Horizontal Rafting Plate for Treatment of the Tibial Plateau Fracture.

OBJECTIVE: This study aimed to investigate the value of a horizontal rafting plate in treating tibial plateau fractures. METHODS: The data of 24 patients in whom a horizontal rafting plate was used to treat a tibial plateau fracture between October 2014 and January 2018 were retrospectively analyzed, including 16 males and 8 females, aged 21-63 years old, with an average of 40 ± 14.68 years. The fractures included 13 in the left knee and 11 in the right knee. The places where the horizontal rafting plate were used included the anterior margin of tibia, anterolateral tibia, and posterolateral tibia. All cases were followed up for 12-24 months, with an average follow-up of 17.5 ± 5.0 months. At the last follow-up, the Rasmussen radiological criteria were used to evaluate the effect of fracture reduction and fixation. The knee joint function was evaluated using the Rasmussen functional score. Computed tomography (CT) scanning and three-dimensional reconstruction were performed preoperatively and postoperatively, with the quality of reduction of the fractured articular surface clarified by the final follow-up. The flexion and extension abilities of the knee joint were also measured in the postoperative follow-up. RESULTS: Preoperative CT scanning showed that the gap of the tibial plateau was 8.00 ± 1.40 (5-24) mm. The heights of the fracture of the articular surface at all three sites during the final follow-ups were significantly different from the height before the surgery (P < 0.05). The vertical distance between the articular line and the highest point of the articular surface after reduction was 0.17 ± 0.05 mm. Anatomic reductions were obtained in 24 patients. The Rasmussen functional score after surgeries was 27.25 ± 0.94 points. Bony union was achieved in all the patients. According to the Rasmussen radiological criteria, the scores during the last follow-up were as follows: the total score was 13-18 points, with an average of 16.00 ± 1.72 points; the scores were excellent in 17 cases and good in seven cases. Therefore, 100% of results were excellent or good. No infection or fracture nonunion was found. CONCLUSION: Using a horizontal plate can be an effective method for treating special types of fractures of the tibial plateau, including the anterior margin and anterolateral and posterolateral tibial plateau, with satisfactory treatment efficacy.

Surgical Strategy for Anterior Tibial Plateau Fractures in Hyperextension Knee Injuries.

OBJECTIVE: The aim of the present study was to summarize the clinical characteristics, treatment strategies, and clinical results for anterior tibial plateau fractures caused by hyperextension injuries. METHODS: We performed a retrospective analysis of 26 cases of anterior tibial plateau fractures that were treated with open reduction and internal fixation from January 2016 to December 2019, including 16 men and 10 women, aged 26-68 years old, with an average age of 47 ± 12.5 years. According to the three-column theory classification, there were 16 cases of single-column fractures (9 cases of anteromedial fractures and 7 cases of anterolateral fractures), 3 cases of two-column fractures (anteromedial + anterolateral fractures), and 7 cases of three-column fractures. Options for the surgical approach included anteromedial, anterolateral, modified anterior median, and anterolateral + posteromedial incision. The implants included a T-shaped plate, an L-shaped plate, a horizontal plate, and a TomoFix plate. The surgical approach and fixation method were selected based on the characteristics of the anterior tibial fracture. The Rasmussen radiological criteria were used to evaluate the effects of fracture reduction and fixation. The knee joint function was evaluated using the knee function evaluation criteria of the Hospital for Special Surgery. Medial and lateral stress tests, the Lachman test, and the pivot shift test were used to evaluate the stability of the knee joint. The range of knee motion was recorded. RESULTS: All cases were followed up for 12-24 months, with an average follow up of 15.7 months. The operation time was (148 ± 42) min; the intraoperative blood loss was (150 ± 50) mL. A total of 22 cases were anatomically reduced and 4 cases were well-reduced, and the compression reduction rate was 100%. According to the Rasmussen radiology scoring, 17 cases were excellent and 9 cases were good. The excellent and good rate was 100%. The fracture healing time was 3.3 months. There is no difference in fracture healing time for different fracture types. Both the Lachman and pivot shift test findings were normal in 24 patients and nearly normal in 2 patients. The posterior drawer test was normal in 25 patients and close to normal in 1 patient. The varus stress test was normal in 24 patients and nearly normal in 2 patients, while the valgus stress test was normal in 23 patients, nearly normal in 2 patients, and abnormal in 1 patient. The range of motion (ROM) was 100°-137°, with an average of 125° ± 11.7°. The Hospital for Special Surgery (HSS) knee score at the last follow up was 79-98 points, with an average of 87.54 ± 8.36 points; the results were excellent in 21 cases and good in 5 cases. Therefore, 100% of results were excellent or good. Two cases had superficial wound infections after the operation. The recovery of 2 patients with common peroneal nerve injury was poor. CONCLUSION: The appropriate surgical approach and fixation method were performed according to the different positions of the anterior tibial fracture and satisfactory results were obtained after surgery.

