The analysis of the therapeutic effect for 10 cases of type C extreme distal radial fracture in micro needle plate internal fixation / 中国骨伤

OBJECTIVE@#To analyze the clinical outcomes of mini-plate combined with wireforms in the treatment of Type C distal radial fractures with marginal articular fragments.@*METHODS@#This retrospective study included a total of 10 cases, including 5 males and 5 females, with 6 cases involving the left side and 4 cases involving the right side, of Type C distal radial fractures with marginal articular fragments. The age of the patients ranged from 35 to 67 years old. All patients underwent surgical treatment utilizing mini-plate combined with wireforms for internal fixation.@*RESULTS@#The follow-up period ranged from 6 to 18 months. Complete fracture healing was observed in all cases, with healing times ranging from 10 to 16 weeks. During the entire follow-up period, patients reported high levels of satisfaction with the treatment outcomes, and there were no incidences of incision infection, chronic wrist pain, or wrist traumatic arthritis. At the final follow-up assessment, the Mayo score for the wrist joint ranged from 85 to 95, with 7 cases rated as excellent and 3 cases as good.@*CONCLUSION@#Mini-plate combined with wireforms proves to be an effective fixation method for Type C distal radial fractures with marginal articular fragments. The early initiation of wrist joint exercises, strong fixation, maintenance of proper reduction, minimal complications, and high rates of excellent and good outcomes demonstrate the reliability and efficacy of this treatment approach.

Basic and clinical research progress in pulmonary alveolar microlithiasis / 医学研究生学报

Pulmonary alveolar microlithiasis (PAM) is a rare genetic disease characterized by calcifications within the alveoli in the lung. Mutations in SLC34A2 gene, which encodes a type IIb sodiumphosphate cotransporter, are responsible for PAM, leading to the intra-alveolar accumulation of phosphate which favors the formation of microliths. A "sandstorm" appearance is the typical radiographic presentation of PAM. The hallmark of this disorder is clinical-radiological dissociation, with typical imaging findings, specific pathological findings and closely correlated specific genetic mutations. The disease has an insidious onset, runs a chronic course and the prognosis is poor. There is no effective treatment except for lung transplantation. This article summarizes the epidemiology, molecular genetics and clinical features of pulmonary alveolar calculi.

Clinical outcomes of buttress plating in treating posterior Pilon fractures through modified posteromedial approach / 中国骨伤

<p><b>OBJECTIVE</b>To explore clinical outcomes of buttress plating in treating posterior Pilon fracture by amodified posteromedial approach.</p><p><b>METHODS</b>From July 2014 to January 2015, 10 patients with posterior Pilon fracture were respectively analyzed, including 7 females and 3 males, aged from 31 to 54 years old. One patient were type , 3 patients were type IIand 6 patients were type III according to classification of Pilon fracture by YU Guang-rong. All patients were treated by buttress plating through amodified posteromedial approach. Postoperative complications, fracture healing and reduction were observed, AOFAS score were used to evaluate function recovery at 1 year after operation.</p><p><b>RESULTS</b>All patients were followed up for 12 to 18 months with an average of(14.1±3.2) months. All incisions were primarily healed at stage I without wound complication, neurovascular injuries or musculus flexor contracture. According to Burwell-Charnley imaging scoring, 8 patients got anatomical reduction and 2 patients got moderate reduction. All fracture got healing from 12 to 16 weeks with an average of(13.2±1.8) weeks. According to AOFAS score at 1 year after operation, 8 got excellent results and 2 moderate. All patients returned to work at about(4.7±1.4) months (ranged from 3 to 6 months) after operation.</p><p><b>CONCLUSIONS</b>Buttress plating using a modified posteromedial approach in treating posterior Pilon fractures is an effective method, has less complications, and could recovery early weight-bearing functional exercise.</p>

Treatment of chronic anterolateral ankle instability by reconstructing lateral ligament with semitendinosus autograft / 中国骨伤

