Repair of extremity soft tissue defects using anterolateral femoral flaps with versus without anastomosis of anterolateral femoral cutaneous nerve / 中华创伤骨科杂志

Objective:To analyze the necessity of anastomosis of the cutaneous nerve by comparing anterolateral femoral flaps with versus without anastomosis of the anterolateral femoral cutaneous nerve in the repair of extremity soft tissue defects.Methods:A retrospective analysis was made of the clinical data of 30 patients with extremity soft tissue defects who had been admitted to Department of Orthopedics, The Sixth People＇s Hospital affiliated to Shanghai Jiaotong University School of Medicine from September 2019 to March 2022. The patients were assigned into 2 groups according to whether the anterolateral femoral cutaneous nerve was anastomosed or not in the repair of extremity soft tissue defects using anterolateral femoral flaps. In the anastomosis groups of 14 cases, there were 7 males and 7 females, with an age of (46.4±15.2) years and a flap size of (22.4±7.3) cm×(8.5±1.3) cm. In the non-anastomosis group of 16 cases, there were 11 males and 5 females, with an age of (39.9±15.8) years and a flap size of (23.0±6.4) cm×(9.0±2.1) cm. The 2 groups were compared in terms of flap survival, Semmes-Weinstein recovery degree and area of monofilament tactile sensation, and time periods for temperature sensation and two-point discrimination.Results:There was no statistically significant difference between the 2 groups in the preoperative general data, showing they were comparable ( P>0.05). All the flaps survived completely without vascular crisis. In the anastomosis group, the time periods required for Semmes-Weinstein recovery of monofilament tactile sensation to the areas of 20.0%, 50.0%, and 80.0% [(2.5±0.7) months, (6.7±1.1) months, and (11.0±1.2) months] were significantly shorter than those in the non-anastomosis group [(3.6±1.3) months, (8.6±1.4) months, and (15.0±2.2) months], the recovery area at the last follow-up [100.0% (100.0%, 100.0%)] was significantly larger than that in the non-anastomosis group [84.6% (81.7%, 89.9%)], and the time period for recovery of temperature sensation [(3.9±0.7) months] significantly shorter than that in the non-anastomosis group [(6.1±1.1) months] (all P<0.05). The time for recovery of two-point discrimination in the 14 patients in the anastomosis group was (10.4±1.7) months while only 7 of the 16 patients in the non-anastomosis group recovered two-point discrimination after (14.7±1.4) months, showing a significant difference between the 2 groups ( P<0.05). Conclusion:In the repair of extremity soft tissue defects using anterolateral femoral flaps, compared with no anastomosis of the cutaneous nerve, anastomosis of the anterolateral femoral cutaneous nerve may ensure more or less the sensory recovery of the flaps.

Efficacy of staged treatment for calf Gustilo-Anderson type IIIC fracture / 中华创伤杂志

Objective:To evaluate the clinical efficacy of staged surgery in treatment of calf Gustilo-Anderson type IIIC fracture.Methods:A retrospective case series was conducted to analyze clinical data of 16 patients with calf Gustilo-Anderson type IIIC fracture admitted to Shanghai Jiao Tong University Affiliated Sixth People's Hospital from January 2017 to December 2019. There were 12 males and 4 females, with the age of (38.6±8.2)years (range, 18-53 years). All patients had limb salvage treatment at one stage in the emergency department. The survival of the limb and the occurrence of vascular crisis were examined within one week after limb salvage. The second stage involved the repair of skin and soft tissue defects with the defect area from 12.0 cm×5.0 cm to 20.0 cm×8.0 cm using free flaps. The survival of the flap, vascular crisis, and donor site healing within two weeks after the flap procedure. The third stage used bone graft revision and bone lengthening technology to repair bone tissue. The lower extremity functional scale (LEFS) and Mazur ankle joint function score were used to evaluate the function of the affected limb before bone repair and at the last follow-up. The fracture healing and related complications were observed at the last follow-up.Results:All patients were followed up for (14.2±4.6)months (range, 8-20 months). At one stage, the limb-saving surgery was successful in all patients, among which one had vascular crisis. At second stage, free flaps survived in all patients, among which two had vascular crisis. All donor areas were healed by first intention. At third stage, the LEFS of the affected limb was increased from (32.0±7.4)points before bone repair to (48.0±10.2)points at the last follow-up ( P<0.01) and the Mazur score was increased from (50.9±15.3)points before bone repair to (73.8±11.9)points at the last follow-up ( P<0.01). All bone defects were repaired and healed without complications such as infection or osteomyelitis at the last follow-up. Conclusion:For calf Gustilo-Anderson type IIIC fracture, the staged strategy can effectively save limbs and restore limb function.

