Treatment of proximal humeral fractures accompanied by medial calcar fractures using fibular autografts: A retrospective, comparative cohort study.

BACKGROUND: Severe proximal humerus comminuted fractures are often accompanied by medial calcar comminuted fractures and loss of medial support, which are important factors that lead to internal fixation failure. The appropriate treatment for proximal humerus comminuted fractures has not been established. Therefore, this study assessed the outcomes of using a fibular autograft with locking plates to treat severe proximal humerus comminuted fractures. AIM: To investigate the outcomes of using a fibular autograft with locking plates to treat severe proximal humerus comminuted fractures. METHODS: This retrospective, comparative cohort study included two groups of patients. Group 1 comprised 22 patients and group 2 comprised 25 patients with complete follow-up data. Group 1 was treated with a fibular autograft with open reduction and locking plates to enable internal fixation. Group 2 was treated with open reduction and locking plates to enable internal fixation. The intraoperative blood loss volume from the shoulder wound, operative time, shoulder wound pain, bone fracture healing time, Constant-Murley score of the shoulder joint, preoperative Holden walking function score, Mallet score of the shoulder joint, and humeral neck-shaft angle during surgery of the two groups were compared, and the differences were analysed using an independent sample t-test. RESULTS: Group 1 had a shorter mean operative time than group 2 (2.25 ± 0.30 h vs 2.76 ± 0.44 h; P = 0.000). Group 1 had a lower shoulder wound pain score on the first day after surgery than group 2 (7.91 ± 1.15 points vs 8.56 ± 1.00 points; P = 0.044). Group 1 had a shorter fracture healing time than group 2 (2.68 ± 0.48 mo vs 3.64 ± 0.64 mo; P = 0.000). Group 1 had higher Constant-Murley scores of the shoulder joint at 3, 6, and 12 mo after surgery than group 2 (76.64 ± 4.02 points vs 72.72 ± 3.02 points, 86.36 ± 3.53 points vs 82.96 ± 3.40 points, and 87.95 ± 2.77 points vs 84.68 ± 2.63 points, respectively; P = 0.000, 0.002, and 0.000, respectively). Group 1 had higher Mallet scores of the shoulder joint at 3, 6, and 12 mo after surgery than group 2 (10.32 ± 0.57 points vs 9.96 ± 0.54 points, 13.36 ± 1.00 points vs 12.60 ± 0.87 points, and 13.91 ± 0.75 points vs 13.36 ± 0.70 points, respectively; P = 0.032, 0.007, and 0.013, respectively). CONCLUSION: Using locking plates with a fibular autograft can recreate medial support, facilitate fracture healing, and improve shoulder function; therefore, this may be an effective treatment option for severe proximal humerus comminuted fractures.

Comprehensive Rehabilitation Therapy Plus Glucosamine Hydrochloride for Exercise-Induced Knee Injuries and the Effect on Knee Function of Patients.

Objective: To assess the application value of comprehensive rehabilitation therapy plus glucosamine hydrochloride for exercise-induced knee injuries and its effect on knee function. Methods: A total of 96 patients with an exercise-induced knee injury who were admitted to our hospital from February 2019 to February 202 were recruited and assigned at a ratio of 1 : 1 with matched general information to a control group (n = 45) or an experimental group (n = 51). Both groups of patients received comprehensive rehabilitation therapy, and the patients in the experimental group were daily given additional glucosamine hydrochloride tablets for 8 weeks. Results: The experimental group showed a higher treatment efficacy than the control group (P < 0.001). After the treatment, the VAS scores and C-reactive protein of the two groups showed a decline, with a lower result in the experimental group than in the control group (P < 0.001). The Lysholm knee scores were increased in the two groups after the treatment, and the experimental group had a higher score (P < 0.001). After the treatment, patients of both groups showed reduced five-times-sit-to-stand-test (FTSST) results, with a better outcome obtained in the experimental group (P < 0.001). Conclusion: Comprehensive rehabilitation therapy plus glucosamine hydrochloride effectively improves the clinical efficacy of exercise-induced knee joint injuries and enhances the knee joint rehabilitation of the patients.

[A case-control study of preserving the shape of iliac bone and traditional iliac osteotomy].

