Treatment of displaced humeral supracondylar fractures in children with external fixation using plaster or splint / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the therapeutic effects of closed reduction and external fixation (plaster or splint) for the treatment of displaced humeral supracondylar fractures in children.</p><p><b>METHODS</b>From March 2007 to September 2009,33 children (15 female and 18 male) with humeral supracondylar fractures treated in our hospital, ranging from 3 to 12 years old with an average of 6.4 years old. All the fractures were extension-type injuries, the flexion injures were excluded in our study. The humeral supracondylar fractures were classified according to Gartland classification. There were 21 Type H and 12 type III. In the initial treatment, all the patients were treated with closed reduction and external immobilization. The blood supply of the damaged upper extremity was evaluated before and after treatment. Clinical assessment was obtained at final follow-up using Flynn criteria, and radiologic assessment was obtained using Baumann and lateral humerocapitellar angles.</p><p><b>RESULTS</b>All the children were treated successfully with closed reduction in the initial time; 24 children maintained limb alignment by external immobilization. Nine patients lost position due to the swelling around the elbow which affected unstable external fixation during the follow-up, 5 of which were treated with a repeated closed reduction and internal fixation with Kirschner wires, 4 of which were treated with traction. Thirty-one patients had a satisfactory outcome and 2 patients had an unsatisfactory outcome according to the Flynn criteria at the latest follows-up.</p><p><b>CONCLUSION</b>Closed reduction and external stabilization is an important method for the treatment of displaced humeral supracondylar fractures in children. Making regular follow-up visits after closed reduction and casting is important for patients to maintain acceptable alignment, avoid complications and diagnose any loss of reduction.</p>

The applications of arthroscopy on malleolus fractures / 中华创伤杂志(英文版)

It was well known that in 1918 Takagi performed the first arthroscopic inspection of a cadaver's knee in Japan.(1) His interest in this area laid the foundation for arthroscopy and facilitated the development of arthroscope. In 1931, Burman reported an experimental study on the arthroscopic exploration of cadaveric joints, but he believed that the ankle joint was unsuitable for such techniques because it was too narrow to pass through the posterior puncture.(2) Unexpectedly, several years later Takagi described a routine method for arthroscopic examination of the ankle.(1) Since 1970's, ankle arthroscopy had made some significant progress after almost four decades of silence. In 1972, Watanabe reported 28 cases adopting his newly-developed fiberoptic arthroscope and described the anteromedial, anterolateral and posterior approaches.(3) Then, in 1976, Chen reviewed his experience with ankle arthroscopy on 67 patients and 17 cadavers. He elaborately analyzed the various compartments within the ankle and described their anatomy in detail.(4) Subsequently, many authors reported their experiences and techniques in this field.(5-9) In 2000, Hintermann addressed his experience of the arthroscopic application in acute fractures of the ankle.(10) Meanwhile, with rich knowledge about the anatomic portals, some advanced technologies, including video camera, fiberoptic light transmission, joint distraction by invasive or non-invasive means and instruments for small joints, make it possible to perform diagnostic and operative arthroscopy in the ankle.

Clinical significance of monitoring-flap in massive compound bone grafts for repairing massive bone defects in extremities / 中华显微外科杂志

Objective To explore the significance of designing with monitoring-flap in massive com- pound bone grafts for repairing massive bone defects in extremities.Methods From January 2001 to De- cember 2004,large bone defects in 19 patients(11 men and 8 women,age:6 to 35 years,mean age:18.6 years)were repaired by vascularized free fibular transplant with a monitoring-flap combining with massive deep frozen bone allografts.Average length of the bone defects was 16.6 cm(range,12 to 25 cm).A 7 days' con- tinuously clinical examination including observing the color,turgor,temperature,capillary refill,and bleeding after a needle sticking of the monitoring-falps were used postoperatively,if any one of these were abnormal,the circulation of the compound bone grafts must be in danger and some measures such as re-operation should be taken immediately.Dynamic image analysis was used for evaluating the bone union.Results One monito- ring-flap was vascular artieulo,and the articulo was relieved after exploration and resection of vein thrombus; another one was marginal part necrosis;the remains were normal.All of monitoring-flaps healed normally after 23.2 months(range,6 to 54 months)follow-up.15 patients had the radiographic evidence of bone unions 3 months after surgery.11 patients had been removed intermal fixation,complete bone unios were found one year postoperatively.Conclusion Designing with monitoring-flap in massive compound bone grafts for repairing massive bone defects,and can clearly understand the circulatory statue of compound bone grafts and early pre- dict the final results of massive bone allografts.