Comparison of the clinical effects for different positions of the weight-bearing axis after high tibial osteotomy.

PURPOSE: To analyze the clinical effects of different positions of the weight-bearing axis (WBA) after high tibial osteotomy (HTO). METHODS: The clinical data of 90 patients who underwent HTO in the Department of Orthopedics at our hospital from June 2018 to June 2021 were retrospectively analyzed. Patients were divided into groups A and B (n = 45 per group) according to different post-HTO WBA positions of the affected side. WBAs in both groups were at 50-60% and 62-66% of the tibial plateau, from inside to outside, respectively. American Hospital for Special Surgery Knee Score (HSS), visual analog scale (VAS) score, femorotibial angle (FTA), and medial proximal tibial angle (MPTA) were recorded and analyzed. RESULTS: All patients were followed up with for 12 months. HSS scores increased gradually and VAS scores decreased gradually in both groups preoperatively, and at 3 months, 6 months, and 1 year postoperatively (P < 0.05). Compared to group A, group B had better HHS scores at 6 months and 1 year postoperatively (P < 0.05). There was no significant between-group difference in VAS scores at all aforementioned timepoints (P > 0.05). Postoperative MPTA and FTA were 89.56° ± 2.18° and 177.11° ± 2.63° in group A, and 89.07° ± 1.98° and 177.07° ± 2.36° in group B, respectively, with no significant between-group difference (P > 0.05). CONCLUSION: Patients with post-HTO WBA ranges of 50-60% and 62-66% achieved knee joint function improvement and pain relief. Half a year later, those with a WBA range of 62-66% had better knee joint function scores. However, a comparison of long-term effects warrants further investigation.

Arthroscopic Subscapularis Tendon Repair Using the Mason-Allen Technique.

BACKGROUND: Arthroscopic rotator cuff repair has recently been popularized for treating tears. In a biomechanical trial, the Mason-Allen stitch improved the fixation quality of poorly vascularized tendons. The use of this technique involving the subscapularis tendon remains rare. The aim of this study was to evaluate the clinical outcomes of Mason-Allen technique repaired subscapularis tendons. METHODS: A retrospective research of collected data from 98 patients with subscapularis tears who had undergone arthroscopic repair between May 2015 and December 2018. There were 75 males and 23 females. The mean age was 56.4 ± 9.6 years and the mean follow-up was 12.5 ± 4.0 months. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and Constant-Murley score were used to analyze shoulder function. An MRI was performed to assess the integrity of the repair. RESULTS: Patients had significantly less pain and a better active range of motion compared with preoperative levels. VAS improved significantly from a preoperative mean of 3.42 to a postoperative mean of 1.91. ASES increased significantly from the preoperative mean of 43.6 to the postoperative mean of 74.5. Seven cases suffered from retears, which were confirmed by an MRI examination. CONCLUSION: Arthroscopic rotator cuff repair with the Mason-Allen method resulted in a decreased level of pain and satisfied function recovery.

[Long-term effectiveness of vascularized fibula flap in radiocarpal joint reconstruction following excision of Campanacci grade â ¢ giant cell tumor].

OBJECTIVE: To evaluate the long-term effectiveness of vascularized fibula flap in radiocarpal joint reconstruction following excision of Campanacci grade Ⅲ giant cell tumor (GCT) of distal radius. METHODS: Between December 2010 and December 2014, 10 patients with Campanacci grade Ⅲ GCT of distal radius were treated with en bloc excision and inradiocarpal joint reconstruction using vascularized fibula flap. They were 6 males and 4 females, with an average age of 39.9 years (range, 22-65 years). The disease duration was 1.5-6.0 months (mean, 2.6 months). The length of distal radius defect was 6.0-12.5 cm (mean, 8.4 cm) after en bloc excision of GCT. Vascularized fibula flap with inferior lateral genicular vessels were performed in 6 patients and with inferior lateral genicular vessels and peroneal vessels in 4 cases. RESULTS: All incisions healed by first intention. All patients were followed up 4.4-8.3 years (mean, 6.0 years). There was no tumor recurrence during follow-up. At last follow-up, the mean ranges of motion of wrist joint were 55.0° (range, 25-85°) in extension, 26.5° (range, 15-40°) in flexion, 12.0° (range, 5-25°) in radial deviation, 19.6° (range, 10-30°) in ulnar deviation, 50.5° (range, 5-90°) in pronation, and 66.5° (range, 20-90°) in supination. The mean grip strength of effected wrist was 75% (range, 60%-85%) of the healthy wrist. The mean Musculoskeletal Tumor Society (MSTS) score was 82.7% (range, 75%-90%). X-ray films showed that the fibula flap healed at 12-16 weeks after operation (mean, 14.1 weeks) and there were 9 cases of radiological complications. CONCLUSION: For Campanacci grade Ⅲ GCT of distal radius, application of the vascularized fibula flap in radiocarpal joint reconstruction after en bloc excision of GCT can obtain good wrist function.

