[Fingertip replantation with anastomosis of palm vein and retaining the nail].

OBJECTIVE: To study the replantation methods and clinical results of amputated fingertip. METHODS: From October 2007 to June 2011, 18 fingers of 13 cases were replanted with anastomosis of palm vein and retaining the nail, including 9 males and 4 females,with an average age of 26 years old ranging from 17 to 45 years old. The time from injury to therapy was from 30 min to 5 h, time of broken finger ischemia was from 1.5 to 7 h. All broken fingers were preservation under normal temperature. RESULTS: All fingers were survived, no vascular crisis happened. All cases were followed up from 3 to 24 months with an average of 14 months. The length and shape of replanted fingers were similar to that of the healthy side. The new nails were smooth, the function was perfect,the sense of pain and touched sensation had been recovered. Their two-piont discriminations ranged from 3 to 6 mm with an average of 5 mm. According to the assessment standard of Chinese Medical Association of Hand Surgery, the results were excellent in 14 cases, good in 3 cases, poor in 1 case. CONCLUSION: Fingertip replantation with anastomosis of palm vein and retaining the nail is regained satisfactory appearance and function of the digits with a high survival rate.

[Posterior occipitocervical fixation using C2 pedicle screws and occipitocervical plate systems].

OBJECTIVE: To observe the clinical effect of a occipitocervical fixation systems using C(2) pedicle screws and plates. METHODS: An occipitocervical fixation system was designed. Since June 2001 to March 2003, 38 patients with instability of atlantoaxial joint underwent reconstructive surgery using this systems. Twenty-four patients were associated with congenital occipitalization. The pedicle screws were inserted into C(2) pedicles in the direction as its axis. The occipitocervical plate was slightly bent to fit the occipital contour and fixed onto the occiput. Hyperflexion alignment of the occipitoatlantoaxial complex was corrected by application of extensional force created by tightening of the nut on the pedicle screws. The autogenous cancellous bones were grafted between the occiput and the axis. RESULTS: In this series, neither vertebral artery nor spinal cord was injured. 36 of 38 cases were followed up for an average of 18 months, all cases achieved solid bony fusion. No implant failure was found. CONCLUSIONS: Occipitocervical reconstruction by the combination of C(2) pedicle screws and occipitocervical plate systems can provide sufficient correction of malalignment in the occipitoatlantoaxial region and achieve high fusion rate.