Bridge combined internal fixation system and locking plate system in treatment of closed humeral shaft fracture / 中华骨科杂志

Objective:To compare the clinical effects of bridge combined internal fixation system and locking plate system in treating closed humeral shaft fracture.Methods:From August 2017 to August 2020, there were 45 patients with closed humeral shaft fracture treated with surgery. Bridge combined internal fixation system were performed in 19 patients (bridge combined group, aged 38.3±11.9, range 21-72 years), including 13 males and 6 females. Further, there were 26 patients underwent locking plate system (locking plate group, aged 41.2±14.7, range 20-79 years), including 20 males and 6 females. The operation was performed by minimal invasive percutaneous osteosynthesis with fixators. The patients were followed up every 4 weeks. The fracture healing condition was recorded. Shoulder function was assessed according to University of California at Los Angeles (UCLA) shoulder rating scale and elbow function was assessed according to Mayo elbow performance score (MEPS).Results:The follow-up duration of all patients were 14.2±4.7 (range 10-32) months. All wound were healed completely. The operation duration in bridge combined group (68.1±12.5 min) was longer than that in locking plate group (56.3±11.6 min) ( t=3.32, P=0.002). The blood loss of bridge combined group and locking plate group were 112.6±20.2 ml and 104.2±14.1 ml, respectively ( t=1.65, P=0.107). The volume of drainage of bridge combined group was 68.4±16.2 ml and that of locking plate group was 73.1±14.9 ml ( t=1.00, P=0.323). The hospitalization time of bridge combined group was 9.7±2.3 d and the locking plate group was 9.4±1.9 d ( t=0.57, P=0.573). All above parameters had no statistical significance between the two groups. Fracture nonunion occurred in 1 of 19 patients in bridge combined group. The fracture healing time was 15.3±4.3 weeks in another 18 cases, while that of locking plate group was 15.9±3.9 weeks ( t=0.47, P=0.638). At 4-weeks postoperative follow-up, the UCLA shoulder score (18.1±3.9) and the MEPS (55.4±6.8) of bridge combined group were lower than those of locking plate group ( P<0.05). At 8-weeks postoperative follow-up, the shoulder score (26.2±4.3) and the MEPS (70.9±6.5) of bridge combined group were lower than those of locking plate group ( P<0.05). At 12-weeks postoperative follow-up, the UCLA shoulder score (33.6±1.0) and the MEPS (91.0±3.7) of bridge combined group had no statistical difference with those of locking plate group ( P>0.05). Conclusion:The bridge combined internal fixation system could provide personalized and multidimensional fixation according to the fracture type. The clinical effects of bridge combined internal fixation system on humeral shaft fracture are similar to the locking plate system at 12 weeks postoperatively. However, the operation duration of bridge combined system is longer and with increased the risk of nonunion.

Adult cubitus varus treated by lateral closed wedge osteotomy plus locking plating via a small incision and posterior lateral approach / 中华创伤骨科杂志

Objective:To explore the effects of lateral closed wedge osteotomy plus locking plating via a small incision and posterior lateral approach on adult cubitus varus.Methods:A retrospective analysis was conducted of the 19 adults with cubitus varus who had been admitted to Department of Hand Surgery, Wuhan Fourth Hospital from July 2013 to September 2017.They were 3 males and 16 females, aged from 17 to 27 years (average, 20.3 years). The left side was affected in 13 cases and the right side in 6 ones. The angle of cubitus varus was 20.7°±2.8°. The lifting angle on the healthy side and the cubitus angle on the affected side were accurately measured on the Medical Image Archiving and Transmission System (PACS) to calculate the osteotomy angle. Lateral closed wedge osteotomy plus locking plating was conducted to correct the deformity via a small incision and posterior lateral approach. The lifting angle on the affected side was measured at the last follow-up. The Mayo elbow performance scores(MEPS) was used to evaluate the elbow function and the Bellemore scoring system the effects of elbow correction surgery.Results:The 19 patients were followed up for 9 to 32 months (mean, 14 months). A good healing was observed at the osteotomy site in all patients. At the last follow-up, the elbow lifting angle was 11.4°±1.6° and the surgical scars averaged 4 cm (from 3 to 5 cm). The cubitus varus was significantly improved after operation, leading to fine elbow function. According to the MEPS, 10 cases were excellent, 7 good and 2 moderate. According to the Bellemore scoring system, 13 cases were excellent and 6 good. After operation, injury to partial ulnar nerve was observed in 2 cases and one patient developed mild elbow stiffness. Follow-ups revealed no implant failure like loosening or breakage and none cases of delayed fracture union or non-union.Conclusions:The osteotomy angle should be accurately measured on the PACS before operation. Lateral closed wedge osteotomy plus locking plating should be performed via a small incision and posterior lateral approach. These procedures can ensure the orthopedic angle and postoperative recovery of the elbow joint, resulting in a limited surgical scar, beautiful appearance and fine efficacy.

