Research progress of caput femoris posterior tilt and its impact on prognosis in nondisplaced femoral neck fractures / 中国骨伤

There are still many unresolved problems in the treatment and prognosis of nondisplaced femoral neck fractures, such as nonunion and avascular necrosis of the caput femoris .In order to reduce the risk of various complications after non-displaced femoral neck fractures, the caput femoris posterior tilt of femoral neck fractures and its impact on prognosis have attracted more and more attention. A large number of scholars' studies have found that when the posterior tilt exceeds 20°, the risk of internal fixation failure increases significantly. Based on this concept, we can choose to use primary artificial joint replacement instead of three-screw internal fixation according to the different posterior tilt angles of patients to reduce the incidence of postoperative complications. At the same time, our analysis found that comminution of the posterior segment of the femoral neck would lead to an increase in the posterior inclination angles. The purpose of this review was to investigate the relationship between caput femoris posterior tilt of femoral neck fractures and surgical outcome, and to introduce a new method for measuring caput femoris posterior tilt of the femoral neck.

biomechanical study of the influence to the forefoot plantar pressure of the first tarsometatarsal joint fracture-dislocation fixed by three different implants

Objectives: To study the influence of forefoot plantar pressure of the first tarsometatarsal joint fracture-dislocation by three different implants to provide experimental reference in selecting implants

Methods: Eight fresh foot specimens were made into the models of the first tarsometatarsal joint fracture-dislocation, which were fixed with 3.5 mm cortical screw, 1/4 tubular plate and compressive staple in turn. After the loading of 600N, the changes of the plantar pressure in forefoot were measured by the method of the F-scan plantar pressure system

Results: After first tarsometatarsal joint fracture-dislocation, the peak pressure under the first metatarsal head would decrease, while the pressure under the second metatarsal head would increase [P<0.05]. When the first tarsometatarsal joint was fixed with screw or plate respectively; the peak pressure under the two metatarsal heads would tend to be normal. However, the staple fixation would show the statistical significant difference, although the peak pressure under the first and second metatarsal heads were recovered in some extent [P<0.05]

Conclusions: After the first tarsometatarsal joint fracture-dislocation, the plantar pressure might be compensated partly by the adjacent metatarsal heads. While the first tarsometatarsal joint fracture-dislocation was fixed by screw or plate, the plantar pressure of the forefoot would return to the normal state. However, if the joint was fixed by the staple, it would still be difficult to return the plantar pressure to be normal

Clinical results of femoral head fracture-dislocation treated according to the Pipkin classification

Objective: To summarize the clinical results of femoral head fracture-dislocation treated according to Pipkin classification

Methods: A total of 19 patients with femoral head fracture-dislocation were retrospectively analyzed from Mar. 2008 to Mar. 2015. According to the classification of Pipkin criteria, there were 4 cases in Type-I, 6 cases in Type-II, 6 cases in Type-III and 3 cases in Type-IV. Various procedures were taken according to the different types of the fracture, the time of the fracture, and the age of the patients. X-ray was examined during the follow-up period and functional evaluation was carried out by Harris Hip Score's criteria. The clinical therapeutic effects were analyzed

Results: All the patients got a mean follow-up of 18 months [9-36 months]. No patient suffered from infection, skin flap necrosis and X-ray showed no implants loosening or breakage. According to the Harris Hip Score's criteria, in Type-I, 4 cases were rated as excellent. In Type-II, 2 cases rated as excellent, 3 cases as good and 1 case as fair. In Type-III, 3 cases rated as good, 2 cases as fair and 1 case as poor. In Type-IV, 1 case rated as excellent, 1 case as good and 1 case as fair. The overall rate of excellent and good was 73.7%

Conclusions: Pipkin classification is helpful to make preoperative plan and judging the prognosis in cases of femoral head fracture-dislocation. However, multiple factors such as the time from injury to surgery, the ages of patients, the selection of implants should also be considered, which may affect the clinical results

Comparison of fixation of sustentaculum tali of calcaneus aided by director for sustentaculum tali screwing and ordinary screwing guide / 中国骨伤

<p><b>OBJECTIVE</b>To explore clinical outcomes of director for sustentaculum tali screwing for fixing sustentaculum tali of calcaneus.</p><p><b>METHODS</b>From May 2012 to October 2013, totally 50 patients (60 feet) with calcaneal fractures were analyzed, and divided into director for sustentaculum calcaneous tali screwing treatment group (group A) and ordinary screwing group(group B). In group A, there were 25 patients, including 22 males and 3 females, aged from 17 to 75 years old with an average of (45.08±11.98) years; according to Sanders classification, 9 feet were type II, 16 feet were type III, and 7 feet were type IV. In group B, there were 25 patients, including 20 males and 5 females, aged from 19 to 78 years old with an average of (46.36±15.74) years; according to Sanders classification, 8 feet were type II, 13 feet were type III, and 7 feet were type IV. Radiological change, operative time, postoperative complications were observed and compared, Maryland scoring at 1 year after operation was applied to evaluate clinical outcomes.</p><p><b>RESULTS</b>Fifty patients were followed up, group A was followed up from 12 to 24 months with an average of (17.72±4.08) months;while group B was followed up from 12 to 24 months with an average of (18.68±3.40) months;there was no significant difference between two groups in following-up time(>0.05). There were significant difference in operative time, complications and fluoroscopy times between two groups(<0.05). There were significant difference in Böhler angle and Gissanes angle between two groups before and after operation(<0.05). Maryland score at 1 year after operation in group A was (84.94±12.75) and (76.96±15.32) in group B, had significant meaning between two groups (<0.05).</p><p><b>CONCLUSIONS</b>Fixation of sustentaculum tali of calcaneus aided by director for sustentaculum tali screwing, has advantages of less operative time, fluoroscopy times, incidence of complications and good recovery of function, which could provide a new aiding method for treating intra-articular calcaneal fractures.</p>

