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Objective@#To establish an efficient classification and treatment system for limb long bone defects.@*Methods@#Based on the length of bone defect, soft tissue injury and wound infection, a new classification and treatment system was proposed with reference to Gustilo-Anderson classification for open fractures and Orthopedic Trauma Association (OTA) classification.@*Results@#We divided the limb long bone defects into 3 types, each of which was subdivided into 4 subtypes depending on concomitant soft tissue defect and/or infection. Type Ⅰ are bone defects less than 4 cm in length, including type Ⅰa (simple bone defects with a limited extent), type Ⅰb (bone and soft tissue defects), type Ⅰc (bone defects with infection) and type Ⅰd (bone defects with infection and soft tissue defects). Type Ⅱ are bone defects ranging from 4 to 10 cm in length, including type Ⅱa (simple bone defects with a large extent), type Ⅱb (bone and soft tissue defects), type Ⅱc (bone defects with infection) and type Ⅱd (bone defects with infection and soft tissue defects). Type Ⅲ are bone defects larger than 10 cm in length, including type Ⅲa (simple bone defects with a very large extent), type Ⅲb (bone and soft tissue defects), type Ⅲc (bone defects with infection) and type Ⅲd (bone defects with infection and soft tissue defects).@*Conclusion@#Our new classification and treatment system for long limb bone defects is more efficient and intuitive, facilitating clinical diagnosis and treatment of limb long bone defects.
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Objective To investigate the efficacy of anti-infective reconstituted bone xenograft (ARBX) combined with external fixation in the treatment of adult infective nonunion of humeral shaft.Methods A retrospective case series study was conducted to analyze the clinical data of 18 patients with infected nonunion of humeral shaft admitted to Xijing Hospital of Air Force Military Medical University from January 2014 to December 2016.There were 10 males and eight females,aged 19-62 years [(36.9 ± 11.8)years].According to Umiarov classification of infective nonunion,there were 11 patients with type Ⅲ and seven with type Ⅳ.All patients were treated with anti-infective reconstituted bone xenograft (ARBX) combined with external fixation.The number of operations,bone healing time,bone healing rate,infection control rate,postoperative weight bearing time,the time of external fixation removal,postoperative complications,erythrocyte sedimentation rate (ESR),and C-reactive protein (CRP) before and after operation were recorded.Fracture healing and functional recovery were evaluated using the Johner-Wruch lower limb function score.Results The patients were followed up for 12-30 months [(21.3 ±5.6)months].The operation was performed for (1.4 ±0.9) times,with time of bone healing for (16.6 ± 5.8)months,bone healing rate of 83％ (15/18),and infection control rate of 94％ (17/18).The postoperative weight bearing time in 15 patients who obtained bone healing was (3.3 ± 1.5)months after operation,and the external fixation removal time was (18.5 ± 4.2) months after operation.There were three patients with nonunion after operation including one with infection recurrence.Five patients were found with nail tract infection.ESR and CRP at postoperative 3 months [(13.1 ± 8.4)mm/h and (5.6 ± 4.6)mg/L] were significantly lower than those before operation [(47.3 ± 19.2)mm/h and (23.4 ± 7.4) mg/L] (P ＜ 0.05).According to Johner-Wruch lower limb function scores,the results were excellent in nine patients,good in four,fair in one,and poor in four,with excellent and good rate of 72％.Conclusion ARBX combined with External fixation can effectively treat infective nonunion of humeral shaft,improve bone healing rate,and promote function recovery.
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Objective To establish an efficient classification and treatment system for limb long bone defects.Methods Based on the length of bone defect,soft tissue injury and wound infection,a new classification and treatment system was proposed with reference to Gustilo-Anderson classification for open fractures and Orthopedic Trauma Association (OTA) classification.Results We divided the limb long bone defects into 3 types,each of which was subdivided into 4 subtypes depending on concomitant soft tissue defect and/or infection.Type Ⅰ are bone defects less than 4 cm in length,including type Ⅰa (simple bone defects with a limited extent),type Ⅰb (bone and soft tissue defects),type Ⅰc (bone defects with infection)and type Ⅰd (bone defects with infection and soft tissue defects).Type Ⅱ are bone defects ranging from 4 to 10 cm in length,including type Ⅱa (simple bone defects with a large extent),type Ⅱb (bone and soft tissue defects),type Ⅱc (bone defects with infection) and type Ⅱd (bone defects with infection and soft tissue defects).Type Ⅲ are bone defects larger than 10 cm in length,including type Ⅲa (simple bone defects with a very large extent),type Ⅲb (bone and soft tissue defects),type Ⅲc (bone defects with infection) and type Ⅲ d (bone defects with infection and soft tissue defects).Conclusion Our new classification and treatment system for long limb bone defects is more efficient and intuitive,facilitating clinical diagnosis and treatment of limb long bone defects.