<p><b>OBJECTIVE</b>To investigate clinical effects of chronic anterolateral ankle instability by reconstructing lateral ligament with semitendinosus autograft.</p><p><b>METHODS</b>From September 2014 to November 2016, 28 patients with chronic anterolateral ankle instability underwent lateral ligament reconstruction with semitendinosus autograft. Among them, including 20 males and 8 females with an average age of 28.6 years(18 to 47 years old). Preoperative complications were recorded. AOFAS and VAS score were used to evaluate clinical outcomes.</p><p><b>RESULTS</b>Twenty-eight patients were followed up from 6 to 28 months with an average of 18.2. No iatrogenic fracture or infection occurred. There was no ankle instability or limited at the latest follow-up. AOFAS score was improved from 53.1±6.8 before operation to 90.4±5.9 at the latest follow-up , and had statistical difference(<0.05); while VAS score was increased from 6.3±1.7 before operation to 0.8±0.5 at the lastest follow-up(<0.05).</p><p><b>CONCLUSIONS</b>Chronic anterolateral ankle instability by reconstructing lateral ligament with semitendinosus autograft has advantages of simple operation, good recovery, less compilations and good clinical effects. It is one of stable methods for the treatment of chronic anterolateral ankle instability.</p>

Thickening of the long bone: mechanisms and clinical implications / 中国组织工程研究

BACKGROUND:The thickening of living bone is an important natural rule,and genetic,nutritional and endocrine factors play critical roles in the bone thickening;however,these factors are site-blind.OBJECTIVE:To analyze the mechanism underlying the thickening of the long bone.METHODS:Clinical cases and literature were analyzed.Medline and CNKI databases were retrieved using the keywords of "bone growth in width,skeletal thickening,bone thickening,periosteal apposition" in English and Chinese,respectively.Totally 12 eligible articles were included for result analysis.RESULTS AND CONCLUSION:The mechanical environment of the bone plays a key role in the bone remodeling,which is a site-specific process.The thickening of the long bone is completed through the periosteal apposition,and the coupling effect of stress-angiogenesis-osteogenesis induced by overloading is the pathological basis of bone thickening.The periosteal apposition and periosteal resorption belong to a lifelong dynamic process,and the bending stress is the most important factor to maintain the periosteal osteogenesis.If the bone is shielded from bending stress to a certain extent by the metal fixators,it may lead to bone resorption and thinning,nonunion and other serious consequences.Therefore,the strength of the fixators should match the patient body mass and the thickness of the bone.The marrow cavity is a natural low stress region,so intramedullary fixation theoretically has little effect on the width growth of bone.

Case-control study on the efficacy of preoperative recombinant human erythropoietin administration for reducing transfusion requirements in elderly patients undergoing elective surgery for femoral intertrochanteric fractures / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate preoperative application of recombinant human erythropoietin (rHuEPO) in reducing transfusion requirements in elderly patients undergoing elective surgery for femoral intertrochanteric fractures.</p><p><b>METHODS</b>From January 2011 to December 2013,442 cases of elderly patients with femoral intertrochanteric fracture were retrospectively reviewed. According to inclusion and exclusion criteria, 119 cases were eventually included and divided into the treatment group and the control group. There were 12 males and 40 females, with a mean age (71.4 ± 12.8) years old, and the patients received preoperative administration of rHuEPO 10,000 U qod combined with iron dextran 200 mg (3 times each day). While 16 males and 51 females in control group, with a mean age (70.9 ± 16.2) years old, and the patients only received preoperative administration of iron dextran 200 mg (3 times each day). All the patients received closed reduction and PFNA-II or Internal fixation surgeries. The perioperative blood transfusion rate, average amount of blood transfusion, postoperative complications, the length of hospital stay and mortality within 30 days were compared between the two groups.</p><p><b>RESULTS</b>There were no statistical differences between two groups in the baseline indexes (P > 0.05). Overall,71 of 119 patients (59.7%) received at least one unit allogeneic blood transfusion (ABT). However,there were significant differences in perioperative ABT rates (48.1% vs 68.7%, χ2 = 4.77, P < 0.05) and the average amount of blood transfusion between treatment group and control group, which were (1.8 ± 0.4) U/pte vs (3.6 ± 1.1) U/pte (t = 2.244, P < 0.05). Postoperative hemoglobin (Hb) on postoperative days 7 and 30 was higher in treatment group than that in control group. In addition, in treatment group, Hb levels were higher on postoperative day 30 than those on admission, which were (128.2 ± 20.6) g/L vs (118.2 ± 18.9) g/L (t = 2.133, P < 0.05). There were no statistical differences in postoperative complications, the length of hospital stay and mortality within 30 days.</p><p><b>CONCLUSION</b>For elderly patients with femoral intertrochanteric fractures undergoing elective surgery, preoperative application of rHuEPO can significantly reduce perioperative transfusion requirements, and is likely to reduce ABT-related infection, but its long-term safety remains to be evaluated.</p>

