Displaced Medial-End Clavicle Fractures Treated with Locking Plate Osteosynthesis.

BACKGROUND The purpose of this study was to evaluate clinical efficacy of the medial-end clavicle fractures with a reversed lateral locking clavicle plate. MATERIAL AND METHODS Eleven male patients age 28 to 66 years old with medial-end clavicle fractures were included in the present study from October 2014 and October 2017. All the patients received operation of fixed with reversed lateral locking clavicle plates. In the operation, a curved incision approximately 8 to 10 cm in length was made, and after the reduction, the fracture was fixed by a reversed lateral locking clavicle plate. Postoperative follow-up was performed in order to evaluate the efficacy of the treatment. Disabilities of the Arm, Shoulder and Hand (DASH) score was used in evaluation the shoulder function post-operation. The functional assessment was performed by using the DASH score. RESULTS No intraoperative complications were found during the operation. All patients' incisions achieved healing after operations. Eleven cases were scored by DASH scoring after the operation; Of these, 9 patients were rated excellent, and 2 patients were rated good. There were no neurovascular injuries, nor were there any hemopneumothorax or internal fixation failures. CONCLUSIONS The fixation of with reversed lateral locking clavicle plates is effective safe patients with medial-end clavicle fractures.

[Research progress of early postoperative rehabilitation for acute Achilles tendon rupture after surgical repair].

Objective: To summarize the latest research progress of early postoperative rehabilitation for acute Achilles tendon rupture after surgical repair. Methods: The high-quality randomized controlled trials and systematic reviews/meta-analyses regarding early postoperative rehabilitation for acute Achilles tendon rupture in recent years were reviewed. Results: There are three functional rehabilitations after acute Achilles tendon rupture surgery, including early postoperative mobilization, early weight-bearing with immobilization, and early weight-bearing combined with mobilization. The results of randomized controlled trials show that the effectiveness of early postoperative rehabilitation is similar or better than the early postoperative immobilization. The results of systematic reviews/meta-analyses show that the early postoperative rehabilitation is beneficial to the early function recovery of the Achilles tendon, can reduce the time for functional recovery, and do not adversely affect the outcomes. Conclusion: Early postoperative rehabilitation is beneficial to the functional recovery, and do not increase postoperative complications. There is still no uniform protocol of early postoperative rehabilitation and the timing of weight-bearing, and further studies are needed in the future.

Expression of NF-κB and PTEN in osteosarcoma and its clinical significance.

We investigated the role of nuclear factor-κB (NF-κB) and phosphatase and tensin homolog deleted in chromosome 10 (PTEN) in the pathogenesis of osteosarcoma and its relationship with prognosis. Immunohistochemical method was used to detect the expression of NF-κB and PTEN in osteosarcoma and adjacent tissues. RT-PCR was used to detect the expression of NF-κB and PTEN mRNA in osteosarcoma and adjacent tissues. Western blotting was used to detect the expression of NF-κB and PTEN in osteosarcoma and adjacent tissues and compare their differences. The expression of NF-κB and PTEN was detected in osteosarcoma and adjacent tissues. The positive rate of NF-κB was 75.3 and 32.9%, respectively; while the positive rate of PTEN was 67.1 and 90.4%, respectively. The positive expression of NF-κB and PTEN was statistically significant. There was a negative correlation between NF-κB and PTEN expression (r=-0.502, p<0.05). The positive and negative expression of NF-κB and PTEN was statistically significant for the five-year survival (p<0.05). At gene and protein level, osteosarcoma tissues had higher expression of NF-κB, and lower expression of PTEN, which was significantly different from the adjacent tissues. In osteosarcoma, NF-κB is highly expressed, but PTEN is expressed at low level, and the two are negatively correlated. This is of great significance for the early diagnosis of osteosarcoma and prognosis.

The Protective Effects of Fasciotomy on Reperfusion Injury of Skeletal Muscle of Rabbits.

