Rotationplasty type BIIIb as an effective alternative to limb salvage procedure in adults: Two case reports.

BACKGROUND: Rotationplasty is often performed for malignant tumors, but type BIIIb rotationplasty is rarely reported, and there needs to be more evidence of the procedure and treatment. The purpose of this case study was to report a new direction in the use of type BIIIb rotationplasty in treating patients with limb salvage and long-term non-healing infections. CASE SUMMARY: Case 1: A 47-year-old man underwent radiotherapy for hemangioendothelioma in his left thigh, resulting in a femoral fracture. Despite the use of plates, intramedullary nailing, and external fixators, the femoral bone failed to unite due to infectious nonunion. Multiple operations were unable to control the infection, leaving the patient immobile. We performed a modified tibia-pelvic-constrained hip rotationplasty, utilizing a constrained prosthetic hip between the tibia and pelvis following a femur resection. Two years post-surgery, the patient was able to walk with the prosthetic device without any signs of recurring infection. The corresponding functional scores were 72 points for the Musculoskeletal Tumor Society (MSTS), 53 for the Functional Mobility Assessment (FMA), 93 for the Toronto Extremity Salvage Score (TESS), and 56 for the MOS 36-item short form health survey (SF-36). Case 2: A 59-year-old woman presented with liposarcoma in her left thigh. Magnetic resonance imaging revealed tumors in the medial, anterior, and posterior femur muscles, encircling the femoral vessels and nerves. Fortunately, there were no symptoms of sciatic dysfunction, and the tumor had not invaded the sciatic nucleus. After one year of follow-up, the patient expressed satisfaction with limb preservation post-type BIIIb rotationplasty. The corresponding functional scores were 63 points for the MSTS, 47 for the FMA, 88 for the TESS, and 52 for the SF-36. CONCLUSION: Our study suggests that type BIIIb rotationplasty may be an alternative to amputation in patients with incurable infections. For malignant tumors of the lower extremities without invasion of the sciatic nerve, type BIIIb rotationplasty remains an excellent alternative to amputation. This surgical method may prevent amputation, improve functional outcomes, and facilitate biological reconstruction.

Treatment of talipes equinovarus after triceps surae intramuscular hemangioma surgery by Ilizarov technology in adults: A case report.

BACKGROUND: Postoperative complications of triceps surae intramuscular hemangioma surgery with talipes equinovarus have rarely been described, and the evidence for treatment is limited. The purpose of this case study was to report the new application of the Ilizarov technique, which successfully treated talipes equinovarus in adults after triceps surae intramuscular hemangioma. CASE SUMMARY: A 29-year-old woman treated with the Ilizarov technique for talipes equinovarus in the right leg after triceps surae intramuscular hemangioma surgery. The equinus deformity was roughly corrected after 2 years of follow-up, without significant secondary sequelae. CONCLUSION: Talipes equinovarus caused by postoperative sequelae of intramuscular hemangioma was successfully corrected by the Ilizarov technique. The Ilizarov technique may be used for treating talipes equinovarus caused by various causes.

[Prevention and treatment of complications in the treatment of femoral shaft closed fracture with core drilling intramedullary nail].

