Arthroscopically-assisted reduction and fixation of an old osteochondral fracture of the lateral femoral condyle.

BACKGROUND: Osteochondral fracture (OCF) of the lateral femoral condyle has a low incidence and old OCF is even more rarely seen; it is difficult to differentiate from late osteochondritis dissecans (OCD). CASE REPORT: In this report, we present the case of a 20-year-old male patient with an old OCF of the lateral femoral condyle. The possible etiology of OCF is discussed, along with its clinical manifestation, diagnosis, and treatment. He underwent arthroscopically-assisted reduction and fixation with cannulated screws. Four months after the surgery, arthroscopy showed good osteochondral healing, and screws were removed. He had achieved good functional recovery by the follow-up visit. CONCLUSIONS: Old OCF should be distinguished from OCD in clinical practice, and osteochondral bodies should be preserved as much as possible. Osteochondral reduction and fixation under arthroscopy was minimal and the clinical effect was good.

[Influence of high molecular weight polyethylene on viability of osteoblasts and new bone formation].

To investigate the influence of high molecular weight polyethylene (HMWP) on the viability of osteoblasts and new bone formation in the process of fracture healing, the osteoblasts derived from adult human bone marrow were cultured in HMWP maceration extract and normal culture medium. The viability of the osteoblasts was measured by MTT assay, and the function of the osteoblasts was detected by use of alkaline phosphatase test kit. The locked double-plating (steel plate and HMWP plate) was implanted and fixed at the artificial fracture of distal femur of dogs. Specimens were gained at 3, 6, 9 and 12 weeks postoperatively, examined with macroscopy, microscope and scanning electron microscope (SEM). The results showed that HMWP did no harm to osteoblasts. There is no significant difference in activities of proliferation and alkaline phosphatase between HMWP maceration extract and normal culture medium at each observation time of at 2,4,8, and 14 dyas (P>0. 05). Bone tissue under the implanted HMWP plate manifested no absorption; the new bones formed under the HMWP plate and gradually matured as time went on. It is demonstrated in this study that HMWP has no adverse influence on the viability of osteoblasts and new bone formation and it can be used as internal fixation implant in treating fractures.

[Surgical repair of major vascular injuries in the extremities complicated by other injuries: retrospective analysis of 67 cases].

OBJECTIVE: To retrospectively analyze the surgical repair of injured major vessels in the extremities complicated by multiple other injuries. METHODS: According to different time lengths of sustaining ischemia, sites of the major vascular injuries and conditions of other injuries, 91 operations for end-to-end anastomosis, vessel grafting and repair, ligation and shunting respectively were performed on the 67 patients. RESULTS: Except for 2 fatal cases (one due to preoperative brain hernia and hemorrhagic shock, the other to thyroid crisis during operation), all other cases survived the operations. Vascular crisis occurred in 3 cases (2 arterial spasm and 1 venous crisis) 6, 7 and 12 h respectively after the operations, which were relieved by appropriate treatments and surgical explorations. One patient developed pneumonia and acute renal failure with polyuria at postoperative days 7 and 4 respectively, but full recovery was achieved. CONCLUSIONS: For patients with major vascular injuries in the extremity complicated by multiple other injuries, timely revascularization of the extremities should be performed during or immediately after emergency operations of the vital organs. Particular attention should be given to the diagnosis and repair of closed major vascular injuries in such patients, who need to be monitored for blood coagulation during operation and should receive due post-operative anti-coagulation treatment.

[An experimental study of treatment of comminuted distal femur fracture with locked double- plating].

OBJECTIVE: To explore new techniques for the treatment of comminuted distal femoral fractures to promote functional restoration and reduce the complications of the fracture. METHODS: Sixteen adult canines were selected for this study, and the experimental and control hindlimb for each canine were randomly determined. Distal comminuted fracture (AO/ASIF Type C2) was induced in both sides of the canine's femurs, and one side was fixed with the double plates (steel plate and polyethylene plate), whereas the other with a single steel plate. By the end of 3, 6, 9 and 12 weeks respectively after surgery, 4 of the dogs were used for weight-bearing observation and radiological and histological examination of the limbs. RESULTS: In comparison with dogs in single plate group, double plate fixation resulted in earlier recovery of weight bearing, more abundant and better callus, finer callus moulding and quicker healing. There were slightly more inflammatory cells, however, in the tissues under the polyethylene than those under the steel plate. CONCLUSION: Locked double-plate internal fixation is an excellent alternative for treating comminuted fractures of the distal femur, and may have its potential use in clinical settings.

[Microsurgical repair of syndactyly of the fingers in children].

OBJECTIVE: To evaluate the effectiveness of microsurgical technique for repairing syndactyly of the fingers in children. METHODS: Microsurgical repair of syndactyly of the fingers was performed in 32 children. The skin joining the syndactyly was incised and relaxed under microscope, and dorsal metacarpal flap of comparable size was used to repair the lateral skin defect of the finger and also to reconstruct the finger web. RESULTS: All the flaps survived without scar leaving on the lateral skin of the fingers, and the reconstruction of the finger web was satisfying. CONCLUSION: Microsurgical technique is applicable in the surgical repair of syndactyly of the fingers in children.

[Operative treatment of acetebular fractures].

OBJECTIVE: To discuss the diagnosis and operative technology of acetabular fracture. METHODS: 41 cases of displaced acetabular fractures were enrolled. CT and 3D-CT were performed before operation to understand the classification of fractures and to determine operative regimen. All cases were fixed by reconstruction plates and screws through the best approach. RESULTS: 39 cases were followed up for 1 - 4 years, with an average of 1.5 years. Curative outcomes were assessed by Matta's criteria. Clinically, 16 (53.3%) 30 fresh fractures were excellent, 11 (36.7%) good, 3 (10%) fair. The rate of excellence and goodness was 90%. In 9 cases of old fractures, 2 were excellent, 3 good, 2 fair and 2 poor. The rate of excellence and goodness was 55.6%. Complications consisted of sciatic never injury, necrosis of the femoral head, and heterotopic ossification. CONCLUSIONS: The time of operation, degree of injury, and quality of reduction of fracture are important factors affecting the postoperative function of the hip. The key to enhance the outcome is to verdict the type of fracture, select the proper approach before operation, and precise reduction and appropriate internal fixation during operation.

[Biomechanical study of double-plate fixation for comminuted fractures of the distal femur].

OBJECTIVE: To explore the new treatment approach for comminuted fractures of the distal femur. METHODS: Supra- and intercondylar comminuted fractures were induced in the femurs of 20 fresh adult cadavers, 10 of which received fixation with lateral steel plates and medial polyethylenes plates while the rest with single plate in the lateral only. Biomechanical tests of bending, torsion and compression were performed. RESULTS: Biomechanical test demonstrated that double-plate fixation provided better resistance to compression (P<0.05) as well as bending and torsion (P<0.01) than single-plate fixation did. CONCLUSION: Double-plate fixation is effective and may have potential clinical value in treating comminuted fractures of the distal femur.