The authors aim to investigate protective effects of fasciotomy against ischemia reperfusion injury of skeletal muscle in rabbit and to compare the treatment effects of prereperfusion + fasciotomy and fasciotomy + postreperfusion against ischemia reperfusion injury of skeletal muscle. 24 healthy male Japanese white rabbits were randomly divided into 3 groups, and 4 hours' ischemia was established in these rabbits through surgery. Six hours' reperfusion was performed in group A; reperfusion + postfasciotomy was performed in group B; and prefasciotomy + reperfusion was performed in group C. Result showed that prefasciotomy and postfasciotomy could protect skeletal muscle against ischemia reperfusion injury, reduced MDA (malondialdehyde) expression, MPO (myeloperoxidase) expression, and apoptosis of muscle in the reperfused areas, increased Bcl-2 expression, and decreased Bax expression. The MDA and MPO levels in group B and group C were significantly lower than those in group A, and MDA and MPO levels in group C were significantly lower than those in group B. Prefasciotomy and postfasciotomy could protect against ischemia reperfusion injury in skeletal muscle. The protective effects of prefasciotomy against ischemia reperfusion injury are better than postfasciotomy.

Surgical interventions to treat humerus shaft fractures: A network meta-analysis of randomized controlled trials.

BACKGROUND: There are three main surgical techniques to treat humeral shaft fractures: open reduction and plate fixation (ORPF), intramedullary nail (IMN) fixation, and minimally invasive percutaneous osteosynthesis (MIPO). We performed a network meta-analysis to compare three surgical procedures, including ORPF, IMN fixation, and MIPO, to provide the optimum treatment for humerus shaft fractures. METHODS: MEDLINE, EMBASE, Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, and Cochrane library were researched for reports published up to May 2016. We only included randomized controlled trials (RCTs) comparing two or more of the three surgical procedures, including the ORPF, IMN, and MIPO techniques, for humeral shaft fractures in adults. The methodological quality was evaluated based on the Cochrane risk of bias tool. We used WinBUGS1.4 to conduct this Bayesian network meta-analysis. We used the odd ratios (ORs) with 95% confidence intervals (CIs) to calculate the dichotomous outcomes and analyzed the percentages of the surface under the cumulative ranking curve. RESULTS: Seventeen eligible publications reporting 16 RCTs were included in this study. Eight hundred and thirty-two participants were randomized to receive one of three surgical procedures. The results showed that shoulder impingement occurred more commonly in the IMN group than with either ORPF (OR, 0.13; 95% CI, 0.03-0.37) or MIPO fixation (OR, 0.08; 95% CI, 0.00-0.69). Iatrogenic radial nerve injury occurred more commonly in the ORPF group than in the MIPO group (OR, 11.09; 95% CI, 1.80-124.20). There were no significant differences among the three procedures in nonunion, delayed union, and infection. CONCLUSION: Compared with IMN and ORPF, MIPO technique is the preferred treatment method for humeral shaft fractures.

Early functional rehabilitation versus traditional immobilization for surgical Achilles tendon repair after acute rupture: a systematic review of overlapping meta-analyses.

Several meta-analyses comparing early functional rehabilitation and traditional immobilization following surgical Achilles tendon repair after acute rupture have been published. However, they have led to conflicting conclusions. The aims of this systematic review were to select high-quality meta-analyses from multiple discordant meta-analyses and to provide a postoperative rehabilitation strategy following surgical repair using currently available evidence. We performed a comprehensive search using the PubMed and Embase databases and the Cochrane Library. Assessment of Multiple Systematic Reviews (AMSTAR) instrument was used to assess the methodological quality. Three investigators independently applied the Jadad decision algorithm. Their results were then compared to ensure selection of a meta-analysis that provided the highest quality of evidence. Six meta-analyses met the eligibility criteria. AMSTAR scores ranged from 6 to 10. According to the Jadad decision algorithm, a high-quality meta-analysis with a greater number of RCTs was selected. This meta-analysis showed that early functional rehabilitation was superior to cast immobilization in terms of patient satisfaction and the time to return to pre-morbid sporting levels. There were no differences regarding major complications or the time before return to prior employment and sporting activity. Thus, we recommend early functional rehabilitation as the postoperative strategy for acute Achilles tendon ruptures.

