Repair soft-tissue defect in forefoot with reversed lateral soleus muscle flap / 中国骨伤

<p><b>OBJECTIVE</b>To summarize clinical application results of repair soft tissue defect in forefoot with a reversed lateral soleus muscle flap on peroneal artery pedicle.</p><p><b>METHODS</b>From January 2005 to January 2013, 8 patients with soft-tissue defect on forefoot were underwent reconstruction with a reversed lateral soleus muscle flap on peroneal artery pedicle. There were 6 males and 2 female, aged from 16 to 48 years with an average of 26.8 years old. The reversed lateral soleus muscle flap was transposed to the forefoot defect area, then immediate coverage of the muscle flaps were performed by a meshed split-thickness free skin graft. The donor site was closed directly. The muscle flap survey was observed after the repair of the forefoot.</p><p><b>RESULTS</b>All muscle flaps had survived completely. No clinical vascular deficiency was found on muscle flaps postoperatively. One case occurred recipient area sustained insignificant superficial infection, one patient developed distal muscle flap small skin graft necrosis, and spontaneous heal by 2 weeks' change dressing. Follow-up period was ranged form 2.5 to 5.5 years with an average of 3.5 years postoperatively. A good contour was confirmed at the recipient area. According to Cedell questionnaire, 6 patients obtained good results and 2 fair.</p><p><b>CONCLUSIONS</b>When the local skin flap or muscle flap application is limited, lateral soleus muscle flap survey is satisfactory after repair and very suitable for repair of soft tissue defect of forefoot.</p>

Treatment of the mid and distal segment humeral fractures through modified posterior approach / 中国骨伤

<p><b>OBJECTIVE</b>To summarize clinical result of the modified posterior approach for the treatment of the mid and distal segment humeral fractures.</p><p><b>METHODS</b>Between January 2006 and December 2010, 26 patients with the mid and distal segment humeral fractures were treated with the open reduction and plate fixation by the modified posterior approach including 17 males and 9 females with an average of (37.1±1.5) years old ranging from 24 to 50 years old. The time from humeral fractures to operation were from 8 hours to 6 days with an average of (3.3±0.6) d. The elbow function were assessed by Morrey-Bryan.</p><p><b>RESULTS</b>There was no procedure related complications occurred. No neurologic injury and wound infection after operation occurred. All patients were followed up from 22 to 48 months with an average of (30.1±1.6) months. The humeral fractures were confirmed healing. The clinical results of Morrey and Bryan were excellent in 19 cases (94.6±1.8), good in 7 cases (86.5±1.2).</p><p><b>CONCLUSIONS</b>The modified posterior approach avoided injury of triceps muscle and improved postoperative triceps function. The technique may be particularly useful in the treatment of the mid and distal segment humeral fractures.</p>

Microdecompression for intraforaminal lumbar disc herniations / 中国骨伤

<p><b>OBJECTIVE</b>To summarize clinical results of the microdecompression for the treatment of intraforaminal lumbar disc herniations.</p><p><b>METHODS</b>From September 2005 to May 2013,16 patients( 12 males, 4 females)with intraforaminal lumbar disc herniations underwent microdecompression, ranging in age from 32 to 56 years old with a mean of 38.6 years old. The lumbar disc herniations were located at L(3,4). in one patient, L(4,5) in 10 cases and L5S1 in 5 cases.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 20 to 48 months, with a mean period of 36 months. According to Macnab evaluation, 12 cases got an excellent result, 4 good. No apparent complications related to the technique occurred. Satisfactory clinical results were obtained in this series.</p><p><b>CONCLUSION</b>Microdecompression may be particularly useful in the treatment of intraforaminal lumbar disc herniations. The microdecompression procedures are more likely to be well tolerated by older patients.</p>

Application of cross-leg soleus muscle flap transplantation to treat the soft-tissue defect in contralateral leg / 中国骨伤

<p><b>OBJECTIVE</b>To summarize the clinical application results of the repair soft tissue defect in contralateral leg with a cross-leg soleus muscle flap pedicle transplantation.</p><p><b>METHODS</b>From January 2008 to January 2013, 8 patients with soft-tissue defect in lower leg underwent reconstruction with a cross-leg soleus muscle flap pedicle transplantation (without microvascular anastomoses). There were 7 males and 1 female, aged from 20 to 49 years old with an average of 31.8 years. The operative time after injury was from 2 to 8 weeks with the mean of 46 days. The soleus muscle flap was transposed across to the contralateral leg defect area, then immediate to perform the coverage of the muscle flaps by a meshed split-thickness skin graft. The donor site was closed directly.</p><p><b>RESULTS</b>All the muscle flaps had survived completely. In one case, recipient area edge had a less exudate from drainage hole everyday, the incision spontaneously was healed after 2 week's changing dressing. Follow-up period ranged form 1.5 to 4 years with an average of 2.5 years postoperatively. The tibia and fibula fractures were healed well. A good contour was achieved at the recipient area. According to LEM standard, 2 cases got excellent results, 5 good and 1 fair.</p><p><b>CONCLUSION</b>Soleus flap pedicle transplantation is very suitable to repair the soft tissue defect of the injuried leg only one main blood vessel, and can reduce the damage of donor area.</p>