OBJECTIVE: To summarize the complications of core drilling intramedullary nail in the treatment of femoral shaft closed fracture and explore the treatment strategy. METHODS: From August 2014 to June 2018, a total of 215 patients with closed femoral shaft fractures were treated with closed reduction core drill intramedullary nail, including 129 males and 86 females, aged from 18 to 62 years, with an average of (44.2±10.6) years old. The time from injury to operation was 3 to 21 days. There were 102 cases of AO type A fracture, 82 cases of AO type B fracture and 31 cases of AO type C fracture. The time of operation, the amount of blood loss during operation, the duration of hospitalization, the time of fracture healing and the HSS score of knee joint function at the last follow-up were recorded. The observation of complications included:iatrogenic fracture, core drill broken, core drill twist, postoperative infection, and fracture nonunion. RESULTS: The average operation time was (63.2± 15.6) min and intraoperative blood loss was (150.0±34.5) ml. All the incisions reached grade A healing. Patients were follow up for a mean of (18.5±3.2) months, the average hospital stay was (4.3±1.2) days, and the average fracture healing time was (5.6±2.3) months. At the final follow-up, the average HSS score of knee joint was 90.3±4.7. Related complications occurred in 37 cases (17.2%). The core drill related complications occurred in 13 cases (6.0%), including core drill broken in 5 cases (2.3%), core removal in 1 case and slotting in 4 cases;core drill twist in 8 cases (3.7%). After the core was cut, the core was removed. Similar complicationsof conventional intramedullary nail:iatrogenic fracture was performed in 12 cases (5.6%), including 10 cases of fracture end split and 2 cases of distal perimedullary fracture of intramedullary nail. The patients with cleavage at the fracture end were not treated after judging their stability, and the patients with fracture around the distal end of the intramedullary nail were fixed with auxiliary steel plate during operation;1 case(0.4%) with delayed infection after operation, debridement and external fixation was replaced and healed after bone transfer; fracture nonunion occurred in 11 cases (5.1%), of which 7 cases (3.3%) were hypertrophic nonunion and healed with additional plate. Atrophic nonunion occurred in 4 cases (1.9%), which healed after additional steel plate and bone graft. CONCLUSION: Core drilling intramedullary nail is an effective method for the treatment of closed femoral shaft fracture, and the complications include core drill related complications and conventional intramedullary nail similar complications. Accurate preoperative evaluation, careful operation during operation and early postoperative symptomatic treatment can effectively reduce the occurrence of related complications.

A review of emerging bone tissue engineering via PEG conjugated biodegradable amphiphilic copolymers.

Defects in bones can be caused by a plethora of reasons, such as trauma or illness, and in many cases, it poses challenges to the current treatment approaches for bone repair. With increasing demand of bone bioengineering in tissue transplant, there is a need to source for sustainable solutions to induce bone regeneration. Polymeric biomaterials have been identified as a promising approach due to its excellent biocompatibility and controllable biodegradability. Specifically, poly(ethylene glycol) (PEG) is one of the most commonly investigated polymer for use in bio-related application due to its bioinertness and versatility. Furthermore, the hydrophilic nature enables it to be incorporated with hydrophobic but biodegradable polymers like, polylactide (PLA) and polycaprolactone (PCL), to create an amphiphilic polymer. This article reviews the recent synthetic strategies available for the construction of PEG conjugated polymeric system, analysis of PEG influence on the material properties, and provides an overview of its application in bone engineering.

Recent development in cell encapsulations and their therapeutic applications.

Chronic and degenerative diseases are the main causes of death in the aging population worldwide. These diseases are currently maintained using long term administration of conventional drugs which are not curative and reduce the life quality of patients. It is urgent to develop new therapeutic approaches for the treatment of these diseases. Cell therapy that involves the injection of viable cell into patients is a promising therapeutic strategy in chronic and degenerative diseases. However, the survival of injected cells in host tissue is limited due to immunoresponse. Cell encapsulation potentially improves treatment approaches using viable cells and overcome the immuno-rejection following cell transplantation. In this review, we first present the main components and their different functions in the cell encapsulation, including semi permeable membrane, types of cells and matrix. Then, the recently developed technologies and approaches employed to encapsulate cells are summarized and compared in benefits and flaws. More importantly, the insights and significance of the encapsulated cells are also discussed in the application of treating various diseases.

[Interlock plate fixation for the treatment of femoral hypertrophic nonunions after intramedullary nailing fixation].

