Poking reduction cannulated screw for the treatment of SandersⅡ calcaneal fracture / 中国骨伤

OBJECTIVE@#To evaluate clinical effect of poking reduction cannulated screw based on Pingle orthopedic muscle-bone interoperability balance theory in treating Sanders Ⅱ calcaneal fracture.@*METHODS@#From October 2014 to December 2017, 28 patients with Sanders Ⅱ calcaneal fracture were treated with poking reduction cannulated screw guided by Pingle orthopedic muscle-bone interoperability balance theory, including 20 males and 8 females, aged from 24 to 55 years old with an average of (37.2±3.9) years old. Calcaneal width, Bhler angle, and Gissane angle were measured before and after operation, and Maryland Score before and 6 months after operation were compared.@*RESULTS@#All patients were followed up from 12 to 16 months with an average of (13.7±1.3) months. All fractures healed normally, and healing time ranged from 9 to 12 weeks with an average of (10.2±1.3) weeks. No postoperative wound infection, cortical necrosis, or osteomyelitis occurred. The width of the calcaneus decreased from (34.15±2.58) mm before surgery to (30.49±2.37) mm after surgery, Bhler angle increased from (14.16±3.27)° before operation to (31.95±3.07)°after operation, Gissane angle decreased from (128.45±9.04)° before operation to (120.83±8.15)° after operation. Maryland Score was 15.68±4.73 before operation, and was improved to 88.32±2.65 at 6 months after operation;19 patients got excellent result, 6 good, 2 fair and 1 poor.@*CONCLUSION@#Poking reduction cannulated screw based on Pingle orthopedic muscle-bone interoperability balance theory in treating Sanders Ⅱ calcaneal fracture has certain clinical effects, high acceptation of patient, and without special demand for soft tissue around fracture. But it should avoid choosing severe comminuted Sanders Ⅲand Ⅳcalcaneal fracture.

Synovial inflammation of a rabbit model of early-stage knee osteoarthritis induced by low concentration of papain at different time points / 中国组织工程研究

BACKGROUND:Synovitis plays an important role in the occurrence and development of early knee osteoarthritis.OBJECTIVE:To compare synovial inflammation in a rabbit mode of knee osteoarthritis induced by injecting low concentration of papain at different time points,thus providing reference for the study on synovitis in knee osteoarthritis.METHODS:Twenty-four New Zealand white rabbits were divided randomly into four groups,and received the injection of 0.5 mL mixture of 2％ papain with 0.03 mol/L L-cysteine into the right knee at 1,4 and 7 days,respectively.The model rabbits were respectively sacrificed at 1,2 and 3 weeks after the last injection,and the rabbits in the blank control group were killed at 3 weeks.The local skin temperature and circumference of the knee were recorded,and the synovium and infrapatellar fat pad were separated from the right knees for histopathological observation and ELSA.RESULTS AND CONCLUSION:At the 1stweek after modeling,joint effusion was significantly increased,local skin temperature and circumference of knee joint were higher than those at the 2nd,and 3rd weeks.The levels of interleukin-1,tumor necrosis factor-α and matrix metalloproteinase-13 in the synovium in the three experimental groups were higher than those in the blank control group at 1,2 and 3 weeks after modeling;the levels peaked in the 1st week,but no significant fluctuation appeared in the 2nd and 3rd weeks.There were synovial tissue hyperplasia,thickening,and inflammatory cell infiltration in the 1st,2nd and 3rd weeks,and the proliferation of synovial tissue increased significantly with time.These findings indicate that the intra-articular injection of low concentration of papain and 0.03 mol/L L-cysteine mixtures contributes to a rabbit model of knee synovial inflammation within 1 week,with significantly joint effusion.However,significant synovial tissue thickening and vascular hyperplasia are observed;meanwhile,the joint effusion is decreased obviously.

Treatment of type C3 distal radius fractures with AO 2.4 mm locking plate system after manipulative reduction / 中国骨伤

<p><b>OBJECTIVE</b>To summarize our experiences in the treatment of type C3 (AO/OTA) distal radius fractures fixed with AO 2.4 mm locking plates combined with percutaneous pinning after manipulative reduction.</p><p><b>METHODS</b>From May 2009 to March 2012, 19 patients (2 cases of both sides) with type C3 (AO/OTA) distal radius fractures were treated with volar locking plates combined with percutaneous pinning for distal radius after manipulative reduction. Among the patients, the average age was (45.3 ± 17.4) years old (ranged, 31 to 66 years old). The fracture were complicated with ulnar styloid fracture in 14 wrists and 6 wrists had distal radioulnar joint instability. All the patients had closed fracture and the mean duration was (6.7 ± 3.5) days (4.5 to 9 days). The Henry approach was applied to expose the fracture site. Joint capsule and ligaments were retained for indirect reduction. After indirect reduction, the poking reduction technique was used to correct the residual compression, and congruence of distal ulnar radial joint was verified under fluorscopic guidance. Styloid process was first pinned percutaneously and then AO 2.4 mm volar locking plate was used to support rigid fixation. The fractures complicated with distal radioulnar joint instability and ulnar styloid fracture were treated with forearm plaster support in supination for 6 weeks.</p><p><b>RESULTS</b>Nineteen patients (21 wrists) were followed up for an average duration of 10.5 months (ranged, 7 to 17 months). Radiographic bone union of distal radius was achieved in all cases, nonunion of the ulnar styloid occurred in 3 cases, and no distal radioulnar joint instability occurred. Tendon irritation was found in 2 cases and disappeared after the internal fixation was removed. The volar tilt, radial angle, radial length, incongruence of articular surface and distal radioulnar joint were observed at the follow-up. According to Batra and Gupta scoring system, 13 wrists were assessed to have a score of more than 80, 5 wrists 70 to 90, 3 wrists less than 70. Meanwhile, the subjective and objective evaluation was executed,range of motion of wrist, residual deformity and complications were observed. According to Sarmiento's modification of the system of Gartland and Werley, 17 wrists got an excellent result, 3 good and 1 fair.</p><p><b>CONCLUSION</b>Type C3 (AO/OTA) distal radius fractures could be managed with manipulative reduction. Locking plate internal fixation combined with percutaneous pinning can offer enough support for early mobilization and rehabilitation, resulting in a better clinical outcome and satisfactory prognosis.</p>