Clinical application of posterior tibial artery perforator flap within saphenous nerve branch for sensory reconstruction / 中华显微外科杂志

Objective To explore the operative technique and clinical results of posterior tibial artery perforator flap within saphenous nerve branch for sensory reconstruction.Methods From January,2016 to June,2018,9 patients suffered from soft tissue defect were treated by the posterior tibial artery perforator flap containing saphenous nerve branch.Seven patients were males and 2 were females,with age ranged from 31 to 62 years.Soft tissue defects located in hands in 5 patients,plantar in 2 patients,ankle in 1 patient and dorsal foot in 1 patient.The size of soft tissue defects ranged from 8.0 cm×2.5 cm to 21.0 cm×4.0 cm.The regular post-operative followed-up was performed.Results All flaps survived without complications.The size of flap ranged from 10.0 cm×3.5 cm-23.0 cm×5.0 cm.Donor sites were primarily closed in 5 patients and secondary closed in 4 patients.Followed-up ranged from 6 to 15 months with 10 months in average.The contour of flaps were satisfied and the sensory function of the donor sites were normal.At 6 months followed-up,SW test reached 5.07 in all flaps,and 2PD ranged from 14 to 35 mm.Conclusion The novel sensory flap can provide satisfied sensory outcome without sacrificing main artery and saphenous nerve,and is a good candidate for sensory reconstruction of soft tissue defects.

Clinical effect analysis of palmar venous anastomosis in fingertip replantation / 中华显微外科杂志

Objective To investigate the feasibility and clinical effect of palmar venous anastomosis in fingertip replantation.Methods From October,2008 to May,2017,the clinical data of 15 patients with 24 finger replantation were retrospectively analyzed by outpatient,telephone and WeChat followed-up.One artery was anastomosed for revascularization with or without nerve repair,and 1 palmar venous anastomosis was performed to reestablish the outflow system.The finger nerve was sutured randomly according to the injury.Results The patients were followed-up for 18-65 (mean,39.9) months.Except for 1 replantation finger with rotation avulsed injury failed,the remaining 14 cases with 23 fingers survived completely.Excellent restoration of finger motion was observed during the follow-up.The mean regained static 2-point discrimination sensation was 3.6 (2.8-4.0) mm.All patients were satisfied with the treatment effect.Conclusion Successful palmar venous anastomosis can improve the survival rate of replanted fingertips,simplify postoperative care,reduce postoperative complications,and improve the treatment effect.

Osteotomy, bone shortening and lengthening by one stage with external fixation for a large bone defect following open femoral fracture / 中华创伤骨科杂志

Objective@#To evaluate osteotomy, bone shortening and lengthening by one stage with external fixation for a large bone defect following open femoral fracture.@*Methods@#From April 2014 to April 2019, 11 consecutive patients with a large bone defect following open femoral fracture were treated at Department of Orthopaedics, The Sixth People’s Hospital of Shanghai. They were 9 males and 2 females, with an average age of 40.5 years (from 18 to 70 years). The left side was involved in 6 cases and the right side in 5. All their primary open fractures had deteriorated into osteomyelitis and bone defects after treatment. Their bone defects averaged 60.5 mm after thorough debridement. Postoperative X-ray examinations were taken regularly. Bony union time and index, time till removal of external fixator, external fixation index, flap survival, soft tissue healing, visual analogue scale (VAS), Association for Studying and Application of Methods of Ilizarov (ASAMI) scores for bone healing and lower limb function were recorded.@*Results@#All the patients were followed up for 9 to 30 months (mean, 21.9 months). The bony union time averaged 10.5 months (from 5.2 to 22.3 months). The bony union indexes averaged 52.9 d/cm (from 33.4 to 73.3 d/cm). The time till removal of external fixator averaged 15.5 months (from 9.8 to 27.5 months). The external fixation indexes averaged 86.0 d/cm (from 60 to 113 d/cm). All the bone nonunions healed with no recurrence of osteomyelitis. Complications like union failure, refracture at ends of bone lengthening or fracture, or leg length discrepancy>2.5 cm, happened in none. The VAS scores ranged from 0 to 3 points. By ASAMI evaluation, the bony union was excellent in 10 cases and good in one case, and the lower limb function was excellent in 3 cases, good in 7 cases and fair in one.@*Conclusion@#Osteotomy, bone shortening and lengthening by one stage with external fixation is a reliable treatment for large femoral bone defects because this strategy can remove the lesions and restore the femoral length at the same time.