OBJECTIVE: To investigate clinical effect of locking plate assisted intramedullary nail in treating femoral hypertrophic nonunions after intramedullary fixation. METHODS: From January 2006 to December 2015, clinical data of 40 patients with femoral nonunions after intramedullary nail internal fixation treated with interlock plate internal fixation were respectively analyzed. Among patients, there were 22 males and 18 females, aged from 21 to 60 years old with an average age of (35.0±2.2) years. The time of bone nonunion ranged from 9 to 24 months with an average of (14.1±1.5) months. Operative time, blood loss, hospital stay , complications, bone healing time and recovery of function were observed, Evanich scoring was applied to evaluate clinical effects. RESULTS: All patients were followed up from 12 to 24 months with an average of (15.2±2.7) months. Operative time ranged from 105.1 to 130.2 min with an average of (112.5±10.2) min;blood loss ranged from 207.0 to 250.2 ml with an average of (220.6±14.7)ml; hospital stay ranged from 10 to 15 days with an average of (12.2±1.5) d. All patients were obtained bone healing from 4 to 12 months after additional plate internal fixation, with an average of (6.2±1.9) months. No implant failure and infection occurred after operation. According to Evanich scoring of knee joint, total score was 83.2±5.6, 22 cases obtained excellent results, 17 good and 1 fair. CONCLUSIONS: Limited incision approach locking plate with original intramedullary nail fixation for femoral hypertrophic nonunions subsequent to intramedullary fixation could receive good results, increase stability of fracture, and could increase stability of fracture, provide environment for callus growth. It had advantages of high cure rate, less trauma and complications, and also could do functional exercise earlier to promote good recovery of knee joint.

[Treatment of Vancouver type B1 periprosthetic femoral fracture with locked plate and xenogenic bony plate].

OBJECTIVE: To analyze the therapeutic effect of plate cable system and cortical strut bone graft in the prosthesis revision of the total hip arthroplasty for the treatment of Vancouver type B1 periprosthetic femoral fracture. METHODS: A total of 8 patients were selected from January 2006 to January 2013, including 6 males and 2 females, aged from 56 to 74 years old (62.52 years old on average). All the cases were treated by the long plate cable system and appropriate cortical strut bone graft. Harris score was used to evaluate the hip functions before and after the operation. Prosthesis stability and the bony union were assessed by the digital radiography. RESULTS: All the patients were followed up for 45 months on average ranging from 24 to 60 months after operation. All the fractures reached union, and there was no infection, stem loosening, nonunion and malunion. The Harris score was 28.45±5.78 before operation, which was improved to 83.46±10.21 after operation. X ray showed that the prosthesis was stable, and the host bone and bone graft achieved bony union in 7 patients;and the other 1 patient need further operation of revision around the loose stem. CONCLUSIONS: The prosthesis revision of the total hip arthroplasty with the locking plate and cortical strut bone graft used for the Vancouver type B1 periprosthetic proximal femur fractures has the advantages of simple manipulation, less complications, good recovery of the hip function and can improve bone quality to provide favorable conditions for operation of revision.

Cementless arthroplasty with a distal femoral shortening for the treatment of Crowe type IV developmental hip dysplasia.

BACKGROUND: Severe developmental dysplasia of the hip is a surgical challenge. The purpose of this study is to describe the cementless arthroplasty with a distal femoral shortening osteotomy for Crowe type IV developmental hip dysplasia and to report the results of this technique. MATERIALS AND METHODS: 12 patients (2 male and 10 female) of Crowe type IV developmental hip dysplasia operated between January 2005 and December 2010 were included in the study. All had undergone cementless arthroplasty with a distal femoral shortening osteotomy. Acetabular cup was placed at the level of the anatomical position in all the hips. The clinical outcomes were assessed and radiographs were reviewed to evaluate treatment effects. RESULTS: The mean followup for the 12 hips was 52 months (range 36-82 months). The mean Harris hip score improved from 41 points (range 28-54) preoperatively to 85 points (range 79-92) at the final followup. The mean length of bone removed was 30 mm (range 25-40 mm). All the osteotomies healed in a mean time of 13 weeks (range 10-16 weeks). There were no neurovascular injuries, pulmonary embolism or no infections. CONCLUSION: Our study suggests that cementless arthroplasty with a distal femoral shortening is a safe and effective procedure for severe developmental dysplasia of the hip.

Anterior D-rod and titanium mesh fixation for acute mid-lumbar burst fracture with incomplete neurologic deficits: A prospective study of 56 consecutive patients.