OBJECTIVE: To compare and study the traditional iliac bone extraction and iliac crest preserving bone extraction, and to observe their curative effects. METHODS: From January 2016 to December 2018, 50 patients were treated with traditional iliac bone extraction and iliac crest preserving iliac bone extraction, with 25 cases in each group. In the traditional iliac bone extraction group, there were 18 males and 7 females, aged (42.0±7.9) years, hospitalized for (20.0±5.5) days and followed up for (13.68±1.60) months. There were 16 males and 9 females in the iliac crest preserving osteotomy group, aged (44.0±8.2) years, hospitalized for (21.0±6.5) days and followed up for (14.04±1.54) months. The operation time, intraoperative bleeding, postoperative pain visual analgue scale(VAS), fracture healing and complications were recorded and compared between the two groups. RESULTS: In the traditional iliac bone extraction group, the operation time was (16.20±2.51) min, the amount of bleeding was (63.20±17.73) ml, the VAS score on the first day after operation was 4.72±1.21, and the fracture healing time was (4.84±0.90) months. In the iliac crest preserving osteotomy group, the operation time was (16.24±3.00) min, the amount of bleeding was (62.80±18.14) ml, the VAS score was 4.80±1.29 on the first day after operation, and the fracture healing time was (4.68±0.80) months. There was no significant difference in operation time, bleeding volume, pain VAS on the first day after operation and fracture healing time between the two groups(P>0.05). CONCLUSION: Compared with the traditional iliac bone removal surgery, this bone removal method of preserving the appearance of iliac bone is simple and convenient. While ensuring the amount of bone removal, it retains the appearance of iliac crest as much as possible and reduces local discomfort symptoms after operation. It is worth popularizing.

[Application of double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique for thumb defect].

OBJECTIVE: To investigate the effectiveness of double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique in treatment of thumb defect. METHODS: Between February 2017 and June 2019, 6 patients with traumatic thumb defects were treated with double osteotomy and lengthening of proximal phalanx and metacarpal by Ilizarov technique. There were 5 males and 1 female. The age ranged from 28 to 57 years, with an average of 41.5 years. There were 3 cases on the left side and 3 cases on the right side. All patients were admitted to the hospital in emergency department after injury, and the stump of the thumb was trimmed and sutured. The osteotomy plane was the distal part of the proximal phalanx in 4 cases and the interphalangeal joint in 2 cases. The interval between injury and osteotomy was 20-245 days (median, 34.5 days). After minimally invasive osteotomy and placement of a semi-circular external fixator, the lengthening began on the 5th day. The proximal phalanx and metacarpal were lengthened by 0.5 mm every day, once every 12 hours. The thumb of the affected side was distracted to the middle of the distal phalanx of the healthy thumb, and the fixator was removed after the bone healed. RESULTS: The distraction time was 14-23 days, with an average of 18.8 days. The osteotomies were healed with healing time of 91-147 days (mean, 120.2 days). The total distraction length of the proximal phalanx and metacarpal was 1.40-2.25 cm, with an average of 1.86 cm; healing index was 51.0-72.2 days/cm, with an average of 64.9 days/cm. All patients were followed up 5-12 months (mean, 8.2 months). At last follow-up, the two-point discrimination was 5.3-8.5 mm with an average of 6.98 mm. According to the evaluation standard of the upper limb part of the Chinese Medical Association, the score was 10-14, with an average of 12.5. Among them, 4 cases were excellent and 2 cases were good, with an excellent and good rate of 100%. All patients were satisfied with the function and appearance of thumb after operation. The Quick Disabilities of Arm, Shoulder, and Hand (Quick-DASH) score was 2.3-9.1, with an average of 6.1. CONCLUSION: The double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique is an effective method for the treatment of thumb defects.

Histopathological changes in the infrapatellar fat pad in an experimental rabbit model of early patellofemoral osteoarthritis.

