the extended knee,including Schatzker type Ⅴ and some cases of Schatzker type Ⅵ not associated with knee subluxation.(d) Posterior condylar fracture and flexion injury (32 cases,16.0％).This type only involves the posterior condylar plateau,and is caused by an axial force on the flexed knee.Based on the morphology,posterior condylar fractures can be further divided into three subtypes:simple split of posteromedial condyle,simple collapse of posterolateral condyle,and a combination of the two.(e) Frontal plateau compression fracture and hyperextension injury (4 cases,2.0％).This type is caused by an axial force on the hyper-extended knee.It is characterized by significant compression of the anterior plateau and intact posterior plateau.Conclusion Based on the morphological features and injury mechanisms,tibial plateau fractures can be classified into 5 types:lateral condylar fracture,fracture-dislocation injury,double-condylar fracture,posterior condylar fracture,and frontal plateau compression fracture.

Augmentative plating for treatment of nonunion of femoral shaft fracture after intramedullary nailing: a biomechanical study / 中华创伤骨科杂志

Objective To compare biomechanical effects of augmentative plating assisted by different types and numbers of intramedullary nails in the treatment of nonunion of femoral shaft fracture after intramedullary nailing.Methods Twenty-five specimens of synthetic femur were randomly divided into an experimental group (20 bones) and a control group (5 bones).All the bones were made into models of nonunion of femoral shaft fracture after intramedullary nailing.The control group was subjected to no augmentative plating.The experimental group was further divided into 4 subgroups (n =5) which were subjected to fixation respectively by:a 7-hole plate with 3 bicortical screws on each side,a 7-hole plate with 3 unicortical screws on each side,a 5-hole plate with 2 bicortical screws on each side,and a 5-hole plate with 2 unicortical screws on each side.The torque values of all the subgroups were measured and compared when the models were subjected to torsional angles of 5°,10°,15°,20° and 25°.Results The anti-torsional strengths at torsional angles of 5°,10°,15°,20° and 25° in the 4 experimental groups were all significantly greater than in the control group(P ＜ 0.05).At a torsion angle of 25°,the mean torque value in the 3-bicortical-screw group (46.51 ±6.66 nm) was significantly greater than in the 2-bicortical-screw group (39.03 ±8.52 nm) (P ＜0.05).At torsion angles of 5°,10°and 25°,the mean torque values in the 3-unicortical-screw group (13.48±1.68 nm,23.29±3.72 nm and 48.19±5.34 nm,respectively) were significantly greater than in the 3-unicortical-screw group (9.56 ± 3.62 nm,16.99 ± 5.49 nm and 38.69 ± 6.56 nm,respectively) (P ＜ 0.05).At torsion angles of 20° and 25°,the mean torque values in the 3-unicortical-screw group (39.15 ± 5.07 nm and 48.19 ± 5.34 nm) were significantly greater than in the 2-bicortical-screwgroup (32.50 ± 5.65 nm and 39.03 ± 8.52 nm) (P ＜0.05).Conclnsions The anti-torsional strength of fixation by 3 screws on each side is significantly greater than by 2 screws on each side.When the number of screws is the same,there is no significant difference between fixation by unicortical locking screws and that by bicortical conventional screws.Augmentative plating with 3 unicortical screws or 3 bicortical conventional screws on each side is recommended for treatment of nonunion of femoral shaft fracture after intramedullary nailing.

Comparison of two subcutaneous insulin regimens in type 2 diabetic patients with fractures during perioperative period / 中华全科医师杂志

We compare the results of two subcutaneous insulin regimens in type 2 diabetic patients with fractures during the perioperative period. In group Ⅰ 162 patients received regular insulin three times+ NPH insulin bedtime protocol; in group Ⅱ 72 patients received regular insulin three times + NPH insulin twice protocol. The difference of the time achieving satisfactory level of blood glucose (BG) and associated factors were analyzed, and the related complications were observed. The average time achieving satisfactory BG level was (9.1±3. 3) days and (7.0±2.6) days for group Ⅰ and Ⅱ respectively (P <0.05). There were no statistical differences in hypoglycemia, infection and thrombosis between two groups. Binary logistics regression showed that the time of achieving desired BG level was associated with blood glucose(BG) and the proportion of the regular insulin and the NPH. The results indicate that five times insulin injection method can shorten the time of achieving desired BG level and may be benefit to diabetic patients with fracture.

Measurement of fracture malrotation after interlocking intramedullary nailing of femoral shaft fracture / 中华外科杂志

<p><b>OBJECTIVE</b>To study the quantitative measurement of the extent of malrotation after interlocking intramedullary nailing of femoral shaft fracture.</p><p><b>METHOD</b>CT scan ("routine method") applied in 36 femoral shaft fractures that had been treated with close reduction and interlocking intramedullary nailing. For the judgement of the extent of malrotation, the anteversion of both fracture side and contralateral side were measured and the difference between the 2 sides was evaluated. The increase of anteversion represented internal rotation of the distal fragment, whereas the decrease of anteversion represented external rotation.</p><p><b>RESULTS</b>The maximum anteversion of the fracture sides, whereas 48 degrees, the minimum anteversion -10 degrees, the mean value, 15.04 degrees, and the standard error is 11.34 degrees. The maximum anteversion of the contralateral side, whereas 31.3 degrees, minimum -4.8 degrees, the mean value was 13.96 degrees and the standard error was 10.20 degrees (P < 0.001). Compared with the contralateral side, half of the 36 cases showed increased anteversion and the other half decreased anteversion. The mean value of internal rotation is 11.56 degrees, and external rotation 9.39 degrees. The maximum internal rotation was 37 degrees, the minimum 0.9 degrees. Eight cases had internal rotation less than 8 degrees, 6 between 10 degrees - 15 degrees, and 4 over 15 degrees. The maximum external rotation was 24.3 degrees, and the minimum 1.8 degrees. Eleven cases had external rotation less than 10 degrees, 4 between 10 degrees - 15 degrees and 3 over 15 degrees. The incidence of malrotation more than 10 degrees was 47% (17/36), and more than 15 degrees 19.4% (7/36).</p><p><b>CONCLUSION</b>The incidence of malrotation after femoral shaft fracture treated with close reduction and interlocking intramedullary nailing is high. Attention should be paid to clinical management and strict control for rotational reduction intra-operatively.</p>

Perioperative determination of the activity of blood coagulation and fibrinolysis in patients of orthopaedic trauma / 中华检验医学杂志

Objective To investigate the changes of the activity of blood coagulation and fibrinolysis in fracture patients,and to research the relations between the activity and thrombossis. Methods This reser ch chose 60 patients in the department of orthopaedic trauma in our hospital and 10 normal control.Each patient enderwent laboratory analysis on preoperation?post operation 24 hours?post operation 4 days.The molecule markers of coagulation and fibrinolysis TAT(thrombin/antithrombin Ⅲ complex)?F1+2(prothrombin fragment F1+2)?PAP(Plasmin/? 2-antiplasmin complex) were quantitative measured by enzyme immunoassay. Result Compare with normal control,F1+2 and TAT levels increase obviously(P0.05); FG levels increase obviously (P0.05) .Conclusion It has a high level of the activity of blood coagulation and has no obviously change of the activity of fibrinolysis after trauma injury,it indicates high coagulation activity is correlated with thrombossis.