Correlation among serum homocysteine , cystatin C levels and severity of coronary artery disease／ / 心血管康复医学杂志

To analyze correlation among serum homocysteine (Hcy) ,Cysteine C (CysC) levels and severi‐ ty of coronary artery disease .Methods : A total of 220 coronary heart disease (CHD) patients treated in our hospital from Sep 2015 to Dec 2017 were selected as CHD group .According to Gensini score ,CHD group were divided into mild stenosis group (n＝ 63 ) ,moderate stenosis group (n＝ 71 ) and severe stenosis group (n＝ 86 ).Another 200 healthy people were enrolled as healthy control group .Serum Hcy and CysC levels were measured and compared a‐mong all groups .Correlation among serum Hcy , CysC levels and severity of coronary artery disease were analyzed . Results : Compared with healthy control group ,there were significant rise in serum Hcy [ (8.29 ± 1.02) μmol／L vs. (16. 14 ± 3.01) μmol／L] and CysC [ (0. 65 ± 0.11) mg／L vs.(1. 21 ± 0.12) mg／L] levels in CHD group .P＝0. 001 all.Compared with mild stenosis group ,there were significant rise in serum Hcy [(9. 31 ± 1.12) μmol／L vs.(12. 13 ± 3.32) μmol／L vs.(14.61 ± 3.82) μmol／L] and CysC [ (1.05 ± 0.21) mg／L vs.(1. 51 ± 0. 52) mg／L vs.(3.42 ± 1.01) mg／L] levels in moderate stenosis group and severe stenosis group ,and those of severe stenosis group were significantly higher than those of moderate stenosis group , P＝0.001 all.Pearson correlation analysis indicated that serum Hcy ( r＝0.431 , P＝0.004) , CysC ( r＝0.640 , P＝0. 003) levels were significant positively correlated with Gensini score .Conclusion :Serum Hcy and CysC levels is closely correlated with severity of coronary artery disease . Its detect is help for therapeutic effect and prognosis assessment for CHD patients .

Application of 3D printing technology in treatment of displaced acetabular fractures complicated with posterior pelvic ring injury / 中华创伤骨科杂志

Objective To evaluate the application of 3D printing technology in the treatment of displaced acetabular fractures ( DAF ) complicated with unstable injury to the posterior pelvic ring. Meth-ods A retrospective study was conducted of all the 19 DAF patients complicated with unstable posterior pelvic ring who had been treated from August 2009 to June 2015 in our hospital. They were 12 men and 7 women, aged from 24 to 62 years ( average, 39. 8 years ) . Twelve DAFs were complicated with ipsilateral unstable injury to the posterior pelvic ring, 5 with contralateral unstable injury to the posterior pelvic ring, and 2 with bilateral unstable injury to the posterior pelvic ring. Preoperatively, 3D digital models of the pelvis were reconstructed for the 19 patients using their CT scanning data. Their pelvic models were printed using 3 D printing technology for visual evaluation of their fractures and design of individualized surgical proce-dures. Results With the help of their 3D printing models, the 19 patients obtained successful operations within a mean time of 3. 2 hours. Their intraoperative blood loss averaged 658. 5 mL. They were followed up for an average of 10. 7 months ( range, from 8 to 24 months ) . According to Matta′s criteria for pelvic reduc-tion, 14 cases achieved anatomical reduction, 2 satisfactory reduction and 3 unsatisfactory reduction. Ac-cording to Mears's criteria for reduction of the posterior pelvic ring, 13 cases achieved anatomical reduction, 4 satisfactory reduction and 2 unsatisfactory reduction. The 19 acetabular fractures healed after 9 to 18 weeks ( average, 14. 5 weeks ) . The pelvic fractures healed after 8 to 17 weeks ( average, 13. 5 weeks ) . According to the Merle d'Aubigne-Postel criteria at the last follow-ups, the hip functions were excellent in 7, good in 9, fair in one, and poor in 2 cases. According to the Majeed's functional evaluation, the pelvic functions were excellent in 10 cases, good in 7, fair in one, and poor in one. Complications were incision infection in one, heterotopic ossi-fication in 2, avascular necrosis of the femoral head in one and traumatic arthritis in one. Conclusion In thetreatment of DAF complicated with unstable injury to the posterior pelvic ring, application of 3D printing technology can provide direct visualization of the pelvic and acetabular fractures which facilitate preoperative evaluation and design of individualized surgical protocols, leading to fine outcomes.