[Effect of Ca-bentonite on Cu and Zn Forms in Compost and Soil, and Their Absorption by Chinese Cabbage].

Aerobic composting was conducted to evaluate the effects of the different ratios (0%, 2.5%, 5%, 7.5%, and 10%) of Ca-bentonite (CB) on the speciation of Cu and Zn during pig manure composting, while pot experiment was performed to investigate the role of CB-added compost on the bio-availability of Cu and Zn to Chinese cabbage and its biomass. The results showed that the exchangeable fractions of Cu and Zn decreased, while their oxidized and residual fractions gradually increased during composting; CB addition reduced the distribution ratios of bio-available Cu and Zn in mature compost by approximately 19.84%-48.90% and 4.94%-16.39%, compared to those in the 0% CB-added treatment, and the best result was found in the 10% CB-added treatment.. Meanwhile, the pot experiment confirmed that the addition of compost considerably increased soil organic matter (OM) and electrical conductivity (EC) but decreased soil pH value. On the contrary, the application of CB effectively decreased EC and increased soil pH but inhibited OM mineralization in soil as compared to non-amended treatment. While addition of compost significantly increased plant dry biomass as compared to that with soil alone, maximum biomass was obtained[(6.51±0.34) g·pot-1] in 10% CB-added compost. After the application of CB-added compost, the contents of the bio-available factions of Cu in the harvested soil increased, while the contents of the exchangeable fractions of Zn decreased by 38.91%, 43.69%, 46.02%, 45.12%, and 54.65%, respectively. The absorption of Cu and Zn by Chinese cabbage was considerably reduced after the application of compost, while the uptake of Zn in the plant declined as the CB rates increased, and the absorption of Cu increased. The study indicated that 10% CB addition could significantly reduce the bioavailability of Cu and Zn in compost, and also showed a continuous effect on restricting the bioavailability of Zn after land utilization. Meanwhile CB amendment enhanced Chinese cabbage biomass and reduced the uptake of Zn.

[Effects of Bentonite Amendment on Detoxification, Heavy Metal Passivation and Estrone Elimination of Sewage Sludge Compost].

Sewage sludge was amended with calcium-based bentonite with addition of no more than 10% in dry weight during the 52-day aerobic composting process, the variations of temperature, pH, organic carbon, EC, total nitrogen, nitrate(NH4+-N) and ammonium(NO3--N) were investigated, as well as the compost detoxification(germination test), heavy metals(Zn, Cu, Pb, Cd) passivation and estrone(E1) elimination. The results showed that the amendment facilitated the thermophilic phase, promoted the compost heat inactivation and brought the organic carbon mineral up to more than 15.27% -19.71%. During the composting, the compost pH increased at the beginning and then gradually decreased before reaching values of 6.76-7.05, while the amendments alleviated the dramatic pH value fluctuation. The bentonite amendment reduced the salinity of the compost with final product EC remarkably lower than 1132 µS·cm-1 of the control treatment, and the effect was enhanced with the increase of addition amount. The total nitrogen content increased with time, and there was a remarkable ammonia loss in the beginning stage for the control treatment, while the bentonite addition could facilitate the total nitrogen content increase by reducing the ammonia loss. With the composting variation, the contents of NH4+-N increased and then decreased while the NO3--N content increased gradually. The bentonite addition had a slight inhibitory effect on the plant germination but did not influence the compost maturity and detoxification; meanwhile, the amendment improved the heavy metal passivation and reduced the E1 content, especially from 90.48 to 28.27 µg·kg-1 with 5% treatment during the composting. The study indicated that bentonite addition of lower than 5% was acceptable for the sludge compost amendment, which had great potential in sludge hygienization, detoxification, heavy metal passivation and E1 elimination.