[Novel sternoclavicular hook-plate for treatment of proximal clavicle fracture with dislocation of sternoclavicular joint].

OBJECTIVE: To explore the efficacy of a novel sternoclavicular hook-plate for treatment of proximal clavicle fracture with dislocation of sternoclavicular joint. METHODS: Retrospective analysis of 13 cases of proximal clavicle fracture with dislocation of sternoclavicular joint treated with sternoclavicular hook-plate from June 2011 to January 2019 in our department. There were 9 males and 4 females, aged 26 to 78 years old, with an average age of (54.08±13.91) years old. All the patients had closed injuries without damage of blood vessels and nerves. The patient's operation time, intraoperative blood loss, hospital stay time, and postoperative complications were recorded. Fracture healing and reduction were evaluated according to X-ray and CT after operation. Constant-Murley score and Rockwood sternoclavicular joint score were used to evaluate limb function at 12 months after operation. RESULTS: All the patients were treated with sternoclavicular hook-plate. The operation time ranged from 50 to 76 min, with a mean of (54.08±13.91) min. The intraoperative blood loss ranged from 20 to 56 ml, with a mean of (46.08±11.15) ml. The hospital stay time ranged from 6 to 14 d, with a mean of (8.31±2.32) d. X-ray and CT examination on the second day after operation showed that all fractures and dislocations were anatomically reduced, and shoulder joint function exercise was performed early. All patients were followed up, and the duration ranged from 12 to 24 months, with a mean of (16.77±4.63) months. The healing time ranged from 9 to 13 d, with a mean of (11.00±1.75) d;and the bone healing time ranged from 3 to 4 months, with a mean of (3.65±0.46) months. There were no complications such as infection, internal fixation failure and nerve injury. At 12 months follow-up, the constant Murley score ranged from 78 to 100, with a mean of 87.83± 11.26; and Rockwood score ranged from 9 to 15, with a mean of 13.70±1.85. Among them, 11 cases were excellent, 1 case was good, and 1 case was general. CONCLUSION: The use of the novel sternoclavicular hook-plate for treatment of proximal clavicle fracture with dislocation of sternoclavicular joint is an effectively internal fixation with high safety, allowing early functional exercise for patients.

The invention of an iliosacral screw fixation guide and its preliminary clinical application.

OBJECTIVE: To introduce an iliosacral screw fixation guide and evaluate its efficacy in fixation of sacroiliac joint fracture-dislocations. METHODS: Between January 2011 and May 2011, eight patients (five men, three women) with sacroiliac joint fracture-dislocation underwent percutaneous iliosacral screw fixation with the assistance of this minimally invasive guide and under CT guidance. The patients, aged from 26 to 56 years (mean 32 years), had vertically unstable pelvic fractures. Before surgery, six patients who had displacement of >2 cm in their sacroiliac joints underwent skeletal traction on the femoral condyle. The inserted sites were marked out on the affected side of their buttocks after the best screw trajectory had been determined under CT control. The gear that controls the direction of the minimally invasive guide was adjusted according to the inserting angle determined by CT scans. A K-wire was inserted into the sacroiliac joint along the pilot sleeve of the guide, and a hollow screw (diameter 7.3 mm) was implanted into the sacroiliac joint along the K-wire. RESULTS: All eight operations were successful on the first attempt. The operations lasted from 10 to 20 minutes (mean 14 minutes). Immediate CT scans confirmed that all the screws had been placed in the desired positions, none had penetrated the bones and the configuration of the sacroiliac joints had been satisfactorily restored and firmly fixed. No patient experienced numbness or radiating pain in the lower limbs during surgery. There were no postoperative vascular or neurological complications. CONCLUSION: The minimally invasive guide can eliminate discrepancies resulting from the surgeon's own sensory input when inserting screws under the guidance of CT, making percutaneous iliosacral screw fixation more accurate, safe and simple.

[Analysis of delayed diagnosis of the vertical unstable pelvic fractures].

OBJECTIVE: To explore the causes of delayed diagnosis of the vertical unstable pelvic fractures in patients with multiple trauma so in order to minimize these incidence. METHODS: A retrospective study was conducted in 176 patients with the vertical unstable pelvic fractures from January 2003 to December 2008. The classification of vertical unstable pelvic fractures was recorded. Medical data were compared and statistically analyzed to identify the incidence, and the contributing factors of the delayed diagnosis of the vertical unstable pelvic fractures. Of the 176 patients, 46 (26.1%) had delayed diagnosis of the vertical unstable pelvic fractures. There were 29 males and 17 females with an average age of 34 years old. RESULTS: Of the factors contributing to 46 cases of delayed diagnosis, 41.3% (19/46) closely related to the evaluation by the doctors and were potentially avoidable, and 58.7% (27/46) were associated with the severity of the injuries. CONCLUSION: The patients with multiple trauma had high incidence of delayed diagnosis of the vertical unstable pelvic fractures. The recognition of pelvic fractures, careful clinical assessments, and the awareness of the orthopedic doctors, emergency doctors and ICU doctors. Most of the delayed diagnosis of the vertical unstable pelvic fractures in patients with multiple trauma are potentially avoidable.

[Study on expression of mkp-1 and P-ERK in acutecontusive spinal cord injury rat's model].

To observe the expression of mitogen activated protein kinase phosphatase-1 (MKP-1) and phosphorylation of extracellular signal-regulated kinases (P-ERK) of spinal cord in acute contusive spinal cord injury model, 20 Sprague Dawley rats were divided into two groups at random, Ten rats' spinal cord contusive injuries were produced by using modified Allen's method (using a weight-drop device) after the T10 spinous process and the corresponding vertebral lamina were removed as experimental group. The rest 10 rats received only T10 laminectomies and didn't injury the spinal cord as Sham-operated control group. The injury spinal cord was carried out respectively in two groups at 12h after injury. Pathological alterations were detected by H-E stain. The expression of MKP-1 and P-ERK were analyzed by immunohistochemistry and Western blot analysis. In Sham-operated control group, the micro structure of spinal cord was normal. The pathological alterations were very apparent in the damaged spinal cord area in the experiment group. We also found MKP-1 expression of spinal cord was decreased while P-ERK was increased in experimental group when compared with Sham-operated control group (P<0.01). The results suggested that acute contusive spinal cord injury down-regulated the expression of MKP-1 and up-regulated the PERK, which might play a role in the pathophysiological of spinal cord injury.

An anatomical study of corona mortis and its clinical significance.

OBJECTIVE: To provide detailed information of corona mortis for ilioinguinal approach as an anterior approach to the acetabulum and pelvis. METHODS: The course, branches and distribution of the vascular connection between the obturator system and the external iliac or inferior epigastric systems located over the superior pubic ramus were observed on 50 hemipelvises with intact soft tissues. RESULTS: During the dissections, 72% of the cadaveric sides had at least one communicating vessel between the obturator system and the external iliac or inferior epigastric systems on the superior pubic ramus. The average diameter of the connecting vessel was 2.6 mm (range, 2.0-4.2 mm). It coursed over the superior pubic ramus or iliopubic eminence vertically to enter the obturator foramen and exit the pelvis. The average distance from pubic symphysis to the vascular connections between the obturator and external iliac systems was 52 mm (range, 38-68 mm). CONCLUSIONS: Vascular connections between the obturator system and the external iliac or inferior epigastric systems were found over the superior pubic ramus with a high incidence. They are prone to damage during the ilioinguinal approach as an anterior approach to the acetabulum and pelvis. Thus, corona mortis located over the superior pubic ramus deserves great attention during the ilioinguinal approach.