The Impact of Diabetes Mellitus on Patients Undergoing Cervical Spondylotic Myelopathy: A Meta-Analysis.

AIMS: We conducted a meta-analysis of eligible studies to compare the surgical outcomes between diabetic patients and non-diabetic patients who have undergone cervical spondylotic myelopathy (CSM). METHODS: A systematic literature search of PubMed, Embase, and Web of Science (up to February 10, 2016) was conducted. Eligible studies were case-control or cohort studies that compared the outcomes of cervical surgery between diabetic patients and non-diabetic patients. Weighted mean differences, risk ratios, and 95% CIs were calculated and heterogeneity was assessed with Cochrane Q chi-square test and I2 statistic. RESULTS: Six studies with a total of 38,680 patients were included in this meta-analysis. Pooled estimates showed that diabetic patients had significantly lower Japanese Orthopaedic Association (JOA) score change between pre- and post operation, and recovery rate than patients without diabetes. Moreover, diabetic patients had significantly increased risk of operative wound, epidural/wound hematoma, chronic lung disease, and cardiac complication. Other postoperative complications, including cerebrospinal fluid leakage and C5 radiculopathy, were not significantly different between the 2 groups. CONCLUSION: Diabetes mellitus decreased the JOA score change and recovery rate, as well as increased the risk of postoperative complications in patients undergoing CSM. Controlling diabetes mellitus before cervical spine surgery may lead to better outcomes.

Treatments for the Fifth Metacarpal Neck Fractures: A Network Meta-analysis of Randomized Controlled Trials.

The fifth metacarpal neck fractures (commonly termed boxer's fractures) are the most common type of metacarpal fractures. Many types of treatments are available in clinical practice, some of which have already been compared with other treatments by various researchers. However, a comprehensive treatment comparison is lacking. We estimated the comparative efficacy of different interventions for total complications, through a network meta-analysis of randomized controlled trials. We conducted a systematic search of the literature through October 2015. The outcome measurements were the total complications. We used a Bayesian network meta-analysis to combine direct and indirect evidence and to estimate the relative effects of treatment. We identified 6 RCTs registering a total of 288 patients who were eligible for our network meta-analysis. The literature's quality is relatively high. The median Structured Effectiveness for Quality Evaluation of Study score for the included trials was 33.8. The overall methodological quality was high. Of the 6 studies, all were 2-arm controlled trials comparing active intervention. Among the 4 treatments--conservative treatment (CT), antegrade intramedullary nailing (AIMN), transverse pinning (TP) with K-wires, and plate fixation (PF)--CT had the best rankings (ie, lowest risk of total complications), followed by PF, AIMN, and TP (ie, highest risk of total complications). Furthermore, we also presented the results using surface under the cumulative ranking curve. The surface under the cumulative ranking curve probabilities were 94.1%, 52.9%, 37.3%, and 15.7% for CT, PF, AIMN, and TP, respectively. In conclusion, current evidence suggested that conservative treatment is the optimum treatment for the fifth metacarpal neck fractures because of reduced total complication rates. Moreover, the TP with K-wires is the worst option with highly total complication rates. PF and AIMN therapy should be considered as the first-line choices. Larger and higher-quality randomized controlled trials are required to confirm these conclusions and better inform clinical decision-making.

[DEVELOPMENT AND CLINICAL APPLICATION OF MEDICAL HEAT PRESERVATION DEVICE USED IN HAND SURGERY].