Osteotomy, bone shortening and lengthening by one stage with external fixation for a large bone defect following open femoral fracture / 中华创伤骨科杂志

Objective To evaluate osteotomy,bone shortening and lengthening by one stage with external fixation for a large bone defect following open femoral fracture.Methods From April 2014 to April 2019,11 consecutive patients with a large bone defect following open femoral fracture were treated at Department of Orthopaedics,The Sixth People's Hospital of Shanghai.They were 9 males and 2 females,with an average age of 40.5 years (from 18 to 70 years).The left side was involved in 6 cases and the right side in 5.All their primary open fractures had deteriorated into osteomyelitis and bone defects after treatment.Their bone defects averaged 60.5 mm after thorough debridement.Postoperative X-ray examinations were taken regularly.Bony union time and index,time till removal of external fixator,external fixation index,flap survival,soft tissue healing,visual analogue scale (VAS),Association for Studying and Application of Methods of Ilizarov (ASAMI) scores for bone healing and lower limb function were recorded.Results All the patients were followed up for 9 to 30 months (mean,21.9 months).The bony union time averaged 10.5 months (from 5.2 to 22.3 months).The bony union indexes averaged 52.9 d/cm (from 33.4 to 73.3 d/cm).The time till removal of external fixator averaged 15.5 months (from 9.8 to 27.5 months).The external fixation indexes averaged 86.0 d/cm (from 60 to 113 d/cm).All the bone nonunions healed with no recurrence of osteomyelitis.Complications like union failure,refracture at ends of bone lengthening or fracture,or leg length discrepancy ＞ 2.5 cm,happened in none.The VAS scores ranged from 0 to 3 points.By ASAMI evaluation,the bony union was excellent in 10 cases and good in one case,and the lower limb function was excellent in 3 cases,good in 7 cases and fair in one.Conclusion Osteotomy,bone shortening and lengthening by one stage with external fixation is a reliable treatment for large femoral bone defects because this strategy can remove the lesions and restore the femoral length at the same time.

Free fibular composite tissue flap with peroneus longus and brevis for complicated extremity trauma / 中华创伤骨科杂志

Objective To report our clinical application of free fibular composite tissue flap with peroneus longus and brevis in the treatment of complicated extremity trauma.Methods From August 2014 to September 2017,5 patients with complicated extremity trauma were treated using a free fibular composite tissue flap with peroneus longus and brevis at Department of Orthopaedics,The Sixth People's Hospital of Shanghai.They were 4 men and one woman,aged from 23 to 52 years (average,35.1 years).All of them had tendon defects;one had a radius defect,one an ulnar defect and three a tibial defect.The length of bone defects ranged from 8 cm to 18 cm;the size of soft tissue defects ranged from 10 cm × 5 cm to 18 cm × 8 cm.A fibular composite tissue flap was designed according to the soft tissue condition and defect area to repair and fixate the bone defect after thorough debridement and cover the wound before functional reconstruction.Postoperatively,survival of the flap and functional recovery of the corresponding tendon at the recipient site,healing time of the tibia,and wound healing,ankle motion and complications at the donor site were all observed.Results The 5 patients were followed up for 18 to 38 months (average,25.2 months).All flaps survived without any vascular crisis or infection.The union time for the fibular graft ranged from 4 to 16 months (average,8.4 months).In the 3 patients with a tibial defect,the maximum angle of dorsal extension ranged from 0° to 10° and no foot drop was observed.Thumb and digital flexion was reconstructed in the patients with a forearm bone defect only to achieve opposition of index finger and thumb but we failed to make them have a fist.At the 5 flap donor sites,the wound was sutured by the second stage after vacuum suction and healed well;obvious scar formed in one of them.No obvious foot varus was observed at the donor site.The patients were satisfactory with their ankle joint motion.No refracture of the fibular graft occurred during follow-up.Conclusion A free fibular composite tissue flap with peroneus longus and brevis is a good choice for complicated extremity trauma.