Clinical study on posterior approach incision length in minimally invasive total hip arthroplasty / 中华创伤杂志

Objective To explore the reasonability of posterior approach incision length in an unselected patient cohort with minimally invasive total hip arthroplasty (THA) and compare the clinical results of different incision lengths. Methods A consecutive unselected 256 patients who underwent primary unilateral THA between March 2001 and December 2007 were studied prospectively. Prior to the operation, the incision length was not deliberately selected for the patients. A posterior approach was used for all procedures with minimally invasive surgical techniques. The patients were divided into three groups according to the incision length at the end of surgery: mini-incision group ( ＜ 10 cm, 99 patients) , moderate incision group (10-14 cm, 112 patients) and standard incision group ( ＞ 14 cm, 45 patients). The in-hospital data including age, sex, diagnosis,body mass index (BMI),operation duration, intraoperative blood loss, total blood loss, preservation of the external rotators, anatomic repair of the capsule as well as postoperative radiographs were collected for analysis of the intraoperative and postoperative complications. The pain was estimated by using the individual visual analog scale (VAS) and the functional outcome evaluated by Harris hip score preoperatively and postoperatively. Results All the patients were followed up for an average period of 6.1 years (2.5-9.2 years). The incision length was shortened and optimized ( ＜ 14 cm) in 211 patients. There showed decrease of BMI, less intraoperative blood loss, less pain, satisfactory outcome but higher proportion of abnormal abduction angle of the acetabular prosthesis in the early postoperative period in the mini-incision group, with statistical difference compared with the other two groups (P ＜ 0.05). The preservation of the piriformis tendon, anatomic repair of the joint capsule, operation duration and Harris score at 6th postoperative week in the moderate incision group were similar to those in the mini incision group but showed statistical difference in comparison with the standard incision group ( P ＜0. 05). Conclusions Minimally invasive THA with a smaller posterior incision can attain safe and effective curative effect for the unselected patient cohort. A smaller but not necessarily miniincision may allow minimal soft tissue trauma for the surgeon to perform the procedure well and ensure a long-term clinical results.

Operative treatment of complex posterior tibial plateau fractures via posterior approach / 中华骨科杂志

Objective To evaluate the clinical results of operative treatments for the complex posterior tibial plateau fractures via posterior approach. Methods Eleven cases with complex posterior tibial plateau fracture from June 2008 through June 2010 were reviewed retrospectively. There were 7 males and 4females, with age from 33 years to 60 years (average, 47.8 years). According to AO classification, there were 41-B2.2.4 type in 2 cases, 41-B3.1.2 type in 3, 41-B3.3.2 type in 3, 41-B3.1.2 type combined 41-B3.3.2 type in 2, 41-C3.3 type in 1. Carlson posterior lateral approach were used in 5 cases, posterior medial approach were used in 3 cases, and posterior medial and/or lateral approach combined with anterior approach were used in 3 cases. All fractures were fixed with plates. Autogenous ilium grafts were used if necessary.Results All cases were followed up. The average follow-up time was 1.6 years (range, 3-24 months). At the final follow-up visit, bone union was obtained in all cases. The mean Rasmussen score was 16.7 (range, 15-18), and the mean HSS was 86.2 (range, 75-96). The postoperative knee range of motion were 0°-135°, 0°-130° and -10°-125° in 5 cases with posterior lateral plateau fractures, 3 cases with posterior medial plateau fractures and 3 cases with anterior and posterior plateau and intercondylar fractures respectively. There was no vascular and nerve injuries. Loosing or breaking of hardware's was not found. Conclusion The Carlson posterior lateral and/or medial approach is preferred for the complex posterior plateau fractures, with the advantages of direct reduction and stabilization.