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Objective To observe the long-term efficacy of anti-infective reconstituted bone xenograft (ARBX) combined with external fixation of posttraumatic long bone infection in lower extremities.Methods This retrospective case series study included 36 patients with posttraumatic long bone infection in lower extremities followed up for more than 18 months after receiving one-stage ARBX bone grafting combined with ring external fixation from January 2004 to December 2013.There were 21 male and 15 female patients,at the age of 19-72 years (mean,35.8 years).Multiple fractures were seen in 24 patients and single fractures in 12 patients.Bone and functional results were evaluated using the association for the study and application of the method of Ilizarov (ASAMI) classification.Results Follow-up ranged from 18 to 72 months (mean,38 months).Bone union was seen in 33 cases in a mean period of 5.2 months,and infection was completely cured.Length of limbs in all patients reached the expected extension length with the bone extension length of 3-10 cm (mean,5.2 cm).All the extended areas showed bone healing.According to the ASAMI classification,bone result was excellent in 20 patients,good in 13 and fair in 3,with the excellent and good rate of 92％,and limb function recovery was excellent in 18 patients,good in 11 and fair in 7,with the excellent and good rate of 81％.Conclusion ARBX adjuvant external fixator treatment of posttraumatic long bone infection in lower extremities improves bone healing rate and limb function recovery rate and shortens bone healing time at one stage.
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Objective To compare the effect of proximal femoral intramedullary nail fixation and femoral retrograde intramedullary nail combined with hollow lag screw fixation in the treatment of ipsilateral femoral neck and shaft fractures.Methods Data of 42 patients with ipsilateral femoral neck and shaft fractures who were admitted in our hospital from January 2007 to January 2016 were retrospectively analyzed.According to different fixation methods,the patients were divided into two groups:single intramedullary nail group (SIN group) (20 cases,treated with single proximal femoral intramedullary nail,15 males and 5 females with an average age of 39.4);combined internal fixation group (CIF group) (22 cases,treated with femoral distal intramedullary nail combined with femoral neck hollow lag screw,17 males and 5 females with an average age of 42.2 years).In the SIN group,4 cases were type A,9 cases type B,7 cases type C according to AO classification.And 14 cases belonged to Ⅰ or Ⅱ (stable fracture),6 cases of type Ⅲ or Ⅳ (unstable fracture) according to Garden classification.In the CIF group,3 cases were type A,10 cases type B,9 cases type C according to AO classification.And 16 cases belonged to type Ⅰ or type Ⅱ,6 cases type Ⅲ or Ⅳ according to Garden classification.The incision length,operation time,intraoperative blood loss,fracture healing time,postoperative weight time,stability of internal fixation,hip function score,pain in the knee and postoperative complication rate were compared between the two groups.Results There was no significant difference in gender,age and fracture classification between the two groups.The operation time (75.0±10.2 min),intraoperative blood loss (150.6±80.4 ml),hip Harris score excellent rate (80％) of incidence of knee pain in postoperative 3 months (10.0％) of the SIN group were significantly lower than those of the CIF group (105.2±18.4 min,180.0±56.8 ml,86.4％ and 31.8％).The length of incision (8.3±1.4 cm) in the SIN group was significantly longer than that in the CIF group (4.0±0.6 cm).There was no significant difference in fracture healing time (SIN group 20.O±4.0 weeks,CIF group 19.6±4.2 weeks) and postoperative weight time (SIN group 8.2±4.0 weeks,CIF group 8.0±4.2 weeks) between the two groups.The main complications of the two groups were delayed union (3 cases of SIN group and 1 case of CIF group),nonunion of fracture (1 case of SIN group) and,coxa vara (1 case of SIN group).The complication of SIN group (30％) was significantly higher than that of CIF group (4.5％),which occurred mainly in unstable femoral neck fracture cases.Conclusion Both proximal femoral intramedullary nail fixation and femoral retrograde intramedullary nail combined with hollow lag screw can effectively treat femoral ipsilateral femoral neck and shaft fracture.Femoral retrograde intramedullary nail combined with hollow lga screw has more therapeutic advantages for unstable femoral neck fractures (Garden Ⅲ and Ⅳ).
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Objective To evaluate the effect of rapid-prototyping (RP) fracture model in the teaching of extremity fracture. Methods 60 clinical medical undergraduates of the Fourth Military Medical University, who were receiving “surgery” teaching in 2012, were randomly divided into A and B groups equally by lottery. Undergraduates of Group A were taught by traditional methods while undergraduates of Group B were explained by using RP fracture model about the basic anatomy, fracture mechanism, injury mechanism of important vessels and nerves besides traditional methods. Degree of satisfaction of the undergraduates and examination were applied immediately after class. Original data were imputed into SPSS software (version 17.0) for comparison between the two groups using t-test. Results The difference of the two groups in the degree of satisfaction of the undergradu-ates, the average score of fracture mechanism, injury mechanism, clinical manifestation, key point of diagnosis, treatment principles and the total score all has statistical significance (P=0.000). Conclu-sions Students' self-initiative, learning interest and studying efficiency can be inspired by RP fracture models and their professional examination performance has also improved significantly.
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Objective To validate the effect of anti-infective reconstituted bone xenograft (ARBX) in treating posttraumatic osteomyelitis by one-stage grafting in the adults.Methods With clinical application approval of Medical Command,Logistics Ministry of PLA,ARBX was used to treat 27 adult patients (29 lesions) with posttraumatic osteomyelitis by one-stage grafting after debridement since September 2001.The study analyzed 27 patients (29 grafts) who were followed up for average 26 months (12-63 months).Results The follow-up for average 26 months (12-63 months) in 27 patients showed that infection of 22 patients (24 lesions) was controlled and cured,except for three with failure to control the infection or with recurrence of infection,two with controlled infection but with postoperative nonunion.The infection control rate was 89.7% (26/29) and the cure rate was 82.8% (24/29) ,which were better than the results of traditional therapy.Conclusions ARBX has high osteoinductive activity and enhanced anti-infective capability,which enables it to be used as one-stage grafting to treat posttraumatic osteomyelitis in the adults.