Gradual traction-unlocking closed reduction technique for Tile C old pelvic fractures / 中华创伤骨科杂志

Objective:To explore the technical points and efficacy of gradual traction-unlocking closed reduction technique (GT-UCRT) for Tile C old pelvic fractures.Methods:From August 2012 to June 2021, 6 patients with Tile C old pelvic fracture were treated and followed up at Department of Orthopedics, The Fourth Medical Center, General Hospital of Chinese PLA. They were 4 males and 2 females with an age of (35.8±10.5) years. By Tile classification: 4 cases of type C1.2, 1 case of type C1.3, and 1 case of type C2; time from injury to surgery: 153.8 (64.3, 204.8) days. The 6 patients were treated with GT-UCRT. The time for gradual traction reduction, operation time, hospital stay, intraoperative blood loss and complications were recorded. The modified Matta score was used to evaluate the reduction quality of pelvic fractures, and the Majeed score was used to evaluate the pelvic function at the last follow-up.Results:The 6 patients were followed up for (40.3±22.9) months (from 12 to 72 months) after surgery. The time for gradual traction reduction was (26.7±4.6) days, operation time (119.2±4.6) minutes, hospital stay (11.5±2.9) days, and intraoperative blood loss (533.3±189.6) mL. By the modified Matta score, the pelvic reduction after surgery was rated as satisfactory in 5 cases and as unsatisfactory in 1 case. The length disparity between both lower limbs in the 6 patients was (6.9±1.6) cm before surgery and (1.0±0.4) cm immediately after surgery, showing a statistically significant difference ( t=11.135, P<0.001). One fracture healed 3 months after surgery and 5 fractures 6 months after surgery. The Majeed pelvic score at the last follow-up was (80.8±9.0) points for the 6 patients, yielding 2 excellent cases, 3 good cases and 1 fair case. Delayed wound healing was reported in 1 patient, calf intermuscular venous thrombosis in 2 cases, and emotional anxiety and sleep disorder in 1 patient. No new lumbosacral plexus injury was found in any patient. Conclusions:In the treatment of Tile C old pelvic fractures, since our self-designed GT-UCRT combines the advantages of Ilizarov technique and unlocking closed reduction technique, it can not only protect the lumbosacral plexus but also obtain satisfactory reduction of the fracture.

Cannulated screws with sutures for treatment of transverse patellar fractures / 中华创伤骨科杂志

Objective:To evaluate the clinical efficacy of cannulated screws with sutures in the treatment of patellar transverse fractures.Methods:A retrospective analysis was performed of the data of 70 patients with patellar transverse fracture who had been admitted to Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital from January 2017 to March 2021. According to the construction methods for the tension band, the patients were divided into 3 groups. In group A of 21 cases subjected to fixation with cannulated screws with sutures (Fiber-Tape), there were 8 males and 13 females with a median age of 55.0 (48.0, 65.0) years; in group B of 32 cases subjected to fixation with Kirschner wire tension band, there were 15 males and 17 females with a median age of 52.5 (41.5, 63.0) years; in group C of 17 cases subjected to fixation with Cable-Pin system, there were 5 males and 12 females with a median age of 55.0 (37.0, 65.0) years. The 3 groups were compared in terms of complications, secondary surgery (removal of internal fixation), operation time, intraoperative blood loss and knee function rated by the Lysholm and B?stman scores at the last follow-up.Results:There were no significant differences in the preoperative general data between the 3 groups, showing they were comparable ( P > 0.05). There was no significant difference in the operation time, intraoperative blood transfusion or follow-up time among the 3 groups ( P > 0.05). The incidence of soft tissue irritation [4.8% (1/21)] and the secondary operation rate [4.8% (1/21)] in group A were significantly lower than those in group B [43.8% (14/32) and 37.5% (12/32)] and group C [41.2% (7/17) and 35.3% (6/17)] ( P < 0.05), but there was no statistically significant difference between group B and group C ( P > 0.05). In groups A, B and C, respectively, the Lysholm knee score was 84.0 (69.0, 88.0), 89.0 (71.5, 95.0) and 82.0 (63.0, 90.0), and the B?stman knee score 26.0 (23.0, 28.0), 26.5 (24.0, 27.5) and 26.0 (22.0, 28.0), showing no significant difference ( P > 0.05). There was no significant difference either in the incidence of other complications among the 3 groups ( P > 0.05). Conclusion:In the treatment of patellar transverse fractures, compared with the Kirschner wire tension band and Cable-Pin system, cannulated screws with sutures (Fiber-Tape) may lead to a lower incidence of soft tissue irritation and a lower rate of secondary surgery, but no significant differences in operation time, intraoperative blood loss, other complications or postoperative functional scores.