Application of selective nerve root blocks in limited operation of the lumbar spine / 中国骨伤

<p><b>OBJECTIVE</b>To summarize the clinical application result of the selective nerve root blocks in limited operation of the lumbar spine.</p><p><b>METHODS</b>From January 2008 to October 2012,68 patients with lumbar spinal canal stenosis with multiple levels were underwent the selective nerve root blocks in limited operation of the lumbar spine,including 47 males and 21 females with an average age of 56 years old ranging from 45 to 80. After never roots blocks,64 cases were positive for limited operation of the lumbar spine; the other 4 cases were negative and abort the operation.</p><p><b>RESULTS</b>The nerve roots block operation smoothly and no complications related to the nerve roots block occurred. There was no neurologic injury complication in this study. Follow-up period ranged from 16 to 45 months postoperatively (means, 32 months). The recovery effect was calculated with Macnab scores, the result was excellent in 44 cases, good in 18 cases, poor in 1.</p><p><b>CONCLUSION</b>Operative treatment for lumbar spinal canal stenosis with multiple levels is focused on the areas causing symptomate neural compression rather than prophylactic decompression at areas of nonsymptomatic disease. Application of selective nerve root blocks can accurately judge the responsible vertebral body and pain source and improve the curative effect of limited operation of the lumbar spine</p>

Repair of-limb soft tissue defect with free deep inferior epigastric perforator flap / 中国骨伤

<p><b>OBJECTIVE</b>To report the clinical application results of free deep inferior epigastric perforator flap in the repair of soft tissue defect.</p><p><b>METHODS</b>From January 2006 to January 2012,13 patients with soft tissue defect (7 cases in leg and 6 cases in forearm) underwent reconstruction with a free deep inferior epigastric perforator flap. There were 9 males and 4 females, aged from 21 to 45 years old with an average of 33 years. Soft tissue defect in the extremities were from 7 cm x 17 cm to 8 cm x 26 cm. The medial branch and lateral brangh flaps were 7 cases and 6 cases respectively. The donor site was closed directly.</p><p><b>RESULTS</b>One patient developed small wound dehiscence, which spontaneous healed at one month after surgery. All the flaps had survived completely. Follow-up period ranged from 1.8 to 4.0 years with the mean of 2.8 years postoperatively. Satisfactory clinical results were obtained in 12 cases. A good contour was confirmed at the recipient area.</p><p><b>CONCLUSION</b>The free deep inferior epigastric perforator flap for the extremities defects of soft tissue is a good option. This technique is safe and reliable, and can decrease the injury of donor site.</p>

Repairing soft tissue defect coverage in lower leg with a bridge shaped medial hemisleus muscle flap transplantation / 中国骨伤

<p><b>OBJECTIVE</b>To summarize clinical application results of repairing soft tissue defect in lower leg with a bridge shaped medial hemisleus muscle flap pedicle transplantation.</p><p><b>METHODS</b>From January 2008 to January 2012,12 patients with soft-tissue defect in lower leg underwent reconstruction with a bridge shaped medial hemisleus muscle flap pedicle transplantation. There were 8 males and 4 females with an average age of 34 years old ranging from 22 to 50 years old. Time after injury was from 2 to 12 weeks (means, 3.5 weeks ). The immediate coverage of the muscle flaps were performed by a meshed split-thickness skin graft. The donor site was closed directly.</p><p><b>RESULTS</b>All the muscle flaps had survived completely. Follow-up period ranged form 1.8 to 4.0 years (means, 2.8 years) postoperatively. The tibia and fibula fractures were confirmed healing. A good contour was confirmed at the recipient area. The results were evaluated with LEM questionnaire, excellent results were obtained in 6 cases, good in 5 cases and fair in 1 case. Satisfactory clinical results were obtained in 11 cases.</p><p><b>CONCLUSION</b>This technique is particularly useful for repairing soft tissue defect in the injured leg when only one vessel remains, and can reduce injury to donor site.</p>

Percutaneous vertebroplasty complications / 中国骨伤

Percutaneous vertebroplasty(PVP), among various other options,has become a mainstay in the management of osteoporotic compression vertebral fractures. The purpose of this article is to review complications arising from the procedure and describes methods to minimize them. Complications can be classified as mild,which may include a temporary increase in pain; transient hypotension and cement leakage in the intervertebral disc space or into paravertebral soft tissues, moderate, including infection; extravasation of cement into the foraminal or epidural space and severe such as cement leakage in the paravertebral veins, leading to pulmonary embolism, cardiac perforation, cerebral embolism or even death.