Thompson procedure for chronic mallet finger with tendon defect / 中华创伤骨科杂志

Objective To evaluate the Thompson procedure in the treatment of chronic mallet finger with tendon defect.Methods From July 2014 to October 2016,9 cases of chronic mallet finger with tendon defect were treated by Thompson procedure at Department of Hand Surgery,Wuhan Puai Hospital.They were 4 males and 5 females,aged from 25 to 56 years (average,36 years).Their disorder was on the left side in 3 cases and on the right side in 6 ones,involving 2 index fingers,3 middle fingers,3 ring fingers and one little finger.The ranges of motion (ROM) for distal and proximal interphalangeal joints were measured after operation.Operative complications were observed and recorded.Dargan functional assessment was used to evaluate the outcomes at the final follow-up.Results All the 9 patients were followed up for 5 to 36 months (average,16.5months).The wounds healed primarily without such complications as infection,skin breakage,abnormal fingertip sensation or nail deformity.All cases of mallet finger malformation were corrected.About 10 weeks after operation,one case presented with mild mallet finger malformation which was completely corrected after active fixation for 8 weeks.The Dargan assessment at the final follow-up showed 8 excellent and one good cases.Conclusion Thompson procedure can lead to satisfactory outcomes and limited complications in the treatment of chronic mallet finger with tendon defect.

Free bone flap of medial femoral condyle for treatment of old scaphoid fracture with bone necrosis / 中华显微外科杂志

Objective To evaluate the outcomes of the free bone flap of medial femoral condyle for treatment of old scaphoid fracture with bone necrosis and review the utility of this procedure.Methods Eleven cases of old scaphoid fracture with bone necrosis were treated with the free medical femoral condyle bone grafting between Feburay,2013 and May,2015(9 males and 2 females).The average age was 34 years ranged from 27 to 55 years.Six cases were in left wrist,and other 5 cases were in right.Six cases were in waist area,and the other 5 cases were proximal pole nonunion.All cases were evaluated with 3D-CT scan,while humpback deformity were occurred in 6 cases,and avascular necrosis at the proximal pole were occurred in 3 cases.After refreshing the fracture,the free medical femoral condyle bone was transferred to the scaphoid,reduct the scaphoid and fix with the Kirschner wire.An endto-side anastomosis was performed with the bone flap artery and the radial artery,accompanied by the end to end anastomosis of the flap vein and the vein with the radial artery.The plaster was used for 8 weeks.Bone healing was evaluated with X-ray and 3D CT scan.A functional review was performed after the operation and a Mayo wrist scoring test was taken 6 months after the treatment.Results The average followed-up period was 13.1 months(ranged from 9 to 24 months).Bone union were demonstrated in all cases at 13.4 weeks after the operation (ranged from 11 to 18 weeks).Mayo wrist scoring testing showed excellent in 5 cases,good in 4 cases,and fair in 2 cases.Conclusion Free bone flap of medial femoral condyle is constant in vascular anatomy,and is easy to perform with plenty bone graft and less morbidity at donor site.Medial femoral condyle bone flap transplantation based on the descending gennicular vessels is an effective method for treatment of old scaphoid fracture with bone necrosis.