BACKGROUND: The purpose of this study was to characterise the histopathological changes in the infrapatellar fat pad (IPFP) in the early stage of patellofemoral osteoarthritis (PFOA). METHODS: Sixty-four New Zealand white rabbits were randomly divided into experimental (n = 24), sham (n = 16), and control groups (n = 24). In the experimental group, denoted as the patellar ligament uneven shortening group (US group), the patellar ligament (PL) was folded eight millimetres and sutured. After eight weeks, all animals were euthanised, and magnetic resonance imaging (MRI) evaluation, wet IPFP weight measurement, and histopathological and immunohistochemistry analysis were performed to analyse the histopathological changes in the IPFPs. RESULTS: The maximum cross-sectional area (CSA) of the IPFPs in the sagittal position of MRI in the control group, sham group, and US group were 45.50 ±â€¯7.19 mm2, 45.88 ±â€¯6.60 mm2 (vs. control group, P = 0.907), and 53.83 ±â€¯8.24 mm2 (vs. control group, P = 0.015; vs. sham group, P = 0.035), respectively. The MRI intensity of the IPFPs in the control group, sham group, and US group were 115.53 ±â€¯28.85, 108.53 ±â€¯26.73 (vs. control group, P = 0.589), and 154.52 ±â€¯18.48 (vs. control group, P = 0.002; vs. sham group, P = 0.002), respectively. The wet weight of the IPFPs in the control group, sham group, and US group were 0.32 ±â€¯0.05 g, 0.32 ±â€¯0.04 g (vs. control group, P = 0.895), and 0.38 ±â€¯0.06 g (vs. control group, P = 0.017; vs. sham group, P = 0.033), respectively. The Osteoarthritis Research Society International (OARSI) scores of the IPFPs in the US group were 6.00 ±â€¯1.91, which was higher than the scores of 2.50 ±â€¯2.02 (P < 0.001) in the control group and of 2.75 ±â€¯1.67 (P = 0.001) in the sham group. CONCLUSIONS: The histopathological changes of the IPFPs as determined via MRI and microscopic structure appeared to occur much earlier than cartilage damage in PFOA. Furthermore, detecting and treating the IPFP changes may offer aid in the diagnosis and treatment of PFOA.

[Effectiveness of rigid interlocking nails through tip of greater trochanter for fixation of femur shaft fracture in adolescent].

Objective: To explore the effectiveness of rigid interlocking nails through the tip of the greater trochanter for fixation of femur shaft fracture in adolescent. Methods: A retrospective analysis was made on the clinical data of 23 adolescents with femoral shaft fractures treated between June 2011 and June 2015. Of 23 cases, 19 were male and 4 were female, aged from 13 years and 6 months to 17 years (mean, 15.2 years), weighed from 40 to 77 kg (mean, 53.5 kg). The causes were traffic accident injury in 13 cases, sports injury in 7 cases, and falling injury in 3 cases. Fracture located at the proximal 1/3 in 6 cases, middle 1/3 in 10 cases, and distal 1/3 in 7 cases; fracture was typed as transverse in 10 cases, oblique in 6 cases, spiral in 1 case, and comminuted in 6 cases. The course of disease was 3-17 days (mean, 6.2 days). At last follow-up, the leg length discrepancy, femoral neck shaft angle, femoral neck diameter, and articulotrochanteric distance (ATD) were measured on the X-ray films. Results: Wounds healed in all patients, and no infection occurred. All patients were followed up 15-36 months (mean, 26.5 months). The patients had no pain and had normal gait, without lameness. The X-ray films showed bone healing at 5-13 months (mean, 6.5 months). No nonunion, delayed union, malunion of more than 5 °, or rotational deformity occurred. The removal time of internal fixations was 12-24 months (mean, 19.5 months) after operation. No heterotopic ossification, re-fracture, proximal femoral deformity, or femoral head necrosis occurred during follow-up. Two patients had early epiphyseal closure of greater trochanter, which had no impact on gait; leg-length inequality of less than 1 cm was observed in 2 cases. At last follow-up, the neck shaft angle, femoral neck diameter, and ATD of normal and affected sides were (131.7±6.3) and (132.9±7.8)°, (34.1±3.2) and (33.9±3.8) mm, and (27.8±9.2) and (26.5±8.5) mm, showing no significant difference between two sides ( t=-0.24, P=0.86; t=0.18, P=0.92; t=1.03, P=0.49). Conclusion: It is a reliable and effective method to use rigid interlocking nails inserted through the tip of the greater trochanter for the fixation of femur shaft fracture in adolescent.

[EFFECTIVENESS OF SPRING HOOK PLATE FOR POSTERIOR MALLEOLUS FRACTURE].