BACKGROUND: Anterior decompression and reconstruction have gained wide acceptance as viable alternatives for unstable mid-lumbar burst fracture, but there are no mid and long term prospective studies regarding clinical and radiologic results of mid-lumbar burst fractures. MATERIALS AND METHODS: An Institutional Review Board-approved prospective study of 56 consecutive patients of mid-lumbar burst fractures with a load-sharing score of 7 or more treated with anterior plating was carried out. All patients were evaluated for radiologic and clinical outcomes. The fusion status, spinal canal compromise, segmental kyphotic angle (SKA), vertebral body height loss (VBHL), and adjacent segment degeneration was examined for radiologic outcome, whereas the American Spinal Injury Association scale, the visual analog scale (VAS), and the employment status were used for clinical evaluation. RESULTS: The patients underwent clinical and radiologic followup for at least 5 years after the surgery. At the last followup, there was no case of internal fixation failure, adjacent segment degeneration, and other complications. Interbody fusion was achieved in all cases. The average fusion time was 4.5 months. No patient suffered neurological deterioration and the average neurologic recovery was 1.3 grades on final observation. Based on VAS pain scores, canal compromise, percentage of VBHL and SKA, the difference was statistically significant between the preoperative period and postoperative or final followup (P < 0.05). Results at postoperative and final followup were better than the preoperative period. However, the difference was not significant between postoperative and final followup (P > 0.05). Thirty-four patients who were employed before the injury returned to work after the operation, 15 had changed to less strenuous work. CONCLUSION: Good mid term clinicoradiological results of anterior decompression with D-rod and titanium mesh fixation for suitable patients with mid-lumbar burst fractures with incomplete neurologic deficits can be achieved. The incident rate of complications was low. D-rod is a reliable implant and has some potential advantages in L4 vertebral fractures.

Hollow-bone-graft dynamic hip screw can fix and promote bone union after femoral neck fracture: an experimental research.

BACKGROUND: Delayed bone union, nonunion or osteonecrosis often occur after femoral neck fractures in young adults. Secondary bone healing requires strong internal fixation, intramedullary pressure reduction and early functional exercise. OBJECTIVE: To compare bone healing of femoral neck fractures treated with hollow-bone-graft dynamic hip screws (Hb-DHS) and standard dynamic hip screws (DHS) in an animal model. DESIGN: Testing of specifically designed fixation devices in a pig animal model. INTERVENTIONS/METHODS: We designed Hb-DHS and DHS devices appropriate to the femoral neck and head of experimental animals and used them in eight pigs (4-month-old, male or female, 30-40 kg/each). Under anesthesia, we induced medium neck type, Garden III type femoral neck fractures in each pig with fracture gaps of 0.5 mm and then fixed each left femur with Hb-DHS and each right femur with DHS. We assessed the animals radiographically and by postmortem visual appraisal of evidence of bone healing 8 and 16 weeks postoperatively. RESULTS: There were significant differences in radiographic and general findings between the Hb-DHS and DHS groups at weeks 8 and 16 postoperatively. We found statistically significant differences between the Hb-DHS and DHS groups in bone healing scores, trabecular bone volume percentage and bone mineral density as assessed on plain radiographs and computed tomography images (P < 0.05). There were also significant differences between the Hb-DHS and DHS groups in postmortem visually assessed indicators of bone healing at both 8 and 16 weeks postoperatively. CONCLUSIONS: The Hb-DHS device promotes femoral neck bone union, stimulates trabecular bone formation, increases BMD and has advantages over DHS for internal fixation of femoral neck fractures. This animal experiment will contribute to developing optimal treatment for femoral neck fractures in young adults.

[Comparison of three methods of internal fixations for intertrochanteric femoral fractures in elderly patients].