Tibial intramedullary nailing using a suprapatellar approach for the treatment of proximal tibial fractures / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical efficacy of semiextended intramedullary nailing of the tibia using a suprapatellar approach for proximal tibial fractures.</p><p><b>METHODS</b>From January 2013 to January 2014, a total of 16 patients with unilateral proximal tibial fractures, 14 males and 2 females, underwent closed reduction and internal fixation with TRIGEN™ META-NAIL™ via the suprapatellar approach. The average age was 42.2 years old (ranged, 26 to 57 years old). Radiographic and clinical follow-up examinations were performed at a minimum of 1 year after surgery. Measurements included surgery time, complications, bone healing time, tibial alignment, knee range of motion, pain scoring (visual analogue scale) and functional outcome (Lysholm knee score).</p><p><b>RESULTS</b>The average surgery time was (75.7±8.3) minutes (ranged, 65 to 95 minutes). No obvious complications were recorded. Average duration of follow-up was (15.6±8.1) months (ranged, 12 to 24 months). Fifteen patients attained radiological bone union for a mean time of (3.6±1.8) months (ranged, 3 to 5 months). At the final follow-up, all tibial alignments were good, and no patients complained of anterior knee pain. Mean arc of knee motion was (124.4±18.8) degrees for the affected extremity compared with (127.5±16.7) degrees for the contra-lateral knee. The total scores of Lysholm knee score ranged from 77 to 92, average 86.4±12.3.</p><p><b>CONCLUSION</b>For proximal tibial fractures,the semiextended intramedullary nailing technique via a suprapatellar approach can obtain satisfactory clinical outcomes with simplicity in reduction and fixation, minimal complications, and good recovery of limbs function.</p>

Early effect of induced membrane technique for the reconstruction of chronic osteomyelitis defects in limbs of adult patients / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the early clinical efficacy of induced membrane technique for reconstruction of large bone defects after debridement in adults with chronic osteomyelitis of limbs.</p><p><b>METHODS</b>From March 2010 to March 2012,a total of 23 adult patients with chronic osteomyelitis of limbs were treated in our department. There were 15 males and 8 females, with a mean age 35.2 years old (ranged from 26 to 49 years old). Sixteen patients had open fracture history. According to the lesion site, there were 12 cases of tibia, 7 cases of femur, 3 cases of humerus, and 1 case of both radius and ulna. Among them, 19 patients had diseases in diaphysis and 4 patients in the metaphysis. The mean interval from infection to operation was 6.9 months (ranged from 4 to 13 months). All the patients were treated by using induced membrane technique. The follow-up evaluation included clinical complications, time of bone healing and limbs function. The Chinese version of SF-36 scores was used in the assessment of quality of life pre- and post-operation.</p><p><b>RESULTS</b>The average duration of follow-up was (27.6 ± 5.3) months (ranged from 18 to 43 months). Two patients had postoperative flap edge necrosis, 1 patient had superficial iliac incision infection, no obvious complications were recorded. Twenty patients obtained radiological union at a mean time of 4.6 months (ranged from 3 to 7 months). Among them, 16 patients treated with lower limbs surgery achieved full weight-bearing at about 5.2 months (ranged from 4 to 8 months) postoperatively. Four patients suffered from reinfection during follow-up, but 3 of them achieved complete bone healing after the second surgeries with induced membrane technique. At the final follow-up, there was a substantial improvement in each dimension scores and total scores of SF-36 as compared with those before surgery.</p><p><b>CONCLUSION</b>When treating with adult chronic osteomyelitis of limbs, the induced membrane technique can effectively reconstruct large bone defects after debridement, significantly shorten treatment cycle, provide satisfactory results with minimal complications, promote good recovery of limbs function and require relatively simple operation technique.</p>