Application of dual intersecting trapezoid flap in the treatment of scar flexion contractures of fingers / 中华骨科杂志

Objective To explore the procedure method and treatment outcome for the dual intersecting trapezoid flaps for repairing flexion contractures of fingers.Methods From February 2013 to April 2015,data of 26 fingers in 11 patients with flexion contractures who were treated with dual intersecting trapezoid flaps and followed up for more than 1 year were retrospectively analyzed.There were 7 males (16 fingers) and 4 females (10 fingers) with an average age of 38.2 years old (ranged from 28 to 60 years old).17 cases of right finger,and 9 cases of the left.There were 8 fingers of mild contracture,14 fingers of moderate contracture,and 4 fingers of severe contracture.Take the scar wrinkle tension line as the central axis,the distance was from 0.5cm to 0.Scm,and decompose the medial axis evenly,form several symmetrical trapezoid skin flaps on the radial side and ulnar side of the fingers.The direction of the double arm of the trapezoid flap is relative to the angle of the central axis from 60° to 70°,and the double skin flap is interlaced.Incisions were designed in a dual intersecting trapezoid flap over the contracture.Coverd the wound with excess skin and scar folds on the dorsal side of the lateral and interphalangeal joints,and full thickness skin graft was utilized to repair skin defect.Results All 24 flaps survived without blood circulation disorders and infections.Only 2 cases appeared flap tip necrosis,delayed healing.The mean active extension and flexion of DIP joints in mild contracture patients were-3° (ranged from-8° to 0°) and 45° (range from 30° to 60°),respectively;and PIP joints were-5° (ranged from-10° to 0°)and 90° (ranged from 70° to 110°),respectively.Contracture scars were extended by an average of 150％.The mean active extension and flexion of DIP joints in moderate contracture in patients were-5° (ranged from-9° to 0°) and 35° (ranged from 20° to 50°),respectively;and PIP joints were-5° (ranged from-10° to 0°) and 85° (ranged from 75° to 120°),respectively.Contracture scars were extended by an average of 130％.The mean active extension and flexion of DIP joints in severe contracture patients were-8° (ranged from-15° to-5°) and 17° (ranged from 10° to 25°),respectively;and PIP joints were-8° (ranged from-10° to-5°) and 78° (ranged from 70° to 90°),respectively.Contracture scars were extended by an average of 220％.According to the upper extremity functional evaluation standard by Hand Surgery Branch of Chinese Medical Association,mild contracture:the results were rated as excellent in 6 cases,good in 1 case and fair in 1 case.The overall satisfactory rate was 87.5％;moderate contracture:the results were rated as excellent in 12 cases,good in 1 case and fair in 1 case.The overall satisfactory rate was 92.9％;severe contracture:the results were rated as excellent in 2 cases,good in 1 case and fair in 1 case.The overall satisfactory rate was 75％.Conclusion The dual intersecting trapezoid flap plasty is easy to use,which has rich vascularity and mobility,and it is a good way to correct the cross-joint scar contracture flexion deformity with less complications.

Effects of vacuum sealing drainage technique in acute and chronic suppurative tenosynovitis of hand / 中华外科杂志

Objective@#To investigate the effects of vacuum sealing drainage technique in acute and chronic suppurative tenosynovitis of hand.@*Methods@#A total of 9 cases acute and chronic suppurative tenosynovitis patients from January 2013 to April 2015 in Puai Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology were retrospectively reviewed. There were 6 males and 3 females, aging from 27 to 65 years, the average age was 55 years. There were 3 cases of index finger, 3 cases of middle finger, 2 cases of ring finger, 1 case include three fingers. The infection causes included stabbing with fishbone in 3 cases, stabbing with animal bone fragments in 3 cases, wound by sawdust in 3 cases, meat grinder injury in 1 case, multiple fingers crush injury postoperative infection of garbage truck in 1 case. Bacterial infection included 2 cases with Staphylococcus aureus, 2 cases with Staphylococcus epidermidis, 1 case with normal Escherichia coli, 1 case with mixed infection of Enterobacter aerogenes, Klebsiella oxytoca and Staphylococcus, 1 case with Bauman Acinetobacter bacillus, 1 case with Proteus mirabilis and 1 case of no growth of pathogenic bacteria culture. After thorough debridement, vacuum sealing drainage was used to observe the characteristics of irrigation fluid, the formation of cavity inflammation, the prognosis of infection and the recovery of finger function.@*Results@#Seven patients with suppurative tenosynovitis were treated for 7 to 14 days, replaced the vacuum sealing drainage dressing once; 1 patient was an illustration of the finger tip defect flap infected patients after 21 days of treatment, replaced the vacuum sealing drainage dressing twice, 1 patient was an illustration of the central refers to trauma, postoperative infection patients 28 d, replaced three times in the VSD. The follow-up time was 3 to 12 months (mean 8.2 months), 7 patients without tendon necrosis, secondary suture with no infection, 2 cases of traumatic surgery of patients with infection, tendon necrosis was removed, the infection has been effectively controlled, secondary suture with no infection. There were 6 cases were good and 3 cases were poor in the evaluation of postoperative finger function.@*Conclusion@#Thoroughly debridement after vacuum sealing drainage in the treatment of suppurative tenosynovitis of hand has satisfactory curative effect.