The development and present situation of limb replanting and reconstruction in China / 中国修复重建外科杂志

The replantation of amputated finger (or limb) and the reconstruction of the thumb and fingers started in 1960s in China. With the development of microsurgical techniques, both finger replantation and reconstruction achieved worldwide significant success. And now it is not the survival rate but the function of replanted finger that attracted more attention. Moreover, the breakthrough of particular type of digital replantation has broadened its indications. In terms of reconstruction, not only that a great deal of experiences in dealing with different types of thumb defects was accumulated, but also more micro-surgeons focus on minimal invasion and reducing the damage to the donor area.

Ten years retrospective study of using primary microsurgery technology to treat patients with severe lower extremities injury / 中华显微外科杂志

Objective To clarify the role of microsurgery in limb salvage procedure and its efficiency in long-term functional results through a retrospective review of patients who sustained severe injury of lower extremities and had been treated Shanghai 6th people's hospital, in recent 10 years. Methods Patients who sustained severe injury of lower extremities and treated with microsurgical techniques in January, 2006 to January, 2016 were studied. Patients' general information, classification of open fracture, and MESS were noted. The enrolled patients were divided into two groups (group A: primary microsurgical reconstruction;group B: non-microsurgical reconstruction ) according to whether primary microsurgical reconstruction was performed or not. Each group were also further divided into sub-group according to preoperative MESS (MESS<7 and MESS≥7). The reconstruction methods, hospitalization days, op-eration times, postoperative complications, as well as the SIP were then recorded for each groups. The differences of these data among each groups were analyzed and compared. Results The main objection was patient with Gustilo grade III open fracture, totally 548 patients were admitted, with 312 males and 236 females. The main age was 35.6 years old. The main etiology was road traffic accident (79.7％). There were 211 patients (38.5％) in group A, and 337 patients (61.5％) in group B. In group A, there were 37 patients in subgroup one (MESS<7), and 174 patients in sub-group two (MESS≥7). The rate of delayed amputation was 2.8％, while the complication rate was 11.8％. In group B, there were 181 patients in subgroup one(MESS<7), and 156 patients in subgroup two (MESS≥7). The rate of delayed amputation was 4.0％, while the complication rate was 13.3％. In long-term survey, the average VAS score of group B was higher than that of group A, but no significant difference was noted. The average VAS scores in 2 year postopera-tively in the subgroups (MESS≥7) were higher than those in the other subgroups (MESS<7). The results of SIP scores were similar with VAS scores in two groups. Conclusion The techniques of microsurgery has been promoting the successful rates and outcomes for limb salvage procedure over the recent decades. Meanwhile, the current evaluating system for se-vere limb injury needs to be updated to meet the demands of ever-developing limb salvage techniques.

Internal fixation combined with bone grafting for distal humeral nonunion / 中华创伤骨科杂志

Objective To evaluate the outcomes of internal fixation combined with bone grafting in the treatment of distal humeral nonunion.Methods This retrospective study included 48 patients who had undergone internal fixation combined with iliac bone grafting for distal humeral nonunion between January 2011 and December 2015 at Department of Orthopedic Surgery,The Sixth People's Hospital of Shanghai.They were 31 males and 17 females,with a mean age of 35.4 years (from 22 to 49 years).The outcomes were evaluated by clinical examination,X-ray film,Mayo elbow performance score (MEPS) and visual analogue scale (VAS) during follow-up.Results All the 48 patients were followed up for 18 to 60 months (mean,36 months).No wound-related complications were reported in this cohort.Solid bone union was achieved at 3 to 8 months (mean,4.2 months) after surgery.At the last follow-up,the range of elbow flexion-extension was improved from preoperative 66° to 101°,and the ranges of pronation and supination were enhanced from 65° and 45° preoperatively to 82° and 75°,respectively.The MEPS increased from 54 points preoperatively to 82 points postoperatively.The results were excellent in 26,good in 16 and fair in 6 cases (with an excellent to good rate of 87.5％).The VAS decreased from 4.5 points preoperatively to 1.2 points postoperatively,indicating notable relief of the elbow pain due to distal humeral nonunion.Follow-ups revealed no ulnar nerve injury,nonunion,heterotopic ossification,implant loosening or breakage,or instability of the elbow joint.Conclusion Internal fixation combined with bone grafting is reliable in treatment of distal humeral nonunion,leading to satisfactory outcomes.