Risk factors and treatment of intraoperative femur fracture in hip replacement / 中华创伤杂志

Objective To analyze the risk factors related to intraoperative femur fracture in hip replacement and discuss the treatment countermeasures. Methods The medical records and radiographs of 38 patients with intraoperative femur fracture who were treated at Tianjin Orthopedic Hospital from December 2002 to December 2009 were retrospectively studied. Fractures were classified according to the Amstutz system or AAOS standard and the treatment methods were selected accordingly. Reduction and fixation was performed in 25 patients including 14 patients treated with interfragmentary or cerclage fixation, five with plate fixations and six with cortical strut graft. Shank prosthesis was replaced in 12 patients. Results The mean follow up period was 4.5 years, which showed successful union of the fractures in 36 patients and delayed union in two. Replacement of the prosthesis was needed in one patient for prosthesis loosening four years postoperatively. Conclusions Osteoporosis, violence, abnormal femur canal and over large prosthesis are the main causes of intraoperative femur fracture in hip replacement.Proper selection of treatment method according to fracture types may attain fracture union with a stable implant.

Periacetabular osteotomy for the treatment of developmental dysplasia of the hip in adults / 中华骨科杂志

ObjectiveTo study the indications and mid-term outcomes of periacetabular osteotomy on adult patients of developmental dysplasia of the hip (DDH). MethodsTwenty-five adult patients with DDH underwent periacetabular osteotomies through modified Smith-Peterson approach. There were 19 females and 6 males with an average age of 25.5 years(range, 18-45). Every patient had a single dysplasia hip, including 14 hips in the left, and the other 11 in the right. Three cases were operated formerly, 2 of them received Chari osteotomy and 1 received Salter osteotomy. Before operation 13 hips were T(o)nnis Grade 0 osteoarthritis, 9 hips were Grade Ⅰ , 3 hips were Grade Ⅱ. The Shenton line of 18 hips was broken. The lateral center-edge angle was 4.57°±7.39°, the anterior center-edge angle was 0.95°±6.02°, the horizontal tilt angle was 32.50°±5.96°, the femoral head extrusion index was 38.11％±5.70％, the Harris hip score was 75.32±7.51 points. Changes of the indexes mentioned above were observed during the period of follow-up.ResultsAll patients were followed up for average 4.5 years(range, 2.0-7.5). Compared with the preoperative radiographic severity at the latest follow-up, 3 hips of T(o)nnis Grade Ⅰ improved to Grade 0, 2 hips of Grade Ⅱ improved to Grade Ⅰ, 1 hip of Grade Ⅰ changed into Grade Ⅱ. The incident of the break of Shenton line decreased to 10 hips. The lateral center-edge angle improved to 29.07°±5.81° the anterior centeredge angle improved to 29.52°±4.51°, the horizontal tilt angle decreased to 19.17°±4.95°, the femoral head extrusion index decreased to 24.20％±4.83％, the Harris hip score increased to 84.88±4.88 points. The major complication included 16 cases of lateral femoral cutaneous nerve palsy(7 cases of them didn't recover forever) and 1 case of ectopic ossification of Brooker Ⅰ . ConclusionPeriacetabular osteotomy through a modified Smith-Peterson approach were performed to the dysplasia hip of adults, it can increase congruence,improve hip function; it can also prevent subchondral sclerosis and cysts forming, preserve joint space and delay the occurrence of osteoarthritis.

Periprosthetic fractures during primary total hip arthroplasty for developmental dysplasia of the hip in 9 cases / 中国组织工程研究

From February 2002 to May 2007,9 cases(9 hips) of periprosthetic fractures during the primary total hip arthroplasty for developmental dysplasia of the hip were selected,including 1 male and 8 females aged 52-69 years.In the primary total hip arthroplasty,femoral prosthesis with the same size as intramedullary reamer and acetabular prosthesis with 2 mm diameter larger than acetabular reamer were used.The pain,function,range of motion and degree of deformity were accessed using the Harris score.The patients were followed for 1-6 years.Among the 9 patients with periprosthetic fractures,4 acetabular fractures were stable which were treated by additional augmentation screws,and 1 fracture was unstable which was treated by structural bone grafting and additional screws.And there was one Vancouver type AG fracture which was treated by cerclage wire,3 Vancouver B1 fractures which were fixed by locking compression plate(LCP) or cerclage wire,and one Vancouver type C fracture which was also fixed by LCP.No component loosening or migration was found in the postoperative X-ray.The mean Harris score was 87.2 at the final follow-up.The results of the study show that during the primary total hip arthroplasty in patients with developmental dysplasia of the hip,the oversize of the acetabular component should be controlled to equal to or less than 2 mm.For patients with severe osteoporosis,acetabular components with the same size to reamer are recommended combined with additional screws,or cemented cup.When an acetebular fracture is found during total hip arthroplasty,we could use additional screws or bone grafting.Once a periprosthetic femoral fracture occurs during the operation,methods of fixation should be selected based on the type of the fracture and stability of the prosthesis.

