[Repair of the fracture of the joint of tendon and bone of the quadriceps femoris tendon with wire anchor and transverse drilling of the patella].

OBJECTIVE: To explore the effect of suture anchor combined with transverse drilling of patella to repair the fracture of the joint of bone and tendon of quadriceps femoris tendon. METHODS: From April 2016 to January 2018, 6 patients (8 knees) with complete rupture of the joint of the tendon and bone tendon of the quadriceps femoris were treated with the combination of anchor with wire and transverse drilling of the patella, including 5 males (7 knees) and 1 female, aged from 43 to 74 years with an average age of 53 years old. All the patients had pain in knee joint and could not extend the knee actively after trauma. X-ray, CT and MRI were performed on the knee joints, and it was clear that the joint of bone and tendon of quadriceps femoris tendon was completely broken. The X-ray of knee joint was reviewed regularly after operation, and Lysholm score was used to evaluate the function of knee joint. RESULTS: The average operation time of all patients was 60 minutes. Tourniquets were used during the operation, no drainage was placed after the operation, and no blood transfusion was performed in all patients. Six patients were followed up for 15 to 36 months with an average of 26 months. Lysholm score of 6 patients (8 knees) was 79 to 95 in the last follow-up with an average of 89 points. One of the patients with mandatory spondylitis developed infection and healed after 2 debridements. CONCLUSION: The suture structure of the joint of bone and tendon of quadriceps femoris tendon repaired with suture anchor and lateral drilling of patella is simple, reliable and effective.

[Clinical characteristics of triceps brachii tendon rupture at olecranon ending].

OBJECTIVE: To observe the clinical characteristics of triceps brachii tendon rupture at olecranon ending. METHODS: From June 2005 to November 2011,19 patients with triceps brachii tendon rupture at olecranon ending were treated with surgical technique. Among the 19 patients, 7 patients were male, with an average age of 24.1 years old (ranged, 15 to 41 years old); 12 patients were female, with an average age of 51.4 years old (ranged, 16 to 73 years old). Eight patients had injuries in the left elbows, and 11 patients had injuries in right elbows. Seventeen patients had injuries induced by walking fall and 2 patients had injuries induced by falling down. Thirteen patients were simple triceps brachii tendon rupture at olecranon ending, 6 patients were associated with other elbow injuries. Five patients were associated with radial fracture; 1 patient with capitellum fracture; 1 patient with coronoid process fracture; 1 patient with epitrochlear. All the lateral radiographs of the injuried elbow demenstrated the flecks of avulsed osseous material from the olecranon (flake sign). The associated injuries had the homologus presence. All the patients were treated with surgical techniques:15 patients were treated with figure-of-eight tension-band wire; figure-of-eight tension band wire and Kirschner wire in 1 patient; wire cerclage in 1 patient; nonabsorbable suture in 2 patients. The associated injuries were treated simultaneously. Plaster was applied after operation in 2 patients with heavier elbow associated injuries, other patients without any external fixation. The Mayo elbow score were observed to determinate the function of the elbow. RESULTS: All the patients were followed up, 1 patient died of other disease at one year after operation, the other 18 patients were followed up with an average of 47.9 months (ranged from 14 to 91 months). According to the Mayo elbow score, 16 patients got an excellent result and 2 good. CONCLUSION: Traumatic rupture of triceps brachii tendon at olecranon ending is not a rare injury, which is common in female older than fifty and in male younger then thirty. Surgical results are generally excellent. But dysfunction frequently remains in patients with associated elbow injuries.

[Clinical study to the cannulated screws with fluoroscopy in the operation of femoral neck fractures].

OBJECTIVES: To investigate the safe distance from the tip of the cannulated screw to the apex of the femoral head, and to avoid cutting out of the cannulated screws from the femoral head. METHODS: From November 2007 to April 2008, the placement configuration of the cannulated screws in the femoral head on the anteroposterior (AP) and lateral view was investigated. And the relation between the three-dimensional configuration and the two-dimensional perpendicular view of the femoral head to establish a solid geometry formula was analyzed. According to the configuration, the distances from the tips of different cannulated screws to the apex of the femoral head to confirm the screws placement within the femoral head was measured. RESULTS: The actual risk of cutting out of the cannulated screws varied according to the different placement of the cannulated screws in the femoral head, even if the screw tips were within the femoral head on the AP and lateral radiograph. The mean diameter of femoral head was 49.8 mm. If the cannulated screw is in the center of femoral head on the lateral view, the cannulated screw would not cut out as long as it was in the femoral head on the AP view. When the angle was 22.5°on the lateral view, and under 22.5°on the AP view, the distance from the screw tip to the apex of the femoral head would exceeded 2.2 mm. If the angle > 45°on the AP view, the distance would exceed 9.6 mm. When the angle was 45°on the lateral view, and under 22.5°on the AP view, the distance would exceed 8.2 mm. When the angle > 45°on the AP view, the distance would exceed 17.7 mm. When the angle was 67.5°on the lateral view, the distance would exceed 23.1 mm on AP view. CONCLUSIONS: If the cannulated screw is in the center of femoral head on the lateral view, the cannulated screw won't cut out as long as it is in the femoral head on the AP view. The angle is larger on the AP and lateral view (especially on the lateral view), and the distance is longer.