[Injury characteristics and therapeutic strategy of patients injured in "8·8" Jiuzhaigou earthquake].

Objective: To summarize the injury characteristics and therapeutic strategy of patients injured in "8·8" Jiuzhaigou earthquake. Methods: The clinical data of 48 patients injured in "8·8" Jiuzhaigou earthquake who were admitted to Mianyang Central Hospital were analyzed retrospectively. There were 25 males and 23 females with an average age of 36 years (range, 5-87 years). The average interval from injury to admission was 30 hours (range, 3-53 hours). The patients from Sichuan province accounted for 45.8% (22 cases), from other province for 52.1% (25 cases), and from abroad for 2.1% (1 case). Patients were primarily hurted by collapsing houses and flying stones. Thirty-seven patients (77.1%) had single injury, mainly involving 36 patients (75.0%) in limbs, and the other 11 patients (22.9%) had multiple injuries. Ten patients (20.8%) had open fractures, including 1 case rated as typeⅠ, 2 as typeⅡ, 3 as type Ⅲa, 2 as type Ⅲb, and 2 as type Ⅲc according to Gustilo classification criteria. The abbreviated injury scale (AIS) score was 2-3 in 37 patients of single injury, and the injury severity score (ISS) was 8-22 (mean, 13.2) in 11 patients of multiple injuries. Sixteen patients (33.3%) were diagnosed as mental disorders by Hamilton rating scale for anxiety (HAMA), including 8 cases had their anxiety scores≥29, 4 cases of 21-28, 3 cases of 14-20, and 1 case of 7-13. Of the 16 patients, 2 showed suicidal tendency. Results: Except 2 referrals, 30 patients received operationï¼»28 patients (93.3%) for orthopaedic surgeriesï¼½and 16 patients received conservative treatment. The procedures included internal fixation, soft tissue debridement, external fixation, bipolar femoral head replacement, embolization of carotid cavernous sinus arteriovenous fistula, and amputation. Among the 46 patients treated in this hospital, 21 discharged from hospital at 2-12 days (mean, 6.7 days) after admission, the others received further rehabilitation in this hospital or local hospital. No undesirable consequence occurred in 16 patients with mental disorders. Five cases of infection occurred out of hospital were cured after debridement. No dead and nosocomial infection case reported. Conclusion: Intensive treatment, specialist management, multidisciplinary team, and early intervention of nosocomial infection and deep venous thrombosis are the key to improve the general level of successful earthquake medical rescue.

[Treatment of traumatic ulnar styloid impaction syndrome by Sauvé-Kapandji procedure].

Objective: To evaluate the effectiveness of Sauvé-Kapandji procedure in the treatment of traumatic ulnar styloid impaction syndrome. Methods: Between June 2010 and January 2013, 12 patients with traumatic ulnar styloid impaction syndrome were treated by Sauvé-Kapandji procedure. There were 4 men and 8 women, with an average age of 58.9 years (range, 50-69 years). The disease was caused by traffic accident in 1 case, and by falling from height in 11 cases. All patients had dislocation of the distal radioulnar joint, and 7 patients also had old fractures of the distal radius. The main clinical symptoms were pain and limited activity of the wrist joint, and the disease duration was 2-4 months (mean, 3.5 months). The visual analogue scale (VAS) was 6.2±1.4. The clinical outcomes were assessed by VAS, range of motion (ROM) of the wrist, grip strength, Evans score, and X-ray film of wrist joint during follow-up. Results: All patients obtained healing of incision by first intention and were followed up 37-73 months (mean, 58.4 months); no complication of infection, blood vessel injury, or nerves injury occurred. VAS was 1.2±1.0 at the final follow-up, showing significant difference when compared with preoperative one ( t=9.950, P=0.000). The ROM of the affected wrist joint in flexion, extension, ulnar deviation, forearm pronation and supination were improved, but the ROM of the affected side were significantly less than those of normal side ( P<0.05). No significant difference was found in the grip strength and Evans score between the affected side and normal side ( t=-0.885, P=0.386; t=-1.969, P=0.062). According to Evans scores, the results were excellent in 8 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate of 91.7%. Postoperative radiographs showed bony healing in all patients, with the average healing time of 3.5 months (range, 3-6 months). The instability of proximal ulna occurred in 3 cases. Conclusion: Sauvé-Kapandji procedure is a reliable remedy method for traumatic ulnar styloid impaction syndrome, with favorable improvement in wrist pain and forearm rotation. However, the surgical indications for Sauvé-Kapandji procedure should be strictly controlled.