OBJECTIVE: To introduce a new medical heat preservation device, and to explore the application value and effectiveness in replantation of severed fingers. METHODS: The medical heat preservation device was design, water was used as the heating medium, and temperature was set and controlled by microcomputer. Between November 2010 and January 2014, 421 cases undergoing replantation of severed fingers were divided into 2 groups. Within 9 days after operation, the medical heat preservation device was used in 210 cases (experimental group), and the conventional heat lamp was used in 211 cases (control group). There was no significant difference in gender, age, injury cause, the interval between injury and admission, injury finger side, and operation time between 2 groups (P > 0.05). The vascular crisis rate, success rate of replantation of severed fingers, comfort, sleep quality, and the influence on roommates were compared. RESULTS: The comfort and the influence on roommates were good in 188 cases (89.52%) and 201 cases (95.71%) in the experimental group, which were significantly higher than those in the control group (25/211, 11.85%; 145/211, 68.72%). According to Pittsburgh sleep quality index (PSQI) for sleep quality, the results were good in 105 cases, fair in 85 cases, and poor in 20 cases in the experimental group; the results were good in 45 cases, fair in 95 cases, and poor in 71 cases in the control group. Blood vessel crisis occurred in 35 cases (16.67%) of the experimental group, which was significantly lower than that in the control group (76/211, 36.02%) (P < 0.05). The survival rate of replantation in the experimental group (196/210, 93.3%) was significantly higher than that in the control group (181/211, 85.78%) (P < 0.05). Significant differences were found between 2 groups (P < 0.05) in above indexs. CONCLUSION: Medical heat preservation device for replantation of severed fingers can improve the comfortable degree of patients and the quality of sleep, increase the survival rate of finger replantation, and reduce the occurrence of vascular crisis after operation.

Meta-analysis for dorsally displaced distal radius fracture fixation: volar locking plate versus percutaneous Kirschner wires.

BACKGROUND: Dorsally displaced distal radius fractures (DDDRF) are frequent injuries in clinical practice. Traditional percutaneous Kirschner wires (K-wire) and open reduction with volar locking plate (VLP) are the two most common surgical fixation techniques used to manage DDDRF. However, there is no current consensual evidence to guide the selection of one technique over the other. Therefore, we undertook a systematic search and meta-analysis to compare clinical outcomes and complications of these two treatment approaches for DDDRF. METHODS: The following electronic databases were searched by two independent reviewers, up to April 2015: PubMed, ScienceDirect and Wiley Online Library. High-quality randomized controlled trials (RCTs) comparing VLP and percutaneous K-wire fixation for DDDRF were identified. Pooled mean differences were calculated for the following continuous outcome variables: disabilities of the arm, shoulder and hand (DASH) score, grip strength and wrist range of motion. Pooled odds ratios were calculated for rates of total postoperative complications, including superficial infection, deep infection, complex regional pain syndrome (CRPS), carpal tunnel syndrome (CTS), neurological injury, tendon rupture, tenosynovitis, loss of reduction and additional surgery to remove hardware. The meta-analysis was completed using RevMan 5.3 software. RESULTS: Seven RCTs, with a total of 875 patients, were included in our meta-analysis. Open reduction internal fixation (ORIF) with VLP fixation provided statistically lower DASH scores, reduced the incidence of total postoperative complications and specifically lowered the rate of superficial infection, when compared, over a 1-year follow-up, to percutaneous K-wire fixation. VLP fixation also provided significantly better grip strength and range of wrist flexion and supination in the early 6-month postoperative period, compared with percutaneous K-wire fixation. CONCLUSION: ORIF with VLP fixation provided lower DASH scores and reduced total postoperative complications, most specifically lowering the risk for postoperative superficial infection compared to K-wire fixation over a 1-year follow-up period. However, superficial pin track infections do not cause clinical debility in the vast majority of cases. Thus, the claim of reduced superficial infection rate may not be clinically important. The only reasonable conclusion that can be drawn is that at present, there is insufficient data even on our meta-analysis to help the clinician make an informed choice.

Intramedullary nail versus plate fixation for humeral shaft fractures: a systematic review of overlapping meta-analyses.