Medial transposition of the radial nerve in humeral shaft fractures fixation / 中国骨伤

<p><b>OBJECTIVE</b>To summarize clinical outcomes of using medial transposition of the radial nerve in humeral shaft fracture fixation.</p><p><b>METHODS</b>From January 2005 to December 2009, 16 patients with humeral shaft fractures were treated with medial transposition of the radial nerve during open reduction and anterolateral plate fixation, included 12 males and 4 females ranging in age from 26 to 49 years, with a mean of 36 years. There were 7 fractures in the right and 9 in the left. According to AO classification, 6 fractures were type A3.2, 5 fractures were type A2.2, 2 fractures were type A1.2 and 3 fractures were type B2.2. The results were evaluated with DASH (disability of arm-shoulder-hand) Questionnaire by the American Academy of Orthopedic Surgeons (AAOS), where 0 indicates normal upper extremity function, and 1 to 100 indicate varying degrees of damage to the function of the upper extremities.</p><p><b>RESULTS</b>There was no neurologic complication or postoperative would infection in this series. The followed-up period ranged from 20 to 46 (means 29) months postoperatively. The clinical outcomes were evaluated with DASH Questionnaire, indicating that all patients reached a normal value (value of 0). The function of the upper extremities recovered satisfactorily. There was no surgery-related complication.</p><p><b>CONCLUSION</b>Medial transposition of the radial nerve is safe and does not cause iatrogenic nerve injury. It protects the radial nerve during open reduction and anterolateral plate fixation of humeral shaft fractures.</p>

Repair of a soft tissue defect of medial malleolus with cross-leg bridge free transfer of anterolateral thigh muscle flap: a case report / 中华创伤杂志(英文版)

A 38-year-old man sustained a traffic accident injury to his right medial malleolus and leg. It was an open fracture of the right tibia and fibula accompanied by a large soft tissue defect of the right medial malleolus sized 12 cm multiply 4 cm. Doppler examination revealed that the tibialis posterior vessel was occluded due to thrombosis. The anterior tibial artery was patent. Three weeks after injury, the left anterolateral thigh muscle flap was harvested and transplanted to the right medial malleolus defect area for repair of the soft tissue defect, and an end-to-side anastomosis was performed between the posterior tibial vessel of the contralateral leg and the muscle flap's vascular pedicle. A split thickness free skin graft was used to cover the muscle flap and around the flap's vascular pedicle. The vascular pedicle was cut off after 28 days and the muscle flap survived completely. After 3-year follow-up postoperatively, the right tibia and fibula fractures were confirmed healing radiologically. The posterior tibial artery of contralateral leg was patent by clinical and Doppler examinations. This technique can be used to preserve the flow and patency of recipient arteries.

Repair of a large soft tissue defect in the leg with cross-leg bridge free transfer of a latissimus dorsi myocutaneous flap: a case report / 中华创伤杂志(英文版)

A 48-year-old man sustained a traffic accident injury to his left leg. It was an open fracture of the left tibia and fibula accompanied by a large soft tissue defect (27 cm multiply 7 cm). Doppler examination revealed the posterior tibial artery was occluded due to thrombosis. Three weeks after injury, the latissimus dors myocutaneous flap was elevated with a T-shaped vascular pedicle and was interposed between the two vascular ends of the posterior tibial vessel of the contralateral leg. Two end to end anastomoses were performed between the two vascular ends of the posterior tibial vessel of the contralateral leg and the latissimus dors myocutaneous flap's T-shaped vascular pedicle. The latissimus dorsi myocutaneous flap was used for repair of a large soft tissue defect of the left leg. The vascular pedicle was cut off after 28 days and the flap survived completely. After 3-years'follow-up postoperatively, a good contour was confirmed at the recipient area. The right tibia and fibula fractures were confirmed healing radiologically. The posterior tibial artery of contralateral leg was demonstrated patent by clinical and Doppler examinations.