Acetabulum revision alone in 11 patients following total hip arthroplasty / 中国组织工程研究

Eleven patients underwent acetabulum revision using modified anterolateral approach due to acetabulum loosening but femoral prosthesis in sound fixation following total hip arthroplasty in Department of Joint Surgery,Tianjin Hospital between August 2002 and February 2005. During the mean follow-up of 4.2 years,all 11 patients gained primary stable fixation and good function. One patient underwent another revision due to infection; one developed femoral prosthesis loosening and underwent femoral revision. X-ray of the other patients showed no loosening or dislocation or radiotransparent region surrounding the prosthesis. One patient developed lateral femoral cutaneous nerve injury and relieved 6 months later.

Clinical analysis of locking plate for proximal humeral complicated fractures / 中国矫形外科杂志

[Objective]To discuss the treatment effect of locking compression plate(LCP)for proximal humeral complicated fractures.[Method]A retrospective study was done on 21 cases of proximal humeral fractures treated with LCP from April 2005 to June 2006.There were 13 male and 8 female,with age of 26-71 year(mean 42.3 year).According to Neer classification,15 cases were three-part fractures including 5 cases with anterior dislocation and 6 cases with primary osteoporosis;6 cases were four-part fractures including 3 cases with anterior dislocation and 2 cases with posterior dislocation.Reduction and fixation were done by deltopectoral-gap approach,the operator put the locking plate on 10mm positerior to the intergroove of tuberosity,5mm away from the tip of humeral greater tuberosity.If there were bone defects in the fracture site after reduction,they were treated with allografts,locking screws and unlocking screws were drilled into proximal and distal part of the fracture.Shoulder exercise should be performed passively three days after operation.One week after operation,active shoulder exercise was done,which was gradually intensified two weeks after operation.[Result]Twenty-one cases were followed up for 10-14 months,average 12.5 months,all fractures were union in 12 month.According to Neer shoulder score,the result was excellent in 11 cases,good in 7 and fair in 3,with excellent and good rate of 85%.[Conclusion]The screw of LCP can lock the plate so that the plate can firmly fixate the proximal humeral comminution fractures and osteoporosis bone,so simultaneously reach fracture union and function exercise,but attentions should be paid to the suitable procedure of LCP to avoid a series of problem of locking plate.

Operative and non operative treatments of fractures / 中华创伤骨科杂志

A treatment process of fractures consists of diagnosis, reduction, fixation and rehabilitation. Advances made in techniques of open reduction and internal fixation, typing of fractures, and standardization and humanization of treatment, as well as development of four AO principles of fracture treatment have led to constant improvement of therapeutic effects. In treatment of fractures not only biomechanical factors but also biological ones should be taken into consideration. Although operative and non operative treatments have indications of their own, they are supplementary to each other in clinical treatment. Orthopedists must master techniques of both open reduction and close reduction, and pay enough attention to scientific rehabilitation after operation.

Acetabular fractures and open fractures / 中华创伤骨科杂志

With the rapid development of the tra ffic,acetabular fractures and open fractures resulted from high energy injuries occur more freq uently.A combined examination of ro entgenogram,CT scanning and the three-dimensional imaging of the spiral CT helps make an accurate diagnosis of a cetabulum fractures.At present,the fracture is usually classified a ccording to the Letournel classific ation and AO classification.The ind ications for conservative treatment of this frac ture are limited,while surgical tre atment is more often the choice.In th e treatment,good reduction,rigid in ternal fixation and early functional recovery are essential.Much care,however,should be given to the selection of th e operation approach,prevention of complications such as damage to the sciatic nerve,heterotopic ossific ation and venous thrombus.As for the open fracture,thorough debridemen t,fixation,and suturing of the wound a t a possibly early stage are generally recommended.Care should also be given to proper administration of antibio tics and early functional recovery i n order to promote the union of the fra cture and the recovery of the functions.[