Multiple meta-analyses have been published to compare intramedullary nail and plate for treating humeral shaft fractures; however, results are discordant.The purposes of current study were to perform a systematic review of overlapping meta-analyses comparing intramedullary nail and plate fixation for the treatment of humeral shaft fractures, to appraise the methodological quality and the quality of reporting of meta-analyses, and to propose a guide through the currently discordant available evidence.This systematic review was performed according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analysis. The literature was systematically reviewed to identify meta-analyses comparing intramedullary nail and plate fixation for the treatment of humeral shaft fractures. Only meta-analyses exclusively including randomized clinical trials (RCTs) met eligibility criteria in this systematic review. Methodological quality for each included study was assessed using the Oxford Levels of Evidence and the Assessment of Multiple Systematic Reviews Instrument. We extracted all variables from the included studies and listed the results reported by them. Heterogeneity information of each variable was extracted for the included studies. An I of <60% is accepted in this systematic review. The Jadad algorithm was then applied to determine which meta-analyses provided the best evidence.Seven studies met the inclusion criteria in this study. All studies included RCTs or quasi-RCT and were Level II of evidence. Assessment of Multiple Systematic Reviews scores varied from 6 to 10 with a median of 7.86. Heterogeneity of each outcome was acceptable in those meta-analyses pooled results. The Jadad algorithm suggested that the meta-analyses can be selected based on the search strategies and application of selection. As a result, 2 meta-analyses with more RCTs were selected in this systematic review. The best available evidence suggested that the differences between intramedullary nail and plate fixation were not significant in fracture union, radial nerve injury, and infection. But intramedullary nail significantly increased the risk of shoulder complications (shoulder impingement and restriction of shoulder movement) and reoperation.We concluded that plate fixation is superior to intramedullary nail for the treatment of humeral shaft fractures.

[Characteristic and treatment of acute aggravating cubital tunnel syndrome].

OBJECTIVE: To investigate the causes and the characteristics of acute aggravating cubital tunnel syndrome. METHODS: The enrolling criteria of subjects were as follows: (1) Patients with manifestation of cubital tunnel syndrome for more than 6 months; (2) acute exacerbation of the disease for no more than 4 weeks. The clinical data from March 2011 to December 2014 was collected and analyzed retrospectively. Twelve cases aged 52 to 65 met the enrolling criteria and were included in this study, and among them 10 patients were male, 2 were female; 5 cases were on the left and the other 7 on the right. All of them had some degree of cubital tunnel syndrome symptoms before the onset of acute exacerbation. RESULTS: When nerve decompression and anterior transposition of the ulnar nerve was performed, the elbow joint cysts which squeezed the ulnar nerve were found. The cysts were then resected. In all 12 cases, the compression symptoms of ulnar nerve were relieved after surgery. The mean follow up period was 13 months, ranging from 6 to 45 months. According to Gu Yudong functional evaluation criteria for cubital tunnel syndrome, 2 of the patients can be judged as "Excellent", 8 "good" and 2 "acceptable" at the follow-up. CONCLUSIONS: Cyst compression may induce the acute exacerbation of ulnar nerve symptom in patients with cubital tunnel syndrome. Early diagnosis and treatment is critical for these patients.

Percutaneous first annular pulley release for trigger digits: a systematic review and meta-analysis of current evidence.

PURPOSE: To determine the overall success rate and potential influencing factors within the current evidence for percutaneous first annular pulley release. METHODS: We searched PubMed, EMBASE, and the Cochrane Library for all clinical studies of percutaneous release. The rates of successful procedure and complication were extracted and analyzed. We charted the overall success rate on a forest plot with 95% confidence intervals. Data of success rates were analyzed in 5- and 10-year intervals to determine whether the rate of success had increased chronologically. We then performed 3 subgroup analyses according to instrument type (needles vs knife blades), cortisone use (cortisone vs noncortisone), and sonography guidance (sonography vs non-sonography guidance). Pooled success rates were calculated in the subgroups and compared using chi-square test. RESULTS: A total of 34 studies involving 2,114 percutaneous procedures were included in this systematic review and meta-analysis. The total success rate was 94%. There was a trend toward increasing number of publications in the past 20 years. We found a statistically significant trend showing that overall success rates had increased over time. Chi-square test revealed that percutaneous release with sonography guidance had a significantly higher success rate than non-sonography guidance. There were no significant differences in other subgroup analyses including instrument type and cortisone use. CONCLUSIONS: Percutaneous release is an effective and safe procedure for the treatment of trigger digit. It has become progressively popular in recent years, with a trend toward increased overall success. Sonography might be a helpful tool for maximizing success. The success rates were not affected by instruments and cortisone use. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Association analysis between HOXD9 genes and the development of developmental dysplasia of the hip in Chinese female Han population.