OBJECTIVE: To compare the clinical effects of three methods of internal fixations in treating intertrochanteric fractures in elderly patients. METHODS: From 2004 to 2008, the clinical data of 112 patients with intertrochanteric fractures were retrospectively analyzed. There were 63 males and 49 females, aged from 60 to 80 years with an average of 66.2 years. The patients were treated respectively with dynamic hip screws (DHS group, 40 cases), anatomic plate (anatomic plate group, 36 cases) and proximal femoral intramedullary nails (PFN group, 36 cases). The data of each group were collected for statistical analysis on the following aspects: operative time, blood loss volume, clinical healing time of fracture, postoperative complications, and hip functional score of Harris. RESULTS: All these patients were followed up from 20 to 24 months with an average of 22.6 months. There was no significant difference in operative time, blood loss volume among three groups; there was significant difference in clinical healing time of fracture, Harris score and postoperative complications among three groups (P < 0.05). In the healing time, the PFN group was significantly less than that of other groups (P = 0.001), but there was no differences between DHS group and anatomic plate group. In the Harris score, the PFN group was significantly higher than that of other groups (P = 0.001), but there was no differences between DHS group and anatomic plate group. In the aspect of postoperation complication, there was 2 cases of coxa vara, 1 case of internal fixation loosening and 1 case of deep venous thrombosis in the DHS group; there were 2 cases of deep venous thrombosis in the PFN group; there were 2 cases of coxa vara and 1 case of internal fixation loosening in the anatomic plate group (P = 0.001). CONCLUSION: In the treatment of intertronchanteric fractures, proximal femoral intramedullary nail may be the best choice, which can decrease healing time as well as complications postoperatively.

Rap system of stress stimulation can promote bone union after lower tibial bone fracture: a clinical research.

BACKGROUND: Lower tibial bone fracture may easily cause bone delayed union or nonunion because of lacking of dynamic mechanical load. OBJECTIVE: Research Group would design a new instrument as Rap System of Stress Stimulation (RSSS) to provide dynamic mechanical load which would promote lower tibial bone union postoperatively. METHODS: This clinical research was conducted from January 2008 to December 2010, 92 patients(male 61/female 31, age 16-70 years, mean 36.3 years) who suffered lower tibial bone closed fracture were given intramedullary nail fixation and randomly averagely separated into experimental group and control group(according to the successively order when patients went for the admission procedure). Then researchers analysed the clinical healing time, full weight bearing time, VAS (Visual Analogue Scales) score and callus growth score of Lane-Sandhu in 3,6,12 months postoperatively. The delayed union and nonunion rates were compared at 6 and 12 months separately. RESULTS: All the 92 patients had been followed up (mean 14 months). Clinical bone healing time in experimental group was 88.78±8.80 days but control group was 107.91±9.03 days. Full weight bearing time in experimental group was 94.07±9.81 days but control group was 113.24±13.37 days respectively (P<0.05). The delayed union rate in 6 months was 4.3% in experimental group but 10.9% in control group(P<0.05). The nonunion rate in 12 months was 6.5% in experimental group but 19.6% in control group(P<0.05). In 3, 6, 12 months postoperatively, VAS score and Lane-Sandhu score in experimental group had more significantly difference than them in control group. CONCLUSIONS: RSSS can intermittently provide dynamic mechanical load and stimulate callus formation, promote lower tibial bone union, reduce bone delayed union or nonunion rate. It is an adjuvant therapy for promoting bone union after lower tibial bone fracture.

Effects of a sliding plate on morphology of the epiphyseal plate in goat distal femur.

The aim of this study was to observe the effects of a sliding plate on the morphology of the epiphyseal plate in goat distal femur. Eighteen premature female goats were divided randomly into sliding plate, regular plate and control groups. Radiographic analysis and histological staining were performed to evaluate the development of epiphyseal plate at 4 and 8 weeks after surgery. In the sliding plate group, the plate extended accordingly as the epiphyseal plate grows, and the epiphyseal morphology was kept essential normal. However, the phenomenon of the epiphyseal growth retardation and premature closure were very common in the regular plate group. In addition, the sliding plate group exhibited more normal histologic features and Safranin O staining compared to the regular plate group. Our results suggest that the sliding plate can provide reliable internal fixation of epiphyseal fracture without inhibiting epiphyseal growth.

Anterior versus posterior approach in the treatment of chronic thoracolumbar fractures.