The management of femoral shaft fractures with ipsilateral femoral neck fractures / 中华创伤骨科杂志

Objective To analyze the clinical characteris tics and diagnostic outline and to elucidate the effects of different managements of femoral shaft fractures with ipsila teral femoral neck fractures.Methods A retrospective study was carried out in 18patients with ipsilateral femo ral neck and femoral shaft fractures from 1998to 2001,and their managements and final clinical outcomes were reviewed.Results The follow -up ranged from8to 40months with an average of 16mon ths.All the fractures united except one femoral shaft fracture and one femoral neck fracture.Conclusion Retrograde intramedullary nailing with multiple cancellous screws to t reat ipsilateral femoral neck and femora l shaft fractures has been proved an e ffective technique.For the cases overlooked initially,treatment with multiple nailing around the intramedullary n ail is a good choice.[

Clinical application of the reversed sural neurocutaneous island flap / 中华创伤骨科杂志

Objective To investigate the characteristics of the reversed sural neurocutaneou s island flap in clinical application.Methods From June 1997to March 2002,13cases of soft tissue defect in the lower leg,or around the ankle and the heel were repaired with the reversed sural neurocutaneous island flaps.The largest flap size was 15cm ?9cm,while the smallest was 5cm ?6cm.Results11of the flaps survived well and had primary healing,while 2flaps had distal partial necrosis and healed after dressing change.The follow-u p from3months to 4years showed that all fla ps were satisfactory.Conclusion Since the blood supply of the reverse d sural neurocutaneous island flap is reliable,even in patients with insufficient blood supply,and the flap is easy and quick to get without sacrificing the major arteries,it is an ideal method to use this flap to repair the soft tis sue defect in the lower leg and around the malleolus,the heel and the Achilles tendon.[

The clinical application of the reversed saphenous neurocutaneous isla nd flap / 中华骨科杂志

Objective To describe the method of treating so ft tissue defects of the lower 1/3of l egs with the reversed saphenous neurocu taneous island flaps.Methods From June 1998to December 2000,eight cases of soft tissue defects or unstable scars of the lower one third of the legs,or around the ankle and th e heels were treated with reversed sap henous neurocutaneous island flaps.The size of the flaps were from 6cm ?5cm to 15cm ?9cm,averaging 9cm ?6.3c m.In 3cases in order to avoid the inju ry of the blood vessels of the flap pedicle when it passed thr ough the subcutaneous tunnel,a skin fascial bridge was designed in width of 1.5cm as the pedicle of the island f lap and to form the roof of an open tunnel.Results Seven cases had the flaps survived,one case had partially necrosis of the flap.After 6mo nths to 2years follow-up,all of the8cases were evaluated as satisfacto ry.Conclusion The blood supply of the reversed saph enous neurocuta-neous island flap is reliable,even i n patients with insufficienct arterial supply of the distal one third of t he lower limb.The flap does not sacrifice the major arteries and is easy to be perfomed.[

Ipsilateral femoral neck and shaft f ractures / 中华骨科杂志

Objective To elucidate the clinical characteristics and diagnostic outline of ipsilateral femoral neck and shaft fractures.Methods A retrospective study was carried ou t on 7patients with ipsi-lateral femoral neck and shaft fractures associated injuries of the knee;the duration of delay in diagnosis o f the femoral neck fractures,the managem ent of treatment and final clinical o utcomes were reviewed.Results All of the femoral shaft fractures occur red in the middle third and the femora l neck fractures in the base of the neck.Two patients were associated w ith knee injuries.The duration of delay in diagnosis of the femoral neck fractures ranged from 1to 75days.Si x femoral shaft fractures and 5neck f ractures were treated operatively.The mean follow-up period was 15.6mo nths,and all of the shaft and neck fra ctures were eventually healed without the evidence of avascular necrosis of the femoral head in spite of2mal-unions of the femoral neck.Conclusion In case of femoral shaft fracture resulting from high-energy trauma,an A-P pelvic film should be routinely taken.The patients with negative findings on the hip radiographs continue to complain of hip pain following open reduction and intern al fixation of the femoral shaft fractures should undergo CT or MR imaging examination.Once the femoral neck f racture is recognized,operative re duction and fixation should be em-ployed immediately.The outcome of o perative treatment is much superior to that of non-operative.

