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Objective:To evaluate natural reduction at prone position in the treatment of femoral subtrochanteric fractures with intramedullary nailing.Methods:The clinical data of 7 patients with subtrochanteric fracture were retrospectively analyzed who had been treated at Orthopaedic Department, Beijing Tsinghua Changgung Hospital from August 2016 to April 2018. They were 4 males and 3 females, aged from 31 to 87 years (average, 55.6 years). Their fractures happened on the left side in 3 patients and on the right side in 4. By the Seinsheimer classification, there were 3 cases of type Ⅱ, 2 cases of type Ⅲ and 2 cases of type Ⅴ. The time from injury to surgery ranged from 9 to 44 hours, averaging 26 hours. All patients were treated by intramedullary nailing after natural reduction at prone position. Their preoperative preparation time, time required for reduction, total operation time, fluoroscopic frequency for guide pin insertion, fluoroscopic frequency for reduction, reduction quality, complications and curative effect were recorded.Results:Closed reduction and intramedullary nail fixation were completed uneventfully in all the 7 cases. Their preoperative preparation time averaged 29.4 min (from 21 to 42 min), reduction time 6.3 min (from 3 to 10 min), and total operation time 157 min (from 82 to 275 min). Their fluoroscopic frequency averaged 37 times (from 14 to 96 times) for guide pin insertion and 23 times (from 10 to 49 times) for reduction, totaling 244 times (from 121 to 360 times). According to the modified Baumgaetner criteria, the fracture reduction was evaluated as excellent in 6 cases and as fair in one. The 7 patients were followed up for 12 to 34 months (mean, 20.1 months). A drill broke at the interlocking nail hole during operation in one patient, deep venous thrombosis occurred at a lower extremity in another during hospitalization, and fracture nonunion was observed after operation in another, but no complications related to the prone position were observed. The curative effect evaluated by Harris hip score at the last follow-up was excellent in 4 cases, as good in 2 cases and as fair in one.Conclusion:In the treatment of femoral subtrochanteric fractures with intramedullary nailing, the prone position benefits natural reduction and maintenance of reduction and allows convenient fluoroscopy and nail placement during operation, especially for obese patients.
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Objective A retrospective study of GCTTS in the hand was undertaken to determine whether specific clinic or pathologic factors were associated with an increased risk of recurrence, and to investigate the relationship between the recurrence of GCTTS and its biological indices. Methods 83 patients with histologically proven GCTTS were treated and followed up. The clinical materials were reviewed. Comparison was made between certain factors to determine which were associated with increased recurrence rates. Results The patients were followed for an average of 55 months. 22 patients (26.5%) recurred. Age, gender, site, the origin of tumors, size, bone erosion or destruction, cellularity and the mitoses were not risk factors for recurrence. Tumors without capsule had higher recurrence rate than that with capsule, and the difference was highly significant. The local recurrence rate of Nm23 positive group was 28.3%, and Nm23 negative group was 19.2%, there was no remarkable difference between the groups. The PCNA-LI was 0.448?0.130 in recurrent group and 0.358?0.147 in nonrecurrent group, the difference was statistically significant. The aneuploidy DNA content was presented in 50% of the recurrent tumors, and in 23.2% of nonrecurrent ones. The SPF was 6.98?4.64 in recurrent group and 4.70?2.49 in nonrecurrent group. These values were also significantly different. PCNA-LI, the aneuploidy DNA content and SPF were significantly higher in group without capsule than those in group with capsule. These values were not different between tumors with and without bone destruction, large and small diameter, high and low cellular tumors, as well as high and low mitoses tumors. Conclusion The high proliferative indices of recurrent GCTTS may explain its aggressive biologic behavior. Tumors without capsule possess higher proliferative indices than the ones with capsule, and they have higher recurrent rate. The proliferative indices of the tumors with and without bone distruction are comparable, and the difference of the recurrence rate among groups is not significant.
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Objective Twenty- four case of non- traumatic paralysis of radial nerve were reviewed. Methods Between 1985 and 2000, 24 patients with non- traumatic paralysis of radial nerve were referred to this hospital for treatment. There were 18 men and 6 women with a mean age of 38 years (range, 10 to 65 years). Eleven patients had occupations with unduly stress of the forearm. Tendon transfer was performed in 1 patient, operative neurolysis in 18, nerve- grafting in 3, neurorrhaphy in 2. Results Of the 12 patients with the palsy attributed to entrapment of the fibrous edge of muscles, 8 occurred at the supinator, 1 at the tendinous edge of extensor digitorum communis and 3 at multiple sites.The palsy was caused by marked constrictions of the nerves in 5 patients, by benign tumors or tumorous conditions in 4 (by a ganglion in 2, by lipoma in 1 and by haemangioma in 1), by a neurilemmoma on the nerve in 1. The cause was unknown in 1. The patients who accepted neurolysis were followed up from 6 months to 15 years postoperatively. An excellent or good functional result was documented in 14 patients, fair in 3, and poor in 1. The patients who were treated with neurorrhaphy or nerve- grafting were followed- up from 4 months to 6 years, 3 recovered completely, 2 were in the convalescent stage (1 was treated by nerve- grafting and the other by neurorrhaphy). Conclusion The etiology of non- traumatic paralysis of radial nerve was miscellaneous. The results of surgical treatment were satisfactory.
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Objective To observe the results of free medialis pedis mini-flap pedicled on medial branch of deep branch of the medial plantar artery to repair a soft tissue defect of finger. Methods The mini-flap designed on the medial side of the foot pedicled on the medial branch of deep branch of medial plantar artery was used to repair the soft tissue defect of finger or the degloved injury of the finger combined with second toe flap, furthermore, the vascular pedicle of flap was anastomosed with the digital artery and dorsal vein respectively. 13 fingers of 11 cases, which included 10 fingers of 8 cases of male and 3 fingers of 3 cases of female with an average of 32 years ranging from 18 to 58 years, were performed 13 free medialis pedis mini-flaps transplantation. Eight free medialis pedis mini-flaps were used to repair the soft tissue defect of the finger, and 5 free medialis pedis mini-flaps combined with the second toe composite flap were used to reconstruct the degloved finger. Results All the patients were followed up on an average of 21 months ranging from 3 months to 5.5 years. The maximal area of flaps was 5 cm?4 cm, and the minimal was 2.5 cm?3 cm. 12 of the 13 free medialis pedis mini-flaps were survived completely, however, 1 healed but partly necrosis. The color, character and thickness of this flap after transplantation were similar to the skin of the finger; and the appearance of the reconstructed finger by mini-medialis pedis flap and second toe composite flap was perfect. The transplanted skin of donated areas survived well, and the appearance and functions of donated feet were not affected significantly. Conclusion The free medialis pedis flap pedicled on medial branch of the deep branch of the medial plantar artery was one of the optimal flaps to repair soft tissue defect of the finger especially on the palmer side.