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Objective:To investigate the effects of types of ulnar styloid process fracture on the treatment of distal radius fracture.Methods:The 80 patients were analyzed retrospectively who had been treated at The First Department of Hand Surgery, Honghui Hospital from January 2019 to January 2020 for fracture of distal radius complicated with fracture of ulnar styloid process. They were 25 males and 55 females, aged from 30 to 85 years (average, 58.6 years). According to the types of ulnar styloid process fracture, 40 patients were assigned into a Hauck type Ⅰ group and the other 40 into a Hauck type Ⅱ group. The 2 groups were compared in terms of operation, postoperative complications, hospital stay, bone union, visual analogue scale (VAS) on postoperative 1 to 3 days, and modified Mayo wrist function score, wrist range of motion and quality of life by WHOQOL-BREF at the last follow-up.Results:The 2 groups were comparable because there was no significant difference in age, gender, American Society of Anesthesiologists (ASA) rating, or time from injury to operation between them ( P>0.05). All the patients were followed up for 12 to 24 months (average, 17 months). There was no significant difference between Hauck type Ⅰ group and Hauck type Ⅱ group in operation time, intraoperative blood loss, hospital stay, rate of postoperative complications, fracture union, modified Mayo wrist function score or VAS on postoperative 1 to 3 days ( P>0.05). At the last follow-up, the palm tilt and ulnar inclination angles were 13.8°±1.9° and 21.6°±2.8° in Hauck type Ⅰ group, significantly larger than those in Hauck type Ⅱ group (11.9°±1.6° and 18.8°±2.3°) ( P<0.05). At the last follow-up, Hauck Ⅰ group scored 85.3±6.4,85.6±6.5, 84.7±6.3 and 85.0±6.7 respectively in the domains of physical health, psychology, environment and social relationships, significantly higher than those Hauck type Ⅱ group did (78.5±6.5, 78.9±6.5, 77.8±6.1 and 77.9±6.3) ( P<0.05). Conclusions:In open reduction and internal fixation for distal radius fracture, Hauck Type Ⅰ fracture of ulnar styloid process has no significant effect on the functional recovery of the wrist but Hauck Type Ⅱ fracture of ulnar styloid process may. Therefore, surgical fixation needs to be strengthened if Hauck Type Ⅱ fracture of ulnar styloid process is complicated.
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Objective To explore the clinical application and effect of fibular head compound soft tissue flap transplantation on precision repairing of compound tissue defect at limb joints assisted by 3-Dimensional contrast printing technology.Methods From March,2014 to September,2017,9 patients with bone and soft tissue defect at limb joints were selected.In which,2 were distal radius bone defect with joint capsule and ligament defect,2 were lower segment tibia bone and soft tissue defect,2 were femur under section of the bone and soft tissue defect,2 were medial malleolus bone and ligament defect,and 1 was external ankle ligament and bone defect.Using 3-Dimensional printing to conduct bilateral mirror-image contrast prior to the operation,morphology of bone defect at limb joints was acquired.Based on the texture printed out,corresponding fibular head compound blocks with blood vessels were removed from the donor site and transplanted to the recipient site before anastomosing the blood vessels and restoring the blood flow.The regular post-operative followed-up was performed.Results The 9 transplanted tissue blocks survived.The donor sites and the recipient sites were healed.The followed-up for restoration of limb function was from 9 to 35 (average,17.5) months.The ankle function was assessed according Kofoed scale,resulted in 2 excellent and 1 good;The wrist function was assessed according Mayo scale,resulted in 1 excellent and 1 good.The medial malleolus bone defect and criteria bone defect were healed at 6 months.The patients were satisfied with the efficacy.Conclusion The application of 3-Dimensional contrast printing of fibular head compound tissue flap transplantation in repairing compound tissue defects at limb joints can reduce damage to the donor site,realizing precise repairing on limb tissue defect,and make good function restoration.
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Objective To investigate the clinical effect of infective foot ulcer and soft tissue defects of small area with free peroneal artery perforator flap.Methods From February,2016 to Apirl,2017,9 cases of infective foot ulcer and soft tissue defect of small area were repaired with peroneal artery perforator flap.Cause of infection:injury in 6 cases,diabetes in 2 cases,spinal cord injury subsequent pressure sore in 1 case.Infective ulcer part:4 cases on plantar metatarsophalangeal joint,2 cases on dorsal metatarsophalangeal joint,2 cases on interior of the first metatarsophalangeal joint and 1 case on the heel.Defect area:3.0 cm×2.0 cm-5.0 cm×3.0 cm;flap area:4.0 cm×3.5 cm-7.0 cm×4.5 cm.The donor sites were sutured directly.All the flaps contained lateral sural cutaneous nerve.In order to rebuild the sensation of flaps,nerves between surgical area and receiving area were received end-to-side anastomosis.Outpatient follow-up was used in all patients.Results All the flaps survived,and all the wounds were primary healed,without recurrence of infection.All patients were followed-up from 6 to 24 months with an average of 16 months.The appearance of flaps was good with slight bloated.The texture and color of the flaps were close to the recipient site.Flap feel was good except the cases of diabetes and spinal cord injury pressure sore.The AOFAS score at last follow-up time was 80.05±7.80,which was excellent in 5 cases,good in 2 cases,and fair in 2 cases.Conclusion The free peronerl artery perforator flap has many advantages,such as vascular anatomy constant,blood supply is reliable,thickness moderate,easy to get,strong resistance to infection,small district damage,etc.It is a useful clinical method to repair foot infection ulcer and soft issue defects of small area.