A new minimal incision suture technique for acute close rupture of Achilles tendon / 中华创伤骨科杂志

Objective To investigate the clinical efficacy of a new minimal incision suture technique in repair of acute close rupture of Achilles tendon.Methods From August 2008 through October 2014,134 patients with acute close rupture of Achilles tendon were treated with a self-designed minimally invasive suture technique at our institution.They were 130 men and 4 women,with an average age of 37.4 years (range,from 18 to 52 years).The left side was injured in 93 patients and the right side in 41.The interval from injury to surgery was 1 to 7 days (average,2.5 days).The tendon rupture was located at 4.5 to 6.3 cm proximal to its insertion in 133 patients,and at 1.2 cm in one.With the ankle held in full plantar flexion,a 1.0 to 1.5 cm transverse incision was made over the palpable defect.Forceps were then used to mobilize the tendon from beneath the paratenon.The safe puncture site was determined by course and distribution of the sural nerve indirectly located by magnetic resonance imaging (MRI).Ethicon MB66 nonabsorbable suture was passed diagonally through the tendon bulk under epidural puncture needle guidance.The proximal and distal ends of the suture were tied together and buried.The tendon ends were apposed through the transverse incision.Postoperative individual rehabilitation was established based on pathological differentiation for tendon tissue.Results All the patients were followed up for 8 to 48 months (average,19.6 months).All the wounds healed at the first stage.No complications happened related to incision.The nervus suralis was injured in 3 patients;tendon re-rupture occurred in 4 patients,3 of whom received re-operation and one of whom conservative treatment.Their American Orthopaedic Foot and Ankle Society (AOFAS) scores averaged 99.6,giving a good to excellent rate of 100％ (133excellentcasesandonegoodcase).According to the Arner-Lindholm evaluation criteria,ankle function was excellent in 99 cases,good in 34 ones and poor in one,giving a good to excellent rate of 99.3％.Conclusion The new minimal incision suture technique is worthy of promotion in repair of ruptured Achilles tendon,because it is simple and reliable,does not interfere with the blood circulation to the Achilles tendon,prevents such complications as sural nerve injury and recurrent rupture,and leads to little adhesion and quick functional recovery.

Different managements of complete rupture of the deltoid ligament associated with supination-external rotation ankle fracture / 中华创伤骨科杂志

Objective To investigate the clinical outcomes of different managements of complete rupture of the deltoid ligament associated with supination-external rotation ankle fracture.Methods From January 2010 to June 2014,33 cases of complete rupture of the deltoid ligament associated with supination-external rotation ankle fracture were treated with open reduction and internal fixation.According to the different managements of the complete rupture of the deltoid ligament,the patients were divided into 4 groups:9 cases in the non-repair group,7 cases in the superficial layer repair group,9 cases in the deep layer repair group,and 8 cases in the complete repair group.All the patients took anteroposterior,lateral and gravity stress radiographs preoperatively and postoperatively.The 4 groups were compatible in preoperative general data (P ＞ 0.05).The 4 groups were compared in terms of operation time,medial clear space and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.Results All the patients were followed up for 6 to 18 months (average,13.7 months).All wounds healed at the first stage without any infection.All fractures united primarily after 3 to 9 months (average,4.7 months).The operation time for the superficial layer repair group was significantly longer than for the non-repair group,but significantly shorter than for the deep layer repair and the complete repair groups (P ＜ 0.05).In gravity stress radiographs,there was no significant difference in medial clear space among the 4 groups (P ＞ 0.05),but there were significant differences before and after operation in the 4 groups (P ＜ 0.05).The postoperative AOFAS ankle-hindfoot score in the repair groups was significantly higher than in the non-repair group and the superficial layer repair group(P ＜ 0.05).Conclusion To achieve satisfactory outcomes for patients with complete rupture of the deltoid ligament associated with supination-external rotation ankle fractures,anatomic open reduction and rigid internal fixation is necessary,and repair of the deltoid ligament,especially its superficial layer,is a valuable contribution.

Contrasted enhancement and 3D reconstruction CT anatamy of the intertransverse area of lumbar spine / 中国矫形外科杂志

L3、4,and there was no significatant difference between two sides,and the biggest inner diameter of the main vessels averaged 5.3?0.6 mm.[Conclusion]To begin with,the blood supply is adequate in the intertransverse area,and the distribution of blood vessels follows some regularities,so to be familiar with the anatomy and to operate carefully can reduce bleeding.In addition,ILIF in segment L3、4 and L4、5 is feasible.

X-ray Diagnosis of Solitary Globular Lesion of Lung / 实用放射学杂志

Objective To promote the understanding of X-ray examination in the diagnosis of solitary globular lesion of lung.Methods Of 402 cases with solitary globular lung lesion, 398 were proved by operation,pathology and 4 cases of lung abscess were proved by clinical therapy. Anteroposterior radiogrphs were taken in all cases;lateral radiogrphs were taken in 368 cases.Results Of these cases ,there were peripheral lung cancer 96,tuberculoma 33,lung echinococcosis 253, lung abscess 9, pulmonary metastatic carcinoma 3.There were no characteristic signs in the rare diseases. Therefore , it's difficult to diagnose these lesions. The rare diseases include inflammatory pseudotumor 2, pulmonary hamartoma 2 , lung sarcoma 2 , pneumoblastoma 1 and lung fibroma 1. Conclusion X-ray examination is important in the diagnosis of solitary globular lung lesion.