Free chimeric vascularized fibular graft and sural flap for reconstruction of composite extremity defects / 中华创伤骨科杂志

Objective To report clinical application of free chimeric vascularized fibular graft combined with sural flap for reconstruction of composite extremity defects after open fracture.Methods From June 2010 to July 2014,free chimeric vascularized fibular grafts and sural flaps were used to treat 4 patients with composite extremity defects at Department of Orthopaedics,The Sixth People's Hospital.They were 3 men and one woman,aged from 39 to 61 years(average,48.5 years).There were 2 cases of soft tissue defects on the forearm complicated with radial defect,one case of soft tissue defects on the forearm complicated with ulnar shaft defect,and one case of soft tissue defects on the leg complicated with tibial defect.The length of bone defect ranged from 8 cm to 18 cm (average,13.0 cm);the size of soft tissue defects ranged from 22 cm × 6cmto23cm × 15 cm (average,22.3cm × 9.7cm).Results The area of flap ranged from 25 cm × 9 cm to 26 cm × 18 cm (average,25 cm × 13 cm);the length of fibular graft ranged from 8 cm to 18 cm (average,13 cm).The 4 patients were followed up for 8 to 42 months (average,20.5 months).All the chimeric flaps survived.All the fractures united after an average of 8.5 months.The last follow-ups revealed no refracture.All the patients were satisfied with the outcomes.Conclusion Free chimeric vascularized fibular graft combined with sural flap is a reliable choice for reconstruction of composite extremity defects after open fracture.

The combined use of flaps transfer and ilizarov technique reconstruct the large soft tissue defects and bone lose in the lower leg / 中华显微外科杂志

Objective To determine the outcome of the combined use of flaps transfer and ilizarov technique reconstruct the large soft tissue defects and bone lose in the lower leg.Methods Sixteen patients were identified from a retrospective review from July,2008 to July,2013,who suffered the large soft tissue defects and bone lose in the lower leg and underwent single-stage soft tissue and osseous reconstruction using the flap technique and Ilizarov method.There were 12 males and 4 females aged from 22 to 62 years old (average 42.6 years old).The size of soft tissue defect ranged from 8 cm×9 cm to 30 cm×20 cm.The length of the bone discrepancy ranged from 2 to 14 cm.According to the local condition of the lower leg and the size of the composite tissue defects,10 patients received the free flap covering,6 patients repaired by the saphenous neurocutaneous perforator flap (3 cases) and sural nerve neurocutaneous flap (3 cases).Daily monitoring the skin temperature postoperative.Distraction was commenced on postoperative day 10 to 14 at the rate of 1 mm/day and continued in 4 equal increments.Results The follow-up time ranged from 18 to 36 months.Sixteen flaps survived completed,only 1 flap was observed the venous congestion in postoperative day 2.The duration of ilizarov application ranged from 3.5 to 18.0 months.All patients achieved final union.All patients were satisfied with the outcome of the surgery.Conclusion The combined use of neurocutaneous flap and Ilizarov technique for reconstruction of large composite soft tissue defect in the lower leg.Significantly reduce patient treatment time,improving traction osteogenesis of long bones and the ability of resistance to infection.

Bone formation mediated by local administration of thymosin β4 in distraction osteogenesis / 中华创伤骨科杂志

