ABSTRACT
Objective@#To investigate the clinical characteristics and outcomes of Maisonneuve fractures.@*Methods@#Data of 21 cases of Maisonneuve fractures from February 2015 to December 2017 were retrospectively analyzed. There were 16 males and 5 females with an average age of 38.8 years (range, 21 to 61 years). The fractures occurred on the left side in 11 patients and on the right side in 10 patients. The causes of injuries were traffic accident in 4 patients, sprain injury in 9 patients and falling injury from height in 8 patients. There were 16 cases of medial malleolar fractures and 5 cases of ruptures of deltoid ligament (4 entirely and 1 partial). There were 17 cases of fractures of the posterior malleolus, among which there were 5 of typeⅠ, 8 of typeⅡ and 4 of type Ⅲ according to the Bartonícek classification of posterior malleolus. There were 4 cases without fracture of posterior malleolus including 1 complete disruption of posterior inferior tibiofibular ligament. Four cases were overlooked of Maisonneuve fracture at the first time. The interval between injury and operation was 2-12 days (mean, 4.9 days).@*Results@#Stabilization of proximal fibular fractures were achieved with plate in 3 cases. There were 16 cases of medial malleolar fractures, and the fixation were achieved with cannulated screws in 13 cases and with anti-glide plates in 3 cases. The entirely rupture of deltoid ligament was repaired in 4 cases with suture anchors, the partial rupture of deltoid ligament was not repaired. There were 17 cases of posterior malleolar fractures, 12 cases treated with open reduction and internal fixation including cannulated screws in 9 cases and anti-glide plates in 3 cases. Stabilization of syndesmosis was achieved with syndesmotic plate in 1 case; the medial and posterior malleolar fractures were stabilized and anterior inferior tibiofibular ligament was repaired with suture anchor in 1 case; the other 19 cases were stabilized with syndesmotic screws, 2 screws in 11 cases and 1 screw in 8. Twenty-one patients were followed up for 13-48 months with an average of 25.6 months. The time of bony union was from 3 to 6 months with an average time of 4.9 months after operation. All patients received anatomical reduction without postoperative complications such as incision infection, reduction lose, breakage of screw and posttraumatic arthritis. In 13 cases, the syndesmotic screw was removed at the mean time of 15.38 weeks postoperative (range, 13-25 weeks). At the latest follow up, AOFAS score was from 84 to 100, with excellent in 13 cases, good in 8 cases, and the excellent and good rate was 100% (21/21). Baird-Jackson score was from 83 to 100, with excellent in 11 cases, good in 8 and fair in 2, and the excellent and good rate was 90.48%(19/21).@*Conclusion@#The diagnosis of proximal fibular fracture of Maisonneuve fracture is easily missed. The complete rupture of deep deltoid ligament and displaced obviously of posterior malleolar fracture should be reduction and stabilization. The accuracy of reduction of the syndesmosis is of great concern. The outcome of operation is satisfied.
ABSTRACT
Objective To investigate the results and complications in the treatment of the mechanically unstable fractures of the distal femur when Less Invasive Stabilization System (LISS) is used.Methods From September 2011 to July 2014,81 patients with mechanically unstable fractures of the distal femur were treated with the LISS,according to the inclusion criteria and exclusion criteria,59 patients meet the condition including 31 male and 28 female.The mean age of the patients was 49.8 years (range 18-80 years).The fractures occurred on the left side in 40 cases and on the right side in 19 cases.According to AO classification,27 type 33A2,14 type 33A3,13 type 33C2,5 type 33C3.2 cases combined with ipsilateral fractures of the femoral shaft,according to AO classification,1 type 32A1,1 type 32C1.The mechanism of injury was a fall from the height in 8 cases,a traffic accident in 18 cases,a crush injury in 7 cases,a fall injury in 26 cases.55 fractures were closed,and 4 were open.According to the Gustilo-Anderson classification,there were 3 type Ⅰ,1 type Ⅱ.Results The 7-hole plate were used in 21 patients,9-hole plate in 26 patients and 13-hole plate in 12 cases.The 3.5 mm or 6.5 mm lag screw were placed around the LISS plate to stabilized the articular fracture fragment in 11 cases.The mean operation time was 105.2 min (85-145 min),the mean bleeding volume was 203 ml (130-315 ml).All patients were followed up 11-27 months (average 13.2 months).1 delayed union(13 months),the average time to union was 16 weeks (range 12-21 weeks).The average flexion of the knee was 116 degree,0 degree in extension.The functional outcome:32 had an excellent result,19 had a good result and 8 had a fair result,with 86.4％ excellent and good results.No deep infections occurred.No loss of reduction.3 cases had malalignment,2 failed fixation,4 patients with symptomatic hardware irritation.27 cases underwent implants removal after union,cold-welding occurred in 4 cases (9 screws) which resulted in difficult removal.Conclusion LISS is one of the reliable and effective methods in fixation of mechanically unstable fractures of the distal femur.However,its operation indications and operating instructions should be strictly followed.