Management of limb length discrepancy during total hip replacement / 中华骨科杂志

Objective To investigate the management of limb length discrepancy during total hip replacement. Methods Forty-four hips of 44 patients undergone unilateral primary total hip replacement between July 1997 and July 2000 were included in this study. There were 30 males and 14 females. The ages of the patients at the surgery ranged from 42 to 80 years(mean, 65.8 years). Evaluation of the limb length discrepancy through clinical measurements and radiographic templates was done preoperatively to anticipate the optimal implantation position of the components and determine the level of expected femoral neck cut to maintain the equality of the limbs. During the surgery, the distance between two reference points made at pelvis and femur were measured before femoral neck osteotomy was performed based on preoperatively estimated parameters. The distance between the two points was measured again after insertion of the trail components in order to adjust the offsets of the femoral neck and head. Results Of the 30 patients with shortened limb ranging 1.5 to 5 cm preoperatively, only 4 had limb length discrepancy between 1.5 and 2 cm after surgery. Of the 14 patients with equal limb length preoperatively, only one limb had been lengthened more than 1.0 cm postoperatively compared with its contralateral limb. Conclusion The preoperative measurements, templating and intraoperative corrections are helpful in minimizing limb length discrepancy during total hip replacements and correcting preoperative limb length discrepancy as well.

Imaging Diagnosis of Primary Brain Iymphoma / 实用放射学杂志

Objective:To describe the imaging findings of primary brain lymphoma in immunologically normal patients.Methods:The clinical manifestations and imaging findings of 5 patients operated with pathological proved primary brain lymphoma were reviewed.Results:In 5 cases,4 patients were men and one was woman.The median age was 47(range 34 to 63 years).Pathological diagnosis was compatible with primary non-Hodgkins lymphoma of brain for all five patients.Primary brain lymphoma may be soiltary or mutiple and locate at supratentorial or infratentorial.Lesions presented as an isodense to hyperdense on CT scan,hypointense on T1-weighted images and isointense or hyperintense to gray matter on T2-weighted images.Most lesions showed dense homogenous enhancement on CT and MR.Tumors associated with different degrees of mass effect.One patient received whole-body 18 FDG PET examination that presented as an intracranial hypermetabolic lesion.Conclusion:Primary brain lymphoma is a rare tumor that imaging findings overlap with those of other intracranial mass lesions,we can only make a suggestive diagnosis of primary brain lymphoma and pathological confirmation is meeded.

The operative treatment of the lower leg,ankle and foot soft tissue defects / 中华骨科杂志

Objective To research the operative methods and their comments on the lower leg, ankle and the foot soft tissue defects. Methods From June 1997 to December 2005, 43 cases of the lower leg, ankle and the foot soft tissue defects were treated with nine different kinds of pedicle flaps transplant. The patients included 38 males and 5 females, with an average age of 35 years (range from 7 to 63 years). The areas of flaps were from 4 cm?3 cm to 25 cm?15 cm. 9 kinds of flaps were underwent in all patients, which includes medial or lateral gastrocnemis myocutaneous pedical flaps in 2 cases; anteromedial cross leg flaps in 2 cases; medial cross leg flap with saphenous nerve in 1 case; medial reverse flow island leg flap with posterior tibial artery in 1 case; medial distal leg fascia flaps in 2 cases; reversed sural neurocutaneous island flaps in 17 cases; reversed saphenous neurocutaneous island flaps in 14 cases; supra extramalleolus reversed island flaps in 2 cases; and medial pedes distal island flaps in 2 cases. Results 37 flaps of 43 cases were completely survived, 1 case with superficial necrosis and 5 cases with distal edge partially necrosis and these 6 cases all healed after short time dressing change. All the cases were followed up 3 months to 7 years, with an average of 16 months, and none recurred. The flaps completely survived even in some special cases such as diabetes mellitus, dorsal artery of foot defect combined venous varicose, sural nerve injury, Gustilo ⅢC open fracture and serious degloving injury of lower leg and foot. Conclusion In order to achieve the desired results, it is important to grasp the surgical indications of various kinds of flaps and keys for the operation. The sural and saphenous neurocutaneous island flaps could be a satisfactory method to treat the soft tissue defects in lower leg, ankle and foot.