The purpose of this study was to compare the results of anterior approach vs posterior approach in the treatment of chronic thoracolumbar fractures. A total of 36 patients with chronic thoracolumbar fractures were divided into 2 groups. Group A was treated by an anterior approach and group B was treated by a posterior approach. During the minimum 24-month follow-up period (range, 24-62 months), all patients were prospectively evaluated for clinical and radiologic outcomes. Intraoperative blood loss, operative time, operative complications, pulmonary function, Frankel scale, and American Spinal Injury Association (ASIA) motor score were used for clinical evaluation, and Cobb angle was examined for radiologic outcome. All patients in this study achieved solid fusion, with significant neurologic improvement. Operative time, perioperative blood loss, ASIA score on admission and at final follow-up, and complications of respiratory tract infection and intercostal nerve pain were not significantly different between the 2 groups (P>.05), but complications of hemopneumothorax, abdominal distension, and constipation were fewer in group B (P<.05). Postoperative pulmonary function (P<.05) and correction of posttraumatic kyphosis were better in group B (P<.05).

Case report: Bone tumor of the scapula in a patient undergoing liver transplantation.

BACKGROUND: De novo malignancies are serious complications in the late postoperative period after liver transplantation. The most common de novo tumors are skin malignancies, posttransplantation lymphoproliferative disorder, tumors of the head and neck, and Kaposi's sarcoma. Such posttransplant de novo malignancies are apparently rarely found in bone. CASE DESCRIPTION: We describe a patient with a low-grade, aggressive fibrous histiocytoma of the scapula. The patient had undergone liver transplantation 6 years earlier. En bloc resection of the tumor and limb salvage was performed. At the 2-year followup the patient had no signs of local recurrence or metastatic spread; the patient had a Musculoskeletal Tumor Society (MSTS) score of 87. LITERATURE REVIEW: A literature review suggests the main predisposing factors to such malignancies are immunosuppression and its length of use. According to the literature, tumors apparently are rare in bone after liver transplantation, with no clearly documented cases. However, in the presence of such a finding, our study might be the first clearly documented case study of this kind of bone tumor. CLINICAL RELEVANCE: We describe a patient with a bone tumor after liver transplantation. Our literature review suggests liver transplantation and long-term immunosuppression played a role in this patient's tumor.

[Ulnar osteotomy and internal fixation for old anterior dislocation of radial head in children].

OBJECTIVE: To evaluate the clinical results of ulnar osteotomy and internal fixation in treating old anterior dislocation of radial head in children. METHODS: From Jan.2004 to Jan.2010, 18 patients with old anterior dislocation of radial head were treated with open reduction for radial head and ulnar osteotomy and internal fixation, including 12 males and 6 females with an average age of (6.9 +/- 1.3) years (3 to 15 years). Among them, 15 cases had history of external injury, from injury to operation was for 5-65 months with an average of (24.0 +/- 5.5) months. Limitation of activity occurred in all patients including flexion and extension of elbow joint and rotation of forearm, without radial nerve injury and obviously radial head deformation. RESULTS: All incisions obtained primary healing and no nonunion, re-dislocation of radial head and nerve injury were found. All patients were followed up from 9 to 38 months with an average of (17.0 +/- 4.5) months. Union time of fracture was from 2.3 to 3.9 months with an average of (2.8 +/- 0.5) months. Postoperative activity in flexion and extension of elbow joint and rotation of forearm improved significantly compared with preoperative. The clinical effects were evaluated according to Zhuyukui criteria, 14 patients got excellent results, 3 good, 1 fair. CONCLUSION: Ulnar osteotomy and internal fixation in treating old anterior dislocation of radial head in children can obtain satisfactory results and effectively improve the activities in flexion and extension of elbow joint and rotation of forearm and prevent re-dislocation of radial head.

Operative versus nonoperative management of Pipkin type-II fractures associated with posterior hip dislocation.

Little has been written on randomized, controlled studies of operative versus nonoperative management of Pipkin type-II fractures associated with posterior dislocation of the hip. It is difficult to validate the optimal management of these fractures. The goals of this study were to (1) evaluate the results of conservative and surgical treatment for Pipkin type-II fractures associated with posterior dislocation of the hip and supply the optimal management for these fractures and (2) identify whether the Smith-Petersen approach is a safe and reliable surgical approach for Pipkin type-II fractures.Twenty-four patients were randomly divided into 2 groups: the conservative group (n=12) was treated by closed reduction, and the surgical group (n=12) was treated by primary open reduction internal fixation (ORIF) by bioabsorbable screws via a Smith-Petersen approach. Minimum follow-up was 24 months. Functional outcome was measured using the Thompson and Epstein score and the d'Aubigné-Postel score. Heterotopic ossification was classified based on the Brooker classification. The outcome of the conservative group was worse than that of the surgical group (P=.037). Two patients in the conservative group needed joint replacement for avascular necrosis of the femoral head. Heterotopic ossification was found in 6 patients (1 patient in the conservative group and 5 in the surgical group).Primary ORIF by bioabsorbable screws via a Smith-Petersen approach is an effective treatment for Pipkin type-II fractures associated with posterior dislocation.