Introducing a method of central bone grafting for nonunion of tiabial fractures / 中国骨伤

Nonunion of the tibia fracture may be caused by local infection, soft tissue defect,bone defect,fracture malaignment,bone marrow cavity block and degree of injury and so on. For less complications, central bone grafting is better than other methods for the treatment of selected nonunions of the tibia fracture. This procedure is performed through lateral approach, anterior to the fibula. Fresh autogenous bone from the iliac crest is used to form a central bridge between the tibia and fibula and the nonunion of the tibia at top and below. Application of internal fixation is beneficial to correct deformity and promote fracture healing. Central bone grafting is a safe and effective treatment for nonunions of the tibia.

Application of free anterior serratus musculo-fascial flap in bridge style for the soft tissue defect at leg / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the application of free anterior serratus musculo-fascial flap in bridge style for the soft tissue defect at leg.</p><p><b>METHODS</b>From Sept. 2006 to Jan. 2009, the free anterior serratus musculo-fascial flaps were used in bridge style in 7 cases with soft tissue defects at legs. The anterior serratus musculo-fascial flaps were elevated with subscapular and circumflex scapular vessels forming a T-shaped vascular pedicles. The T-shaped pedicle was end-to-end anastomosed with the two ends of the posterior tibial artery at the healthy leg. The musculo-fascial flap and its pedicle were covered with skin graft.</p><p><b>RESULTS</b>All the 7 flaps survived completely with satisfactory result. The patients were followed up for 9-42 months with good functional and esthetic result both in donor site and recipient site. The patency of posterior tibial artery was demonstrated by clinical and Doppler examination.</p><p><b>CONCLUSIONS</b>This technique is particularly useful in leg reconstructive surgery when only one vessel remains. The patency of the posterior tibial artery at the healthy leg is preserved and the morbidity in donor site is minimal.</p>

Progress of operation treatment for subtrochanteric fractures / 中国骨伤

Fracture of the subtrochanteric area of the femur is one of the most difficult about the hip to manage. Many of these fractures are comminuted and result from high-energy trauma. Nonoperative treatment of these fractures may result in a significant rate of malunion, nonunion and other complications. Therefore, subtrochanteric fractures is preferred to be treated with operative methods. The Russell-Taylor classification is useful in planning the type of internal fixation. For fractures located below the level of the lesser trochanter, standard locked intramedullary nails can be used effectively. For fractures that extend into the lesser trochanter but do not involve the piriformis fossa, the options of a cephalomedullary nail versus a 95 degree fixed angle device have yielded the best results. For fractures that have proximal trochanteric extension into the area of the piriformis fossa, sliding nail screw devices may have some usefulness. The DHS implant is not employed for the treatment of subtrochanteric femoral fractures.

Micro-decompression procedure for the treatment of lumbar spinal stenosis with multilevel / 中国骨伤

<p><b>OBJECTIVE</b>To summarize the clinical application results of the micro-decompression procedure for the treatment of lumbar spinal stenosis with multilevel.</p><p><b>METHODS</b>From January 2004 to December 2008, 40 patients with lumbar spinal stenosis with multilevel were treated by micro-decompression procedure. There were 28 males and 12 females, ranging in ages from 55 to 80 years,with an average of 58 years. The course of this disease ranged from 18 months to 12 years,averaged 32 months. Forty patients with lumbar spinal stenosis with multilevel were diagnosed by CT or MRI examination. There were 20 cases with two levels stenosis (L4,5 and L5S1), 15 cases with three levels stenosis (L3,4, L4,5 and L5S1), and 5 cases with four levels stenosis (L2,3, L3,4, L4,5 and L5S1). The therapeutic effects were evaluated according MacNab standard in aspect of pain, bladder function, range of lumbar spine motion and muscle strength of lower limb.</p><p><b>RESULTS</b>All of the incisions healed without infections and complications. The mean operation time of each side was 70 minutes (ranged from 50 to 90 minutes), and mean blood loss was 150 ml (ranged from 90 to 200 ml). All the patients were followed up from 22 to 52 months with an average of 26 months. According to MacNab standard, 28 cases got an excellent result, 10 good and 2 poor.</p><p><b>CONCLUSION</b>Operative treatment for lumbar spinal stenosis with multilevel should focus on the symptom sites causing by neural compression and preventive decompression operations are not necessary for nonsymptomatic sites. The micro-decompression procedure can be easily tolerated by older patients;it can decrease the damage to the posterior stabilizing structures of the lumbar spine. It is easily to access to spinal canal and decompress the nerve roots.</p>