Acutrak headless compression screw fixation for the treatment of scaphoid non-union / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the early clinical and radiographic outcome of scaphoid non-unions treated with Acutrak headless compression screw.</p><p><b>METHODS</b>From January 2008 to July 2011,21 patients with scaphoid non-union were treated in our department. There were 18 males and 3 females with a mean age of (23.6 +/- 4.6) years; 12 cases were on right hand and 9 were on left. According to Herbert-Fisher classification, there were 10 cases with type D1, 7 cases with type D2, 3 cases with type D3, and 1 case with type D4. The mean time from injury to operation was (12.4 +/- 2.7) months. All patients were treated with Acutrak headless compression screw fixation (6 cases received 2 screws fixation, 15 cases received 1 screw fixation, and Matti-Russe bone grafting was applied in 7 cases). The carpal height, the scaphoid index and changes of the scapholunate angle were assessed before and after the operation. Range of motion and grip strength were recorded and the wrist function was assessed according to the Patient-Rated Wrist Evaluation (PRWE).</p><p><b>RESULTS</b>Average duration of follow-up was (21.3 +/- 3.6) months. All the patients attained radiological union in a mean time of (13.3 +/- 2.4) weeks following the operation. No obvious complications were recorded. The surgical treatment allowed the preoperative mean scaphoid index of 0.61 +/- 0.13 and the preoperative mean scapholunate angle of (59.4 +/- 6.8) degree to be improved to 0.69 +/- 0.10 and (44.3 +/- 8.2)degree postoperatively, respectively. There was a substantial improvement in grip strength and pain amelioration after surgery. The preoperative mean PRWE score of 45.2 +/- 4.7 was improved to 76.1 +/- 5.2 postoperatively. All patients returned back to the original work,the average time from surgery to work was (6.0 +/- 1.1) months.</p><p><b>CONCLUSION</b>For scaphoid non-unions, Acutrak headless compression screw fixation can provide anatomical reduction, provide satisfactory results with a high union rate, well return of function and minimal complications in the early stage.</p>

Outcome of accessory navicular fusion for the treatment of the painful accessory navicular bone of type II in adults / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical outcome of accessory navicular fusion for treatment of the painful accessory navicular bone of type II in adults.</p><p><b>METHODS</b>From June 2006 to June 2012, a total of 38 feet (in 35 adult patients) with painful accessory navicular with type I underwent an fusion operation of the primary and accessory navicular bones,including 26 males and 9 females with a mean age of (32.4±7.3) years old ranging from 18 to 44 years old. The course of disease ranged from 3 to 10 months. The perioperative complications and radiological outcomes were observed and recorded. The foot function before and after operation were assessed by the American Orthopedic Foot and Ankle Society (AOFAS) midfoot score, and the easement of the pain was evaluated by visual analog score (VAS).</p><p><b>RESULTS</b>Two patients had transient superficial inflammation of the incision, no obvious perioperative complications occurred. All patients were follow-up for (53.5±14.7) months (12 to 84 months). Bone union was confirmed on plain radiography in 32 cases (35 feet). The mean time from the operation to union was (13.7±2.3) weeks (9 to 18 weeks). Postoperative pain VAS score was improved obviosly than preoperative (V=12.14,P< 0.01). The talar-to-first metatarsal angle [(9.4±3.5)° vs (8.3±2.7)°, t=0.736, P>0.05)], calcaneal tilt angle [(17.7±2.2)° vs (18.9±3.4)°, t=0.794, P>0.05],talonavicular uncoverage angle [(14.3±3.4)° vs(12.5?4.6)°,t=0.947, P>0.05) ],and height of the first tarsometatarsal joint [(14.8±3.1) mm vs (15.9±2.8) mm,t=0.814,P>0.05)] before and after operations had no statistic difference. The AOFAS midfoot score was improced from preoperative 45.6±5.3 to postoperative 82.5±7.4 (t=3.214,P< 0.01).</p><p><b>CONCLUSION</b>For the painful accessory navicular bone of type II in adults, if the patient has a large navicular bone and not complicated with rigid flatfoot, once the conservative treatment fails, fusion of the primary and accessory naviculars may be a successful intervention. Overall, the procedure provides reliable pain relief, definite foot function improvement, and good patient satisfaction.</p>

Minimally invasive transarticular plate osteosynthesis for type C fractures of distal femur / 中华创伤骨科杂志

Objective To report the clinical results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in treatment of type C fractures of distal femur.Methods A retrospective study was conducted to an- alyze 14 consecutive cases of distal femoral fractures who had been treated with MIPPO in our department from April 2002 to February 2005.According to AO/ASIF classification,there were three cases of type C1,six cases of type C2,and five cases of type C3.At first,the fractures of articular surface were directly reduced and fixed with spongy screws.Next,the condylar fractures were indirectly reduced and fixed with buttress or LISS (less invasive stabi- lization system) plates through transarticular approach.Results Follow-ups,ranging from 10 to 32 months for 12 cases,revealed that they all reached union.The time for their bony union was 10 weeks to 12 months (mean,4.6 months).Their functional recovery was evaluated according to criteria by Kolmert and Wulff.Four cases were rated as excellent,five as good,two as fair and one as poor.The total satisfactory rate was 75%.Conclusion MIPPO is a safe and effective procedure for the type C fractures of the distal femur with the benefits of limited invasion to soft tissues and a high rate of bone union.