Intralesional curettage and wide excision for treatment of giant cell tumors (GCTs) of the distal radius: A Meta-analysis / 中国骨伤

<p><b>OBJECTIVE</b>To search all studies that had been published in the world with regarding to the effectiveness of the extent of intralesional curettage and wide excision for recurrence rate and complications and comparative functional outcomes in patients with giant cell tumours (GCT) of the distal radius and analyze them which were in high quality by means of Meta analysis, in order to give some evidences for the choice of method dealing with giant cell tumors GCT in surgery.</p><p><b>METHODS</b>Cochrane central register of controlled trials(Issue 8 2014), PubMed(1970-01-01/2013-01-01), Ovid (1970-01-01/2013- 01-01), Elsevier (1970-01-01/2013-01-01), CNKI (1970-01-01/2013-01-01) were searched. Including intralesional curettage and wide excision were performed to treat giant cell tumors (GCTs) of the distal radius in the literatures, selecting on meet eligibility in the standard literatures underwent strict quality assessment. The Meta-analysis was performed with software RevMan5.0 from the Cochrane collaboration. Additionally, the analysis checked the heterogeneity of data. The effectiveness of the extent of intralesional curettage and wide excision for recurrence rate and complication in patients with giant cell tumours of the distal radius were evaluated and Odds Ratio was calculated.</p><p><b>RESULTS</b>Seven relevant articles were identified involving total 163 cases. Among them, 92 cases were intralesional curettage (PMMA, n = 54; bone graft, n = 33; no PMMA or bone grafts, n = 5) and 71 cases were wide excision. The patients in the intralesional curettage group had a higher recurrence rate [OR = 3.87, 95% CI (1.42, 10.53)],especially for Campanacci grade 3 GCTs [OR = 10.12, 95% CI (1.57, 65.27)], yet fewer major complications [OR = 0.13, 95% CI (0.04, 0.40)] than the wide excision group. The use of PMMA versus bone graft did not affect the recur- rence rate [OR = 0.96, 95% CI (0.26, 3.56)]. By selecting the system evaluation of MSTS, the VAS and dynamometer, the result showed that the intralesional curettage group was equivalent or preferable to wide excision in terms of function rehabilitation.</p><p><b>CONCLUSION</b>Based on data obtained from the limited number of studies available, intralesional curettage appears to be moreappropriate for the treatment of local lesions (Grade 1 and 2) than Grade 3 GCTs of the distal radius. Moreover, PMMA was not additionally effective as an adjuvant, the intralesional curettage group was found to be equivalent or preferable to wide excision in terms of function rehabilitation.</p>

Short term clinical outcome of total hip arthroplasty for the treatment of Crowe IV congenital dysplasia of the hip in adults / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the short term clinical effects and surgery methods of the total hip arthroplasty (THA)for the treatment of Crowe type IV congenital dysplasia of hip (CDH) in adults.</p><p><b>METHODS</b>From March 2013 to March 2015, 20 patients (20 hips) with Crowe type IV CDH in adults were underwent THA, including 4 males and 16 females, with an average age of 52 years old ranged from 32 to 68 years old. All the cementless acetabular cups were placed at the original anatomic location. S-ROM prosthesis was adopted together with subtrochanteric transverse osteotomy in femoral side. All the patients were evaluated by using the Modified Harris Hip Score. Radiographic evaluations were made preoperatively and during follow up.</p><p><b>RESULTS</b>The incisions were healed by first intention. There was no hip dislocation events and venous thrombosis occurred. All patients were followed up for 8 to 60 months with an average of 38.1 months. Postoperative X ray films showed all acetabular prosthesis were in true acetabulum. No nonunion and loosening were found in all patients. Harris score at final follow up improved from preoperative 50.90±9.35 to postoperative 90.25±3.16. The difference was statistically significant (<0.05). There were 1 patient with femoral split fracture, 1 patient with nerve injury, 1 patient with heterotopic ossification of Brooker I. The hip function of all patients was good, the pain was disappeared.</p><p><b>CONCLUSIONS</b>THA with S-ROM prosthesis and subtrochanteric osteotomy is an effective method for the treatment of Crowe type IV CDH in adults. The recent clinical curative effect is satisfied.</p>

management of acetabular malunion with traumatic arthritis by total hip arthroplasty

To explore the treatment strategies and clinical effect of the acetabular malunion with traumatic arthritis by total hip arthroplasty. A retrospective analysis was conducted on 47 cases of acetabular malunion with traumatic arthritis from June 2000 to December 2009. All the patients underwent total hip arthroplasty with bone grafting or titanium cage for bone defect of the acetabulum. Harris hip scoring system was used for evaluating the functional recovery of the hip joint. Thirty three cases had an average of 47 months follow-up. No prosthesis was loosened and the function of hip joint was improved obviously with the Harris hip scores improving from 43.5 to 87.6. However, there were one case of sciatic nerve injury and four cases of heterotopic ossification postoperatively. Total hip arthroplasty might be an effective treatment of acetabular malunion with traumatic arthritis. Proper evaluation and reasonable reconstruction of acetabular defect as well as reasonable selection of prosthesis are essential to obtain an excellent outcome