Objective To explore the effect and mechanism of local administration of thymosin β4 (Tβ4) on bone regeneration in a distraction osteogenesis model of rat fenur.Methods Sixty Sprague-Dawley rats were randomly divided into groups A,B and C in this study.A distraction osteogenesis model was established in the left femur after osteotomy.At the end of distraction period,the bone regeneration area in group A was subjected to no treatment,that in group B to injection of phosphate buffer saline (PBS),and that in group C to injection of Tβ4.On days 22,29 and 43 postoperatively,the rats from each group were randomly sacrificed and processed for observation of bone regeneration in the distraction osteogenesis area using radiography,Micro-CT,histology and immunohistochemical staining.RT-PCR was used to detect the expression of related genes as well.Results Radiography revealed that the bone regeneration in group C was superior to that in groups A and B on days 22,29 and 43 postoperatively.Micro-CT examination showed significantly increased bone volume (BV),bone mineral density (BMD) and ratio of bone volume to tissue volume (BV/TV) in group C on days 22,29 and 43 postoperatively,and significantly decreased ratio of bone surface area to bone volume on postoperative day 43 in comparison with groups A and B(P ＜ 0.05).HE staining indicated that local capillary density was significantly higher in group C than in groups A and B after local administration of Tβ4 in the distraction osteogenesis.Immunohistochemical staining showed that the capillary density and osteoblasts in group C were higher than in groups A and B.RT-PCR results revealed significantly higher expression of eNOS and Osterix mRNA in the local callus in group C on postoperative day 22 than in groups A and group B (P ＜ 0.05).Conclusion Local administration of thymosin β4 may promote bone formation,which is probably related to the increased expression of eNOS and Osterix.

Progress of interference screw in the reconstruction of anterior cruciate ligament / 中华骨科杂志

The anterior cruciate ligament (ACL) injury in sports is a common knee joint injury.It is widely accepted to reconstruct ACL under arthroscopy with autologous patellar ligament or popliteal ligament fixed in tibial or femoral tunnel with interference screws.Interference screws are widely used as intra-articular fixation devices in ACL reconstruction.The ideal materials for interference screw provide rigid fixation of graft with high mechanical strength,long-lasting stiffness and the bioactivity to stimulate osteointegration and tendon-bone healing.Current interference screws are made of metals and bio-absorbable polymers.Metallic interference screws provide high mechanical strength and stiffness for tendon graft fixation,but require a second surgery for removal.Bioabsorbable interference screws made of polymers avoid second surgery for removal,but have lower mechanical strength and might cause aseprtic inflammation during its degradation as well as screw slip,tunnel enlargement and many other complications.Magnesium (Mg) has been investigated as a novel and potential biomaterials for biodegradable interference screws.Mg is essential nutrient element and has good biocompatibility.Its mechanical strength and related stiffness are much higher than that of biodegradable polymers and are close to cortical bone.Furthermore,the degradation rate of Mg in vivo could be modulated via techniques such as alloying.In previous studies,the relationship between screw design and its pull-out force has been investigated,based on which the design of interference screw is optimized.The mechanical properties (the ultimate load to failure and the related stiffness) of interference screws proved to be higher than that of bioabsorbable interference screws sharing the same design both in vitro and in vivo.Furthermore,Mg performs good biocompatibility without severe intra-articular inflammatory reactions,as well as unique bioactivities to promote osteointegration,mineral deposition and the regeneration of fibrocartilaginous entheses.The present study reviews the researches of Mg interference screws both in vitro and in vivo,gives reference for further research and has great importance for the application of Mg interference screws in ACL reconstruction.

Effectiveness of lateral approach combined with anteromedial approach for the treatment of terrible triad of the elbow injuries / 中华骨科杂志

Objective To investigate the outcomes of lateral approach combined with anteromedial approach for the treatment of terrible triad of the elbow injuries.Methods Data of 23 patients with terrible triad of the elbow injuries treated at our hospital using this modified surgical technique from July 2008 to January 2011 were retrospectively analyzed.Two patients lost to follow-up leaving 21 patients (21 elbows) for evaluation.There were 17 males and 4 females with a mean age of 38.4 years (range,17-63 years).The 21 elbows were treated surgically after a mean of 4 days from the injury.According to O'Driscoll classification of coronoid fractures,there were 5 cases of type A1,12 of A2,and 4 of B2.According to Mason classification of radial head fracture,there were 2 cases of type Ⅰ,12 of Ⅱ,and 7 of Ⅲ.According to Zhong Biao classification of soft tissue injury in terrible triad of the elbow,there were 6 cases of type Ⅰ,12 of Ⅱ,and 3 of Ⅲ.Our surgical procedure included fixation or replacement of the radial head and repair of the ruptured lateral collateral ligament (LCL) through a lateral approach.Simultaneous fixation of the coronoid process and repair of the common flexor muscle and medial collateral ligament (MCL) injury were performed through an anteromedial approach.Mayo elbow performance score (MEPS) was determined for each patient at the latest clinic visit.The Broberg and Morrey classification was used for evaluating traumatic arthritis.Results The mean follow-up period was 32 months.At the latest follow-up the mean flexion-extension arc of the elbow was 126° (range,115°-135°) and the mean forearm rotation was 139°(range,125°-145°).The mean MEPS was 95 points (range,85-100 points),with 19 excellent results and 2 good results.Concentric stability was restored in all cases.Early post-operative complication occurred in one patient as a wound infection,which healed uneventfully after surgical debridement and antibiotic therapy.Late post-operative complication occurred in four patients including two cases of heterotopic ossification,1 case of radial head nonunion,and one case of ulnar nerve neuropathy,but none of them required additional surgery.Conclusion Lateral approach combined with anteromedial approach for terrible triad of the elbow provided both bony and soft-tissue stability,thereby allowing early active motion as well as functional recovery of the elbow.