BACKGROUND: Developmental dysplasia of the hip (DDH) is a congenital or acquired deformation or misalignment of the hip joint which affects mainly females. We hypothesized that HOXD9 gene could be regulated in acetabular size or shape and related in DDH developing. METHODS: Two hundred and nine Chinese Han female DDH patients and 173 ethnic, age matched healthy female controls were genotyped for HOXD9 two tag SNPs using sequenom method. RESULTS: One of the two tag SNPs, rs711822, was not shown significantly differences in genotypic or allelic distribution between case and control group. Comparing the genotypic distribution of rs711819, there was significant differences between DDH patients group and control group (χ² = 7.54, df =2, P =0.023), and the association to DDH developing reached significance (P =0.045, OR =1.79, 95 % CI: 1.01-3.17 by dominant mode). CONCLUSION: In conclusion, the association between one tag SNP of HOXD9 gene and the development of DDH reach significant in our study population, this result indicate the positive correlation between HOXD9 gene and DDH developing. Further study in larger sample size and different population as well as functional studies will help to understand the pathogenesis of DDH.

Treatment of posttraumatic equinus deformity and concomitant soft tissue defects of the heel.

BACKGROUND: To evaluate the operative method and clinical outcome for the treatment of posttraumatic equinus deformity and concomitant soft tissue defect of the heel. METHODS: Between June 2006 and May 2010, seven cases of posttraumatic equinus deformity and concomitant unstable scar or ulcer of the heels were treated by using a hinged Ilizarov apparatus and reversed sural fasciocutaneous island flap transfer. Achilles tendon lengthening was also done in all patients. The average duration of follow-up was 21 months. The sizes of sural flaps were from 7 cm × 6 cm to 10 cm × 9 cm. Two weeks after the flap transfer, distraction of the Ilizarov fixator was initiated to gradually correct the equinus position of the foot. RESULTS: Results were evaluated by using the following criteria: (1) the degree of active dorsiflexion of the ankle, (2) the total active range of motion of the ankle, and (3) walking ability and flap durability. For active dorsiflexion of the ankle, the results were good in three patients and fair in four patients. For range of active motion of the ankle, the results were good in five patients and fair in two patients. For walking ability and flap durability, the results were good in six patients and fair in one patient. CONCLUSION: This study showed that posttraumatic equinus deformity accompanied by soft tissue defect of the heel can be treated effectively with Achilles tendon lengthening, reversed sural fasciocutaneous island flap transfer, and a hinged Ilizarov technique.

Diagnosing suspected scaphoid fractures: a systematic review and meta-analysis.

UNLABELLED: Imaging protocols for suspected scaphoid fractures among investigators and hospitals are markedly inconsistent. We performed a systematic review and meta-analysis to assess and compare the diagnostic performance of bone scintigraphy, MRI, and CT for diagnosing suspected scaphoid fractures. Twenty-six studies were included. Sensitivity, specificity, and diagnostic odds ratio were pooled separately and summary receiver operating characteristic curves were fitted for each modality. Meta-regression analyses were performed to compare these modalities. We obtained likelihood ratios derived from the pooled sensitivity and specificity and, using Bayes' theorem, calculated the posttest probability by application of the tests. The pooled sensitivity, specificity, natural logarithm of the diagnostic odds ratio, and the positive and negative likelihood ratios were, respectively, 97%, 89%, 4.78, 8.82, and 0.03 for bone scintigraphy; 96%, 99%, 6.60, 96, and 0.04 for MRI; and 93%, 99%, 6.11, 93, and 0.07 for CT. Bone scintigraphy and MRI have equally high sensitivity and high diagnostic value for excluding scaphoid fracture; however, MRI is more specific and better for confirming scaphoid fracture. We believe additional studies are needed to assess diagnostic performance of CT, especially paired design studies or randomized controlled trials to compare CT with MRI or bone scintigraphy. LEVEL OF EVIDENCE: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

[Comparison of cannulated screws fixation with different reduction methods at different time points for displaced femoral neck fractures in terms of fracture healing].