ABSTRACT
Objective To study the physical characteristics of the OPEN stereotactic body radiotherapy system for the clinical application. Methods The 0. 125cc ioniztion chamber, 160 mm polystyrene sphere model,Gafchromic EBT2 films and IBA film analysis software were used to evaluated the focus position tolerance,dose rate,repeatability,linear relation,penumbra and composite error of the OPEN stereotactic body gamma knife. We used the DTA method to verify the accuracy of dose distribution between the plans and measured value. Resualts The focus error was 0. 36 mm,max dose rate tolerance 3%,linear relation error 2%,repeatability error 0. 3%,composited error 2. 5 mm. There was 90% pass rate when the distance away from test point was less than 2 mm and the dose error was set less than 5 % . Conclusions Parts of the test resualts were similar to the head gamma knife national protocal of OPEN stereotatic body gamma knife. The deliver dose distribution can meet the clinic need.
ABSTRACT
Objective To investigate the feasibility of closed reduction assisted with Kirschner wires for irreducible femoral neck fracture.Methods From June 2008 to April 2011,32 patients with irreducible femoral neck fracture were treated.There were 15 males and 17 females,aged from 21 to 59 years (average,46 years).According to Garden classification,there were 6 of Ⅱ,16 of Ⅲ and 10 of Ⅳ.According to displacement direction of the femoral head showed by preoperative X-rays and CT scans,irreducible femoral neck fracture was divided into 3 types:angulation-impaction (11 cases),rotation-separation (15 cases) and abduction-impaction (6 cases).One to three Kirschner wires were penetrated into the femoral head to reduce the displacement in opposite direction of fracture displacement.After reduction was satisfied,guide pins were penetrated,and then the fractures were fixed with cannulated screws.Results Anatomic or nearly anatomic reduction was achieved in 30 patients after closed reduction assisted with Kirschner wires.Two patients underwent open reduction finally due to failure of closed reduction.The operation time ranged from 40 to 80 min,and the blood loss ranged from 20 to 50 ml.According to Garden index,anatomic reduction was achieved in 29 and acceptable reduction in 1.Among 30 patients who had undergone closed reduction,29 patients were followed up for 12 to 20 months.Bone union was achieved in 28 patients,and the fracture healing time ranged from 4 to 10 months.One patient with rotation-separation displacement before closed reduction underwent total hip replacement due to avascular necrosis of femoral head occurred at 15 months after closed reduction.Conclusion Closed reduction assisted with Kirschner wires is an effective method for irreducible femoral neck fracture,which can achieve satisfactory anatomic reduction rate and fracture healing rate.