Effects of valproic acid on axonal regeneration and recovery of motor function after peripheral nerve injury in the rat

Valproic acid [VPA] is used to be an effective anti-epileptic drug and mood stabilizer. It has recently been demonstrated that VPA could promote neurite outgrowth, activate the extracellular signal regulated kinase pathway, and increases bcl-2 and growth cone-associated protein 43 levels in spinal cord. In the present research we demonstrate the effect of VPA on peripheral nerve regeneration and recovery of motor function following sciatic nerve transaction in rats. The rats in VPA group and control group were administered with valproic acid [300mg/kg] and sodium chloride respectively after operation. Each animal was observed sciatic nerve index [SFI] at 2-week intervals and studied electrophysiology at 4-week intervals for 12 weeks. Histological and morphometrical analyses were performed 12 weeks after operation. Using the digital image-analysis system, thickness of the myelin sheath was measured, and total numbers of regenerated axons were counted. There was a significant difference in SFI, electrophysiological index [motor-nerve conduct velocity], and morphometrical results [regenerated axon number and thickness of myelin sheath] in nerve regeneration between the VPA group and controls [P<0.05]. The results demonstrated that VPA is able to enhance sciatic nerve regeneration in rats, suggesting the potential clinical application of VPA for the treatment of peripheral nerve injury in humans

The application of absorbable self-enhancing cartilage nails in the treatment of radial head fractures / 中华骨科杂志

Objective To evaluate the clinical effect of absorbable self-enhancing cartilage nails in the treatment of radial head fractures.Methods Data of 22 patients with radial head fractures,who had undergone open reduction and internal fixation with absorbable self-enhancing cartilage nails from January 2008 to December 2011,were retrospectively analyzed.Among them,data of 18 patients were complete,including 10 males and 8 females.According to the Mason classification,there were 14 cases of Mason Ⅱ,3 cases of Mason Ⅲ and 1 case of Mason Ⅳ.Two patients were combined with radial neck fractures,9 with osteochondral fractures of capitellum,and 1 with posterior dislocation of the elbow and olecranon avulsion fracture.The radial head fractures were temporarily fixed with Kirschner wires after open reduction,then absorbable self-enhancing cartilage nails with length from 16 to 24 mm and diameters of 1.5 mm were applied to reach final fixation.The heads of nails were right underneath of cartilages without penetrating bone cortexes on the contralateral side.The radial neck fractures were reduced and fixed with T-plates or anatomical plates after the radial head fractures were fixed with cartilage nails.Four cases of osteochondral fracture of capitellum were fixed with absorbable sutures to external epicondyle of humerus.For other 5 cases of osteochondral fracture of capitellum,the bone fragments were removed due to too small to fix.Results All 18 patients were followed up for 6 to 54 months (average,31.3 months).All fractures achieved bone union,and the healing time ranged from 5 to 12 weeks (average,8.7 weeks).There were no complications,such as internal fixation failure,nonunion,hematoma,sinus formation,osteolytic changes of radial heads and so on.According to the Broberg-Morrey elbow performance score,13 cases were excellent,4 good,and 1 fair,with the total excellent and good rate of 94.44％ (17/18).At final follow-up,the elbow range of motion was 90° to 150° (average,123.8°),and the range of forearm rotation was 130° to 180° (average,152.5°).Conclusion Absorbable self-enhancing cartilage nails can be used to treat various kinds of radial head fractures,and the results are satisfactory.