OBJECTIVE: To investigate the effectiveness of spring hook plate for posterior malleolus fracture by comparing with cannulated screw. METHODS: Between March 2012 and September 2013, 100 cases of posterior malleolus fracture were treated. Fracture was fixed with spring hook plate in 50 cases (research group) or with cannulated screw in 50 cases (control group). There was no significant difference in gender, age, cause of injury, associated injury, and injury to operation time between 2 groups P>0.05). The operation time, intraoperative blood loss, union time of fracture, ankle range of motion (ROM), and complications were recorded and compared. The ankle joint function was evaluated by the ankle hindfoot scale of American Orthopedic Foot and Ankle Society (AOFAS). RESULTS: There was no significant difference in operation time and intraoperative blood loss between 2 groups P>0.05). The patients were followed up 6-12 months (mean, 9.8 months) in the control group and 6-12 months (mean, 9.2 months) in the research group. The X-ray films showed that fracture union was achieved in 2 groups; the union time of the research group[(9.5±1.4) weeks] was significantly shorter than that of the control group[(10.5±1.3) weeks] (t=2.029, P=0.017). The ROM was (25.1±3.2)° for dorsal extension and was (45.3±2.3)° for plantar flexion in the research group at 6 months after operation, which were significantly better than those of the control group[(22.2±2.3)° and (41.2±2.5)°] (t=-3.950, P=0.001; t=-5.212, P=0.000). The ankle hindfoot scale of AOFAS was 85.1±8.6 in the control group at 6 months; the results were excellent in 15 cases, good in 20 cases, and moderate in 15 cases with an excellent and good rate of 70%. The ankle hindfoot scale of AOFAS was 89.4±7.9 in the research group; the results were excellent in 20 cases, good in 22 cases, and moderate in 8 cases with an excellent and good rate of 84%; there was significant difference between 2 groups (t=-2.191, P=0.042; χ2=0.413, P=0.018). Incision infection occurred in 3 cases of the control group and in 2 cases of the research group, which was cured after dressing change; screw loosening and fracture displacement occurred in 3 and 4 cases of the control group, but did not in the research group. The complication rate of the control group and the research group was 20% and 4% respectively, showing significant difference between 2 groups (χ2=6.061, P=0.028). CONCLUSIONS: Spring hook plate can shorten the time of union, increase the ROM of the ankle after operation, get good functional restoration, and decrease the rate of complication compared with cannulated screw fixation.

Nationwide desert highway assessment: a case study in China.

The natural environment affects the construction of desert highways. Conversely, highway construction affects the natural environment and puts the ecological environment at a disadvantage. To satisfy the variety and hierarchy of desert highway construction and discover the spatio-temporal distribution of the natural environment and its effect on highway construction engineering, an assessment of the natural regional divisions of desert highways in China is carried out for the first time. Based on the general principles and method for the natural region division, the principles, method and index system for desert highway assessment is put forward by combining the desert highway construction features and the azonal differentiation law. The index system combines the dominant indicator and four auxiliary indicators. The dominant indicator is defined by the desert's comprehensive state index and the auxiliary indicators include the sand dune height, the blown sand strength, the vegetation coverage ratio and the annual average temperature difference. First the region is divided according to the dominant indicator. Then the region boundaries are amended according to the four auxiliary indicators. Finally the natural region division map for desert highway assessment is presented. The Chinese desert highways can be divided into three sections: the east medium effect region, the middle medium-severe effect region, and the west slight-medium effect region. The natural region division map effectively paves the way for the route planning, design, construction, maintenance and ongoing management of desert highways, and further helps environmental protection.

[Clinical analysis in treating lumbar intervertebral disc herniation with nucleus pulposus resection through small incision and lamina fenestration].

OBJECTIVE: To analyze effect of treatment of lumbar intervertebral disc herniation with nucleus pulposus resection through small incision and lamina fenestration,and to explore operative advantage and mattars needing attention. METHODS: Ninety-six patients with lumbar intervertebral disc herniation, including 48 males and 48 females with an average age of 46.4 years (ranging for 16-75 years) and an average course of 5 years (ranging from 1 month to 30 years), were treated with nucleus pulposus resection through small incision and lamina fenestration. The clinical effects were analyzed according to JOA scoring criteria of lower back pain. RESULTS: All patients were followed up from 6 months to 3.5 years with an average of 1.2 years. According to JOA scoring criteria, 34 cases obtained excellent result, 55 good, fair 7. The rate of excellent and good was 92.71% and the mean improvement rate was 54.53%. CONCLUSION: Nucleus pulposus resection through small incision and lamina fenestration can obtain satisfactory outcome in treating lumbar intertebral disc herniation. The incidence of lumbar instability and postoperative complications were low. It is one of the better method for the treatment of lumbar intertebral disc herniation.