[Surgical resection of heterotopic ossification after open reduction internal fixation of acetabular fractures].

OBJECTIVE: To evaluate the clinical effect of surgical resection of the severe heterotopic ossification (HO) after the open reduction internal fixation (ORIF) of acetabular fractures. METHODS: Five cases of severe HO after the ORIF of acetabular fractures were treated by surgical resection from October 2005 to April 2007. All patients were male, the average age was 34 years (22 to 45 years). The average time of HO after ORIF of acetabular fractures was 14.2 months (3 to 30 months). The original surgical approaches were: Kocher-Langenbeck approach as 4, ilioinguinal combined K-L approach as 1. According to the Brooker classification, there were 4 patients with IV degree and 1 with III degree. The average total movement for all the 5 patients was 8 degrees. All patients received one time radiation therapy before or after operation, the dosage was 7-8 Gy. The surgical approach was Kocher-Langenbeck for all patients. During operation the nerve stimulator was used to explore the sciatic nerve and carefully protected it, resected all HO bone and removed all implants. For one patient, because of confusion between femoral head and acetabulum, total hip replacement were performed. The joint exercise (passively and actively) began from the second day after operation, and at the same time, all patients took the indomethacin to prevent the occurrence of HO. RESULTS: All patients were followed up for 4 to 22 months. There was no recurrence of HO, the average total movement for all the 5 patients was 160 degrees. CONCLUSION: Early surgical resection and combined with radiation and indomethacin for the severe HO after the ORIF of acetabular fractures can obtain excellent results.

[Related factor analysis of avascular necrosis of the femoral head after internal fixation with cannulated screws in femoral neck fractures].

OBJECTIVE: To observe the accident of avascular necrosis of the femoral head after internal fixation with cannulated screws in femoral neck fractures and analysis of the related factors. METHODS: 212 cases of femoral neck fracture treated with cannulated screws between Sep. 1989 and Dec. 1999 were reviewed retrospectively. The average age was 45.2 years old, ranging from 13 to 70 years. Among the fractures, 3 were Garden stage I, 32 were Garden stage II, 107 were Garden stage III, 53 were Garden stage IV, and 17 unclassified. Average duration of follow-up was 32.7 months, ranging from 12 to 101 months. RESULTS: Fracture healing occurred in 203 cases (95.8%). Avascular necrosis of the femoral head occurred in 70 cases (33.0%) and late collapse developed in 30 cases (14.3%). The rate of the avascular necrosis and late collapse of the femoral head according to the Garden stage was 0/0, Garden stage I; 6.3%/0, Garden stage II; 33.6%/15.9%, Garden stage III; 49.1%/20.8%, Garden stage IV. Avascular necroses of the femoral head were observed within 3 years in most cases (95.7%). Correlation analysis shows Garden stage of the fracture was the major factor contributed to the accident of avascular necrosis and late collapse of the femoral head. It also shows the low risk of avascular necrosis and late collapse of the femoral head was related to the patient's age over 60; time of surgery within 14 days and Garden's reduction index within 155-180 degrees on both AP and Lateral views. CONCLUSION: Garden stage of the fracture is the major factor contributed to the accident of avascular necrosis and late collapse of the femoral head, emergency operation and good reduction is beneficial to reduce the accident of avascular necrosis of femoral head.

[Outcome of hip fractures after traction treatment in elderly].

OBJECTIVE: To observe the outcome of hip fractures which accepted traction treatment instead of operation considering their general condition in elderly. METHODS: 102 cases of hip fractures accompanied by heart disease, hypertension, diabetes etc from Nov. 2000 to Jan. 2005 were accepted traction treatment. Among them, 37 cases are femoral neck and 65 cases are femoral intertrochanteric fractures. The average age was 75.8 years old, ranging from 48 to 98 years old. All cases were treated at home. RESULTS: one-year mortality was 8.8% (9/102). According to the incidence, the complications include bedsore (30/102, 29.4), pulmonary infection (6/102, 5.9%), DVT (2/102), PE (1/102), Urine infection (1/102). The rate of healing in femoral neck fractures was 51.7% (15/29); in intertrochanteric fractures was 97.6% (40/41). The decrease of Harris score between pre-injury and post-injury was 23.1 in femoral neck fractures and 15.6 in intertrochanteric fractures. CONCLUSION: For non-displacement and stable femoral neck fractures and some intertrochanteric fractures, good results could be obtained by traction treatment. Considering its low cost, traction treatment had its own indications.