Clinical evaluation of modified transthecal digital block and traditional dorsal digital block techniques for hand injury of adults in emergency / 中国组织工程研究

BACKGROUND:Dorsal digital block refers to the commonly used anesthesia for adults in smal or moderate hand injury surgeries, but in recent years, modified transthecal digital block technique is gradualy respected, which is favored with a rapid and good effect and fewer complications. OBJECTIVE:To evaluate the clinical anesthetic outcomes of modified transthecal digital block and traditional dorsal digital block technique for the treatment of hand injury of adults in emergency by a prospective randomized controled study. METHODS:Totaly 60 adult patients with hand injury were enroled and divided into two groups of modified transthecal digital block and traditional dorsal digital block randomly. Blocks were performed by one single surgeon. The operation time, local anesthetic dose, onset time of anesthesia, duration of anesthesia, success rate of anesthesia, visual analogue scale scores and complications were recorded. RESULTS AND CONCLUSION:The anesthesia effects in the two groups were acceptable. There was no significant difference in the onset time of anesthesia, duration of anesthesia, success rate of anesthesia and complications between the two groups (P > 0.05). The operation time of anesthesia, local anesthetic dose, and visual analogue scale scores were significantly different between the two groups (P< 0.05). Modified transthecal digital block is more convenient and has less pain than the traditional root digital block, which is a safe and reliable anesthetic technique.

Vacuum sealing drainage techniqueversus traditional repair in treatment of diabetic foot / 中国组织工程研究

BACKGROUND:Studies have shown that the vacuum sealing drainage technology can effectively promote the wound healing, and it has a wide prospect of clinical application, but there are few reports addressing the treatment of diabetic foot. OBJECTIVE:To discuss the clinical effect of vacuum sealing drainage technology in the treatment of diabetic foot wounds. METHODS: Sixty diabetic foot patients were randomly divided into two groups: traditional treatment group, regulating blood sugar level, dressing and traditional debridement; vacuum sealing drainage group, conventional treatment combined with the vacuum sealing drainage technology. The clinical efficacy of two treatments for diabetic foot was evaluated. RESULTS AND CONCLUSION: Compared with the traditional treatment group, the vacuum sealing drainage showed better outcomes in switching frequency, stable blood sugar control, preparation time, wound healing time and cure rate (P < 0.05). It indicates that the vacuum sealing drainage technology in the treatment of diabetic foot ulcers can resolute wound inflammation, stimulate the growth of granulation, create a favorable surgical condition for secondary skin grafting or flap coverage, significantly shorten the treatment time, and exhibit better curative effects than the traditional treatment.

Locking plate fixation with or without auto-iliac graft for humeral shaft nonunion / 中华创伤骨科杂志