[Masquelet TECHNIQUE COMBINED WITH TISSUE FLAP GRAFTING FOR TREATMENT OF BONE DEFECT AND SOFT TISSUE DEFECT].

OBJECTIVE: To explore the therapeutic effect of Masquelet technique combined with tissue flap grafting for bone defect and soft tissue defect. METHODS: Between August 2012 and April 2015, 18 cases of bone defect and soft tissue defect were treated by using Masquelet technique combined with tissue flap grafting. There were 11 males and 7 females, aged from 23 to 59 years (mean, 37.1 years). The time between injury and treatment was 15 days to 39 months (mean, 0.9 months). Defect located at the proximal tibia in 4 cases, at the middle tibia in 8 cases, at the distal tibia in 4 cases, and at the lateral heel in 2 cases. All patients were treated with debridement. After debridement, the bone defect was (5.7±1.8) cm in length, and the soft tissue defect was 5 cm×4 cm to 13 cm×11 cm in size. In one-stage operation, bone defect was repaired with the antibiotic cement and fracture was fixed by temporary external fixation. The surfaces of wound were repaired with tissue flap. After 6 to 8 weeks when wounds healed with no sign of infection, bone grafting from iliac bone and/or fibula was performed in two-stage operation. RESULTS: Eighteen patients followed up 10-38 months (mean, 24.3 months). After one-stage operation, 6 cases had pin track infection, which was cured by strengthened disinfection and oral antibiotics. All the tissue flaps survived. Bone healing was observed on X-ray film at 15-57 weeks (mean, 25.3 weeks) after two-stage operation. The function of the knee and ankle joint recovered well. According to the American Orthopaedic Foot and Ankle Society (AOFAS) score for the ankle joint, the scores of ankle function ranged from 74 to 98, with an average of 89.7; the results were excellent in 7 cases, good in 10 cases, and fair in 1 case. CONCLUSIONS: The Masquelet technique combined with tissue flap grafting is an effective method to treat bone defect and soft tissue defect.

[Long-term effectiveness of vascularized capitate osteotomy transposition for advanced Kienböck's disease].

OBJECTIVE: To evaluate the long-term effectiveness of lunate excision and vascularized capitate osteotomy transposition for advanced Kienböck's disease. METHODS: Between June 2004 and January 2008, 16 patients with Kienböck disease in Lichtman stages IIIB-IV were treated with lunate excision and vascularized capitate osteotomy transposition. There were 10 males and 6 females at the age of 27-59 years (mean, 38.8 years). The disease was caused by trauma in 10 cases, and unknown reason in 6 cases. The main clinical symptoms were pain and limited activity of the wrist joint, and the disease duration was 5-32 months (mean, 26.5 months). The carpal height index was 0.88 ± 0.05; the radioscaphoid angle was (63.8 ± 9.1)degrees. The visual analogue scale (VAS) score, range of motion (ROM), grip strength, Evans score, and radiographic changes were used to assess the effectiveness during follow-up. RESULTS: All patients obtained healing of incision by first intention and were followed up 5 years and 4 months to 9 years (mean, 5.8 years). VAS score was 2.0 ± 1.5 at the final follow-up. The ROM of the flexion and extension of the wrist joint at the affected side were significantly less than those at the normal side (P < 0.05). However, no significant difference was found in the grip strength and Evans score between the affected side and normal side (t = -0.997, P = 0.327; t = -1.852, P = 0.077). Postoperative radiographs showed that the carpal height index was 0.94 ± 0.03, and the radioscaphoid angle was (48.4 ± 4.8) degrees, which were improved significantly when compared with preoperative ones (t = -3.927, P = 0.000; t = 5.987, P = 0.000). Osteophyte at the dorsal side of the radius and scaphoid rotation occurred in 6 cases and 2 cases, respectively. CONCLUSION: Lunate excision and vascularized capitate osteotomy transposition is a reliable method for advanced Kienböck's disease, with favorable improvement in wrist pain and grip strength for long-term follow-up.