Hand reconstruction using heterotopic replantation of amputated index and little fingers / 中华创伤杂志(英文版)

In cases of severe segmental injury across the hand and wrist, but one or other fingers are still in peak condition, the fingers can be selected for replantation at the forearm bones to restore pinch function. Here we reported an unusual case with a severe crush-avulsion amputated injury to the right hand caused by a machine accident. We conducted hand reconstruction using heterotopic replantation of the amputated index and little fingers. During 19 months follow-up, the bone union healed well with satisfactory outcome. The interphalangeal and metacarpophalangeal joint of the fingers after the heterotopic replantation had a good holding activity. This is a worthwhile procedure and the patient is satisfied with the result. The major disadvantage of this method is the poor appearance of the reconstructed fingers.

The causes and strategies for the postoperative shortening in distal radius fractures / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the cause of the postoperative shortening in distal radius fractures and to find treatment strategies to enhance the reduction effect of distal radius fracture and long-term efficacy.</p><p><b>METHODS</b>From June 2005 to January 2009, 46 patients with distal radius fractures were treated by surgical operation including 17 males and 29 females,ranging from 27 to 90 years old with an average age of 48 years. All fractures were reduced satisfactory with smooth articular surface. The postoperative radial shortening was analyzed.</p><p><b>RESULTS</b>All patients were followed-up for 6 to 24 months with an average of 14 months. Among them, 12 patients had radial shortening. The causes of postoperative radial shortening includes: (1) patients older than 60 years; (2) severe osteoporosis; (3) preoperative displacement and comminuted fractures; (4) inappropriate fixation methods; (5) inadequate bone graft; (6) premature load.</p><p><b>CONCLUSION</b>The key points to enhance the treatment outcomes include precise judgement of the fracture type and bone quality, sufficient bone graft, firmly fixed after anatomical reduction and an appropriate plan for early loadless functional exercise. Traumatic arthritis may be avoided or delayed if the above-mentioned six causes can be taken into consideration or preventive measures can be taken.</p>

Clinical application of the distal island muscle flap of the gastrocnemius muscle for repairing the defects around knee and within the upper 2/3 of lower leg / 中华整形外科杂志

<p><b>OBJECTIVE</b>To summarize clinical application of the distal island muscle flap of the gastrocnemius muscle for repairing the defects around knee and within the upper 2/3 of lower leg.</p><p><b>METHODS</b>18 patients with defects around knee and within the upper 2/3 of lower leg, were treated with the distal island muscle flap of the gastrocnemius muscle, including 12 cases with medial muscle head and 6 cases with lateral muscle head. The muscular flaps were covered with meshed split-thickness skin grafts. The wound at donor sites were closed directly.</p><p><b>RESULTS</b>All the skin grafts and muscle flaps survived with superior infection at the wound edge in two cases. The patients were followed up for 8 months to 4.8 years with satisfactory cosmetic and functional results.</p><p><b>CONCLUSIONS</b>The distal island muscle flap of the gastrocnemius muscle has a reliable blood supply, long pedicle and suitable thickness. It is an ideal method for repairing the defects around knee and within the upper 2/3 of lower leg.</p>

Operative treatment of metastatic tumors of spine / 中国骨伤

The spine is the most common site of metastatic tumors. The highest incidence of metastatic tumors on the spine is in the lumbar region, followed by the thoracic and cervical levels. Most associated spinal cord lesions, however, are located in the thoracic spine. The goals of surgery is decompression of the neural tissues, prevention of neural injury by stabilization of the unstable spinal column,or pain control. When there is a need to decompress the neurologic tissues,the most direct approach is anterior because the most common site of metastatic tumors is in the vertebral body. Laminectomy alone is not effective in improving neurologic function. Nevertheless,the posterior approach is more accessible, less hazardous, and effective in the correction of deformity if combined with instrumentation. If complete vertebrectomy is feasible in anterior bone strut combined with anterior and posterior stabilization is necessary following the vertebrectomy.

Overseas advance on the use of locking plates / 中国骨伤

Locking plate technology offers improved fixation stability in osteopenic bone and for comminuted and periarticular fractures. The additional stability per screw compared with that of conventional nonlocking fixation enhances the application of minimally invasive fracture techniques. The application of locking plates is somewhat more difficult than the placement of conventional plates. Fracture reductions are often done indirectly, the locking screw must be carefully aligned along the axis of the receiving hole to ensure proper tightness, and the length of the plate must be selected carefully. The use of locking plates will likely increase, particularly with the increasing prevalence of osteopenic fractures on our aging population and the increase in high-energy fractures in younger patients severe trauma.