[Transpedicular intracorporeal hydroxyapatite grafting and pedicle screw fixation via paraspinal approach for thoracolumbar fractures].

OBJECTIVE: To investigate the feasibility and safety of the treatment for thoracolumbar fractures with transpedicular intracorporeal hydroxyapatite grafting and pedicle screw fixation via paraspinal approach. METHODS: From June 2007 to December 2008, 19 cases of thoracolumbar fractures were treated with transpedicular intracorporeal hydroxyapatite grafting and pedicle screw fixation via paraspinal approach. There were 7 female and 12 male, ranging from 21 to 57 years of age (mean 40.8 years) at surgery. The time from injury to surgery varied from 1 d to 5 d (mean 2.9 d). Nineteen patients all suffered from single thoracolumbar fracture with the distribution of injury level being T(11) in 1, T(12) in 5, L(1) in 9, and L(2) in 4. According to Denis fracture classification, there were 5 compression fractures and 14 burst fractures. The mean preoperative ratio of the anterior height of the body was 57.2%, kyphosis angle was 17.6° and occupation of spinal canal was 27.7%. The mean preoperative load-sharing classification of spine fractures was 5.2. Based on the ASIA neurologic grading system, preoperative neurological function was grade B in 2 cases, C in 9 and D in 8. RESULTS: Median operating time was 83.8 min (range 60-95 min) and median blood loss was 133 ml (range 90 - 200 ml). Infection did not occur in any of the patients and the operative incisions were healing well. Average follow-up time was 19.2 months (range 12 - 36 months). At the latest follow-up, the height of the anterior border was corrected to 88.4%, the kyphosis angle was 6.1°, and the occupation of spinal canal was 8.2% on average. The postoperative neurologic function of all 19 patients was improved with grade D in 2 cases and E in 17. There were no instances of instrumentation failure and no patient had persistent postoperative back pain. CONCLUSIONS: Transpedicular intracorporeal hydroxyapatite grafting and pedicle screw fixation via paraspinal approach could provide reliable neurologic improvement in patients with incomplete neurologic deficit, and could prevent the development of kyphosis.Furthermore, it has the obvious advantages of less invasive and blood loss, and decreases the risks of postoperative lumbodorsal pain.

[Application of absorbable screw in treatment of scaphoid fracture by retrograde internal fixation].

OBJECTIVE: To evaluate the surgical effects of treatment of scaphoid fracture with retrograde internal fixation using absorbable screw. METHODS: From December 2001 to December 2007, 18 cases of scaphoid fracture were treated with absorbable screw by retrograde internal fixation. There were 12 males and 6 females with an average age of 26 years ranging from 17 to 40 years. Ten cases were medium fractures of scaphoid and 8 cases were proximal fraxtures. RESULTS: All patients were followed-up for from 12 to 36 months (means 25 months). Among them, 17 cases were union and 1 case was nonunion. The mean time of union was 13 weeks. The mean range of motion of wrist was about 90% and mean scratch strength of wrist was about 95% to fine lateral. There were no pain in 14 cases, and slight pain in 3, medial pain in 1 casea of ununion. According to Cooney's clinical evaluation system, the score was increased from (68.2 +/- 1.5) before operation to (88.7 +/- 1.2) after operation, the postoperative score was higher than preoperative remarkable; 9 patients were fine, 8 were good and 1 was bad. CONCLUSION: This technology had some advantage such as simple surgery, decreasing demonstrate rest blood circulation, stable fixation, reducing bone healing time and increasing healing time. It is an effective way to treat scaphoid fracture.