Enhancing nerve regeneration by tubes filled with valproic acid on peripheral nerve defect rats / 中华显微外科杂志

@#Objective To observe enhancing effect of nerve regeneration on peripheral nerve defect models bridged by silicone tube idled with valproic acid (VPA). Methods In present research we demon-strate the effect of VPA on peripheral nerve regeneration and recovery of motor function following sciatic nerve transaction in rats. An 8-mm sciatic nerve deficit was created in a rat mode land bridged by a 1-cm silicone tube.Then, 10 lad of 8% VPA were perfused into the silicone chamber in the VPA group. The same volume of normal saline was delivered in the control group. Results Each animal was observed sciatic nerve function index (SFI) at 2-week intervals and studied electrophysiology at 4-week intervals for 12 weeks. Histological and morphometrical analyses were performed at the end of the experiment, 12 weeks after operation. Using the digital image-analysis system, thickness of the myelin sheath was measured, and total numbers of regenerated axons were counted. There was a significant difference in SFI, electrophysiological index (motor-nerve conduct velocity, MCV), and morphometrical results (regenerated axon number and thickness of myelin sheath) in nerve regeneration between the VPA group and controls (P ＜ 0.05). Conclusion The results demonstrated that VPA is able to enhance sciatic nerve regeneration in rats, suggesting the potential clinical application of VPA for the treatment of peripheral nerve injury in humans.

Application and biocompatibility of pedicle screws for the internal fixation of thoracolumbar vertebra fracture / 中国组织工程研究

OBJECTIVE:To study the application and development of pedicle screws for the internal fixation of thoracolumbar vertebra fracture and to evaluate the biocompatibility. METHODS:A computer-based online search was conducted in Medline database and CNKI with the OBJECTIVE:To study the application and development of pedicle screws for the internal fixation of thoracolumbar vertebra fracture and to evaluate the biocompatibility. METHODS:A computer-based online search was conducted in Medline database and CNKI with theof "pedicle screws,thoracolumbar,fractures,biocompatibility" in both Chinese and English from 1989 to June 2009. A total of 32 out of 57 articles were included according to inclusion and exclusion criteria to summarize the treatment of thoracolumbar vertebra fracture using pedicle screws and the complication prevention and cure of pedicle screws,and to investigate clinical application,biocompatibility,and prevention of interruption of pedicle screws. RESULTS:Internal fixation of posterior pedicle screws was an effective method to treat thoracolumbar vertebra fracture; however,breakage of pedicle screws was easily caused following internal fixation. Pedicle screws combined with implantation of autogenous bone or artificial materials into cavity of injured vertebra could effectively relieve loosening and interruption of implants; however,the price was expensive. Sufficient bone graft for internal fixation and implant dislodgment following bone fracture healing might effectively prevent interruption of internal fixation device. Pedicle screw intension of stainless steel materials was strong,but the biocompatibility was poor. While,the biocompatibility of titanium materials was great,but the intension was weak,thus the pedicle screws were easily broken. CONCLUSION:Internal fixation of pedicle screws is an effective method to treat thoracolumbar vertebra fracture. However,the biocompatibility still needs to be improved. Titanium pedicle screws have a good biocompatibility but poor intension; however,stainless steel pedicle screws have a good intension but poor biocompatibility.

A reverse dorsal digital island fascial flap with the dorsal branch from the proper digital nerve for repair of pulp defects / 中华骨科杂志

Objective To utilize a reversed digital dorsal fascial vascular pedicled island fa scial flap with the dorsal branch of the proper d igital nerve to repair finger pulp defect.Methods Based on the features of blood supply of the dorsa l skin of the finger,the flap was designed on the proximal phalanx at the middle and distal segments and the dorsum of the proximal interphalangeal joint.The lateral margins of the fl ap did not cross the midlateral line,th e axial point was designed on the ulnar or the radial dorsum of the distal interphalangeal joint.The axis was paralleled to the longitudinal axis of finger.The dorsal branch of the pr oper digital nerve in the flap was sutured to the end of the proper digital nerve of injured site.From November 1997to April 2001,28pulp defects in 27cases were repaired with this method.E mergency operations were per-formed in 24cases and selective operations in 3.The flaps measured 1.8cm?1.5cm -2.5cm ?2.2cm and the length of pedicle was 1.5-2.2cm.Results All flaps survived completely.The p atients were followed up for 7to 32months,with an average o f 21months.The pulps after reconstr uction had good appearance,soft texture with wear-resisting.T here was no touch pain.Static two-point discrimination was 3.5-6.5mm.Conclusion The operation does not damage the major artery and nerve of the wounded fin ger.It is simple and safe,and can be done at one settin g.It does not interfere with the function of other digits.The sensation of the reconstructed pulp can be satisfactorily recovered.[