Operative treatment of the old trimaleolus fractures / 中华骨科杂志

Objective To explore the operative methods of open reduction and fixation for the old trimalleolus fractures. Methods Fifty-eight patients of the old trimalleolus fractures were treated from January 2000 to January 2004. There are 41 males and 17 females with an average age of 43 years (ranged from 19 to 61 years). The average time of postinjury was 48 days (ranged from 29-76 days). The fractures were classified by Lauge-Hansen system. Supination-external rotation type in 37 cases. Pronation-external rotation type in 21 cases. The anterior-medial approach and anterior-lateral approach were chosen. Explore the original fracture line of medial and lateral malleolus sharply, resect scar tissue at the fagment and ankle mortise, make the ankle joint valgus, expose the posterior malleolus fragment directly and explore the original fracture line. Reducted and fixed the posterior malleolus. According to the fibular crest, the normal length and alignment were recovered. The fracture was fixed with 1/3 tubular plate or ordinary plate. Medial malleolus was fixed with screw or tention band. The time of partial weight bearing was 10-12 weeks. Results The mean duration of follow up was 37 months (range from 18-65 months). Superficial skin necrosis was in 2 cases. The wound delayed union in 4 cases. The average time of fracture healing was 25 weeks(range from 21-29 weeks). The fibula malalignment in 2 cases. 6 cases developed arthrosis. 2 cases in this 6 patients had a good reduction of fractures. The average time of the operation in this 6 patients was 58.5 d after injury. According to the AOFAS scoring system, excellent in 31 cases, good in 22 cases, fair in 5 cases. The total rate of good results was 91.4%. The pain score was up to 20 in 5 cases. 9 cases had restriction of dorsiflexion with less than 10?. Conclusion The excellent reduction and clinical results were obtained by explore the original fracture line sharply, reduct posterior malleolus fragment directly and maintain normal length of the fibula, rotation and alignment for the old trimaleolus fractures which injuried within 76 days.

Surgical treatment for ipsilateral fractures of femoral neck and shaft / 中华骨科杂志

Objective To investigate the surgical treatment for ipsilateral fractures of femoral neck and shaft. Methods 26 cases of ipsilateral fractures of femoral neck and shaft treated from January 1996 to December 2002 were retrospectively reviewed. There were 22 males and 4 females, with an average of 28 years (range 17-50 years). The causes of fractures were traffic accident in 17 and fall in 9. The femoral neck fractures were diagnosed in emergency in 16 cases, and delayedly in 10 cases. The delayed time was 3-75 days, with an average of 13.1 days. All cases were divided into three types according to the site of femeral shaft fracture. Type Ⅰ: the proximal 1/3 femoral shaft fracture combined with neck fracture, in 3 cases; Type Ⅱ: the middle 1/3 femoral shaft combined with neck fracture, in 18 cases; Type Ⅲ: the distal 1/3 femoral shaft fracture combined with neck fracture in 5 cases. All cases were undergone surgical reduction and internal fixation. The femoral shaft fractures were stabilized with dynamic compression plate (DCP) in 13, with antegrade intramedullary locking nail in 2 cases, with retrograde intramudullary locking nail in 5 cases. The femoral neck fractures of these 20 patients were stabilized with cannulated lag screw. The femoral neck and shaft were stabilized with dynamic hip screw system (DHS) in 2, with constructive nail in 4. Results All of the patients were followed up for 3 to 9 years, with an average of 4.4 years. The femoral shaft fractures obtained rigid union at the latest follow-up study in 25. The duration for bone union ranged from 16 to 32 weeks, with an average of 20 weeks. The femoral neck fractures were united at the latest follow-up study in 25. The duration for bone union ranged from 12 to 28 weeks, with an average of 16 weeks. The complications included infection in 1, hardware failure in 1, nonunion of femoral neck fracture in 1 and osteonecrosis of femoral head in 1. Conclusion The ipsilateral fracture of femoral neck and shaft is rare, and the neck fracture is easy to miss diagnosis. The surgical treatment for ipsilateral fractures of femoral neck and shaft depends on the position of femoral shaft, and the situation of femoral neck.