OBJECTIVE: To compare the therapeutic effect of cannulated screws fixation at different time points through different reduction methods on the healing of displaced femoral neck fractures. METHODS: From January 1997 to September 2007, 240 patients with displaced femoral neck fracture were treated, including 121 males and 119 females aged 22-79 years old (average 56 years old). All cases were fresh and close fractures. According to the fractured part, there were 133 cases of subcapital fracture, 64 of transcervical fracture and 43 of basal fracture. According to Garden classification, there were 105 cases of type III and 135 of type IV. Cannulated screws fixation was performed on all the patients, and the time from injury to operation was 6 hours to 7 days. Fifty-five cases received closed reduction and 59 cases received limited open reduction as emergency treatment, while 65 cases received closed reduction and 61 cases received limited open reduction as selective operation. Different groups were compared in terms of the healing rate of fracture, the excellent and good rate of reduction as well as the excellent and good rate of fixation. RESULTS: There was no significant difference between the closed reduction and the limited open reduction in terms of operation time and bleeding volume (P > 0.05). Postoperatively, all wounds healed by first intention, no infection was observed, avascular necrosis of femoral head occurred in 44 cases, and the rate of avascular necrosis of femoral head in the limited open reduction at emergency group was less than that of other 3 groups (P < 0.01). All the patients were followed up for 12-72 months (average 38 months), 193 cases got fracture healing at 10-23 months after operation (average 14 months). For the closed reduction as emergency operation group, the limited open reduction as emergency operation group, the closed reduction as selective operation group, and the limited open reduction as selective operation group, the healing rate of fracture was 74.55%, 91.53%, 69.23% and 86.89%, respectively; the excellent and good rate of reduction was 73.73%, 94.92%, 70.77% and 91.80%, respectively; the excellent and good rate of fixation was 76.36%, 93.22%, 73.85% and 88.52%, respectively. The healing rate of fracture, the excellent and good rate of reduction as well as the excellent and good rate of fixation in the limited open groups were higher than that of the closed reduction groups (P < 0.01), and there was no significant difference between the emergency operation groups and the selective operational groups (P > 0.05). CONCLUSION: The reduction methods have significant influences on the healing of fractures after cannulated screws fixation of the displaced femoral neck fracture, and the operation time has no obvious effect on fracture healing.

[Primary repair of soft tissue defect in fingers with arterialized venous flap].

OBJECTIVE: To summarize the results of the free transplantation of anti-valve-inflow and pro-valve-outflow arterialized venous flap in repairing soft tissue defect of fingers in emergency treatment. METHODS: From October 2002 to March 2007, 7 cases of soft tissue defects of fingers were repaired with arterialized venous flaps. There were 6 males and 1 female, aged 17-46 years. Defect was caused by crush injury in 6 cases and by stab injury in 1 case. The interval between injury and operation was 2-7 hours and the size of defects ranged from 3.0 cm x 2.0 cm to 6.0 cm x 3.5 cm. All defects were repaired by arterialized free venous flap from the ipsilateral forearm, in which the proximal ends of veins were anastomosed to artery and vein of the finger. The donor site was directly sutured. RESULTS: Six cases of arterialized venous flap survived completely and 1 case had partial superficial necrosis and healed with conservative management. The donor site healed by first intention. Postoperative follow-up ranged from 3 months to 4 years, the texture and the thickness of the flaps were satisfactory, only one presented partial pigment deposits because of superficial necrosis. No sclerosis, contracture and limited range of motion occurred in all flaps. According to the evaluation criteria for upper limb function issued by Hand Surgery Branch of Chinese Medical Association, the results were excellent in 3 cases and good in 4 cases. CONCLUSION: It is an ideal method to repair soft tissue defect of fingers by using anti-valve-inflow and pro-valve-outflow arterialized venous flap.

[A new technique determining tibial rotational alignment in total knee arthroplasty].