Objective To evaluate the clinical outcomes of open reduction and locking plate fixation with or without auto-iliac graft for humeral shaft nonunion.Methods Between January 2008 and May 2012,65 cases of humeral shaft nonunion were treated in our department.They were 48 men and 17 women,24 to 54 years of age (39.8 years).Of them,43 were atrophic and 22 hypertrophic.The radial nerve was exposed and protected during operation.After the nonunion portion was debrided,the humeral length was recovered.Next the fracture sites were fixated by a locking plate.The defected area was filled with auto-iliac graft if necessary.The visual analogue scale (VAS) scores and The Short Form-36 (SF-36) scores were documented after operation; the functional recovery was evaluated using Constant scoring at the last follow-up.Results The patients obtained a mean follow-up of 13.8 months (from 10 to 32 months).Of them,50 achieved clinical bone union after an average of 3.8 months (from 3 to 7 months).The remaining 6 cases showed no sign of union 9 months postoperatively.Of the 50 patients with union,the mean VAS score was decreased significantly from the preoperative 5.1 ± 3.2 points to the postoperative 1.4 ± 0.8 points,and the mean SF-36 score was increased significantly from the preoperative 45.7 ± 16.9 points to the postoperative 72.9 ± 18.5 points (P ＜ 0.05).The function was scored at the last follow-up as excellent in 34 cases,good in 12,fair in 2 and poor in 2,giving an excellent to good rate of 92.0％.The radical nerve injury was repaired within 3 months postoperation in 3 patients.Rotation deformity occurred in 3 cases without obvious functional limitation.No implant complications such as plate breakage and screw loosening were observed.Conclusion Open reduction and locking plate fixation with or without auto-iliac graft is one effective treatment of humeral shaft nonunion,but damage to the radial nerve should be avoided and fixation of 6 layers of cortex should be maintained at both fracture ends during operation

Osteoporotic fracture of proximal humerus treated with Spatial Subchondral Support(S3) locking plate of proximal humerus / 中华创伤骨科杂志

Objective To evaluate the surgical techniques and clinical outcomes of treating osteoporotic fracture of proximal humerus with Spatial Subchondral Support (S3) locking plate of proximal humerus.Methods From July 2010 to July 2011,21 patients with osteoporotic fracture of proximal humerus,12 males and 9 females,were treated in our department.They were 66.0 years old on average (from 58 to 80 years old).According to the Neer classification system,13 cases were 3-part fractures,8 4-part fractures,and 2 combined with shoulder dislocation.All cases were evaluated carefully with routine CT scans pre-operatively to define the type of fracture and the involvement of articular surface.Open reduction and internal fixation with S3 locking plate of proximal humerus was performed 2 to 7 days after injury (average,4.0 days).Regular X-ray follow-ups were taken and complications recorded as well.Overall function evaluation was carried out according to the modified Constant-Murley score system (CMS) and visual analogue scale (VAS).Results The 18 cases were followed up for a mean duration of 18.0 months (from 12 to 24 months).No complications of wound infection,implant failure or impingement were observed during the follow-ups.Bone union was achieved after an average of 12.0 weeks (from 10 to 14 weeks).On average,the Modified CMS score was 80.2 and the VAS score 1.5.At the post-operative 10th and 13th months,X-ray manifested avascular necrosis of the humeral head respectively in 2 cases of 4-part fractures,who suffered from moderate pain which was relieved after conservative treatment.Conclusion Fixation with S3 locking plate of proximal humerus is a safe and effective treatment of osteoporotic fracture of proximal humerus,because it is rigid and avoids plate-related impingement.

Treatment of hypertrophic nonunion by using Ilizarov circular fixator / 中华骨科杂志

Objective To evalute the effect of Ilizarov technique in the treatment of hypertrophic nonunion.Methods Form June 2008 to December 2010,12 patients with hypertrophic nonunion were treated with Ilizarov technique,including 10 males and 2 females with an average age of 46.5 years.The pathology sites of nonunion were kept as closed as possible without any bone graft during operation.As to patients who had ever been treated with plate or intramedullary nail,the hardware should be removed by minimal invasive approach.These procedures aimed to keep the vascularity of nonunion site intact.Ilizarov apparatus were preoperatively constructed.Distal segment and proximal segment of nonunion were mounted respectively with two external circle using the smooth wires and half pins.The two-circle stabilizing one segment was nominated with transosseous modules.Distal module and proximal one was connected with a pair of axial hinges.The pathology sites were gradually distracted from the seventh day postoperatively,0.25 mm/d.Accompanying with deformity correction,limb length discrepancy (LLD) also were restored simultaneously.Then,all the screws and nuts in the apparatus should be tightened,which was favourable to the callus consolidation.Results All 12 cases of nonunion healed without any bone graft.The fixator wearing time lasted 6-12 months,with an average of 8 months.Correction of deformity and LLD were achieved.The average lengthening was 3.0 cm (range,2.0-5.5 cm),the average correction angle was 23° (range,10°-30°).After 6-18 months follow-up,all the patients restored satisfactory function.Conclusion Hypertrophic nonunion can be treated successfully with Ilizarov technique.The key of successful callus distraction is strictly identifying the indications.