ABSTRACT
Objective To explore clinical effect of surgical treatment of displaced intra-articular calcaneal fractures via modified lateral L-shaped incision.Methods From January 2005 to October 2011,133patients (143 feet) with displaced intra-articular calcaneal fractures,including 125 males and 8 females,aged from 19 years to 65 years (average,43.2 years),underwent open reduction and internal fixation via modified lateral L-shaped incision.There were 56 cases of left calcaneal fractures,67 cases of right calcaneal fractures,and 10 cases of bilateral calcaneal fractures,and all of them were closed fracture.According to Sanders classification,15 feet were classified as type Ⅱ,107 type Ⅲ,and 21 type Ⅳ.The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale were used to access outcomes.Results One hundred and twenty five patients (135 feet) were followed up for 12 to 28 months (average,18.5months).All fractures healed after an average of 13 weeks (range,8-16 weeks).There were on nerve injury or osteomyelitis.Incision dehiscence occurred in 4 feet,which healed after removing the plate.Subtalar joint traumatic arthritis occurred in 17 feet,with walking pain.Collapse of articular surface occurred in 5 feet after weight-bearing.According to AOFAS ankle-hindfoot scale,excellent result was got in 94 cases,good in 29 cases,fair in 14 cases,poor in 6 cases; and the excellent and good rate was 92.9％.Conclusion Open reduction and internal fixation via modified lateral L-shaped incision for treating displaced intra-articular calcaneal fractures can obtain satisfactory results,but the skilled surgical techniques are needed.
ABSTRACT
BACKGROUND: Compound materials have strong osteogenic ability, which reinforce the substitute materials used alone. Compound material will be commonly used to repair bone defects in tissue engineering. OBJECTIVE: To explore the osteogenic capacity of tetracycline loaded bio-derived bone in vivo. DESIGN, TIME AND SETTING: The randomized controlled observation was performed at Tissue Engineering Laboratory (State Key Laboratory) of West China Center of Medical Sciences, Sichuan University from September 2004 to January 2005. MATERIALS: Twenty-four New Zealand white rabbits were randomly divided into 2 groups (n=12). Rabbit models of radial middle segment defect (1.5 cm) were established. Tetracycline collagen bio-derived bone was made of fresh human bone. METHODS: The tetracycline collagen bio-derived bone was implanted into radial defects of experimental group, and collagen bio-derived bone was implanted into control group. All rabbits were executed 6 and 12 weeks after operation. MAIN OUTCOME MEASURES: Osteogenic condition in all specimens was examined by X-ray and histological methods. RESULTS: Twenty-four animals were included in final analysis. ①X-ray results showed that osteotylus was seen in the whole defect area of the experimental group in postoperative 6 weeks, while only in the defect ends of the control group. In 12 weeks after surgery, new bone tissue filled all defect area of the experimental group, which was basically consistent with normal bone, even medullary canal was formed. Osteogenic images were found in the control group. ②Histological results suggested that new osteoid formation was observed in internal pore zone in the experimental group in 6 weeks, while no bone tissue was found in the control group. In 12 weeks, much woven bone was seen in the experimental group, and lamellar bone structure had formed and medullary cavity of bones had transfixed. Osteoid formation was observed in the control group. CONCLUSION: Both tetracycline collagen bio-derived bone and collagen bio-derived bone can promote bone formation, but tetracycline loaded bio-derived materials show superior effect in repairing defects.
ABSTRACT
BACKGROUND: Each matrix material alone possesses the limited ability of osteogenesis, so it is a future direction of tissue engineering that apply composite materials on the repair of bone defect by enhancing osteogenesis. OBJECTIVE: To study the osteogenesis ability of collagen loaded bio-derived bone implanted in animals. DESIGN, TIME AND SETTING: A random controlled animal experiment was completed in Tissue Engineering Laboratory of West China Center of Medical Sciences, Sichuan University between January and April in 2004. MATERIALS: Sixteen New Zealand white rabbits were adopted to prepare 1.5-cm segmental defect model at the middle part of radius. Human bone was extirpated from donators, and collagen Ⅰ was the product of Sigma Company. METHODS: Rabbit models were divided into 2 groups by randomization, experimental group and control group, with 8 rabbits in each group. The extirpated bone was made into pure bio-derived bone by means of defatting, decellularization and deproteinization. Collagen loaded bio-derived bone was established by the vacuum absorption of collagen on pure bio-derived bone. Collagen loaded bio-derived bone was implanted into the defects of experimental group, while pure bio