OBJECTIVE: To compare the two different techniques determining tibial rotational alignment in total knee arthroplasty (TKA) to enhance postoperative effect and reduce complications. METHODS: From May 2006 to April 2007, 60 patients (27 males, 33 females, aged 55-78 years) received TKA and randomly divided into 2 groups (n=30): tibial rotational alignment in TKA was determined by medical 1/3 of tibial tubercle in Group A, by medial border of tibial tubercle at 0-9 degrees varus in Group B, by medical 1/3 of tibial tubercle at 20 degrees or greater varus or by the mean line between medial border of tibial tubercle and medical 1/3 of tibial tubercle at 10-19 degrees varus. The angle of rotation of polyethylene cushion was calculated. RESULTS: The angle of rotation of polyethylene cushion in Group A was (8.4+/-3.8) degrees at 0-9 degrees varus, (3.5+/-2.7) degrees at 10-19 degrees varus and (0+/-2.4) degrees at 20 degrees varus or over, respectively, and there was significant difference (P<0.05). The angle of rotation of polyethylene cushion in Group B was (0+/-2.1) degrees at 0-9 degrees varus, (0+/-2.0) degrees at 10-19 degrees varus and (0+/-1.7) degrees at 20 degrees varus or over, respectively, and there was no significant difference (P>0.05). The angle of rotation of polyethylene cushion averaged (5.6+/-2.8) degrees in Group A and (0+/-1.9) degrees in Group B, showing significant difference (P<0.05). CONCLUSION: The range of ideal tibial rotational alignment in TKA was from medial border of the tibial tubercle to medical 1/3 of the tibial tubercle, and is decided by the degree of varus deformities and valgus deformities.

[Experimental study on reimplantation of ventral root into spinal cord after brachial plexus avulsion].

OBJECTIVE: To investigate the survival effect and reaction mechanisms of motor neurons after reimplantation of the avulsed root into the spinal cord, and to observe the survival and differentiation in the spinal cord after brachial plexus roots avulsion. METHODS: Thirty adult Wistar rats were randomly devided into the control group and the experimental group (n = 15). Laminectomy of C4-6 was performed via a posterior approach. The ventral and dorsal roots of C5,6 were both avulsed from the spinal cord outside the dura mater and within the vertebral canal. For the experimental group, the ventral root of C6 was reimplanted into the ventral horn under microscope. The dorsal root was left. The ventral and dorsal roots of C5 were placed inside the nearby muscles. For the control group, the ventral and dorsal roots of both C5 and C6 were placed inside the nearby muscles. At 2, 4, 6, 8, 12 weeks postoperatively, the C6 spinal cord was stained with HE. The changes of the number and morphology of motor neurons were observed on HE-stained sections. The C6 spinal nerve root was stained with silver nitrate, and the regeneration of nerve fiber was observed. RESULTS: All rats were recovered well and their wounds were healed at primary stage. The gross observation showed that the avulsed nerve roots in control group adhered to adjacent muscles, however the one in experimental groups which had been implanted into spinal cord adhered to scar tissues and were not separated from spinal cord. At each time point postoperatively, the HE-stained transverse sections showed that the number of motor neurons decreased significantly with soma swollen and atrophied, Nissle bodies decreased or disappeared. The survival rates of motor neurons in the control group were 60.9% +/- 5.8%, 42.3% +/- 3.5%, 30.6% +/- 6.1%, 27.5% +/- 7.9% and 20.4% +/- 6.8% respectively; in the experimental group, the survival rates were 67.1% +/- 7.4%, 56.35% +/- 4.6%, 48.7% +/- 8.8%, 44.2% +/- 5.5% and 42.5% +/- 8.3% respectively. The survival rates of motor neurons in the experimental group was higher than those in the control group at all time points, showing statistically significant difference (P < 0.01). At 12 weeks postoperatively, the silver nitrate stained specimen from the C6 nerve root showed regeneration of the motor neurons in the ventral horn into the reimplanted nerve root through axon in the experimental group, but the degeneration of the nerve fiber appeared and the number of the myelinated nerve fiber decreased in the control group. CONCLUSION: Through reimplantation of the avulsed ventral nerve root into the ventral horn, degeneration of the motor neurons in the ventral horn can be reduced. After reimplantation of avulsed nerve root, there is axonal regrowth of motor neurons into the spinal nerve root and regeneration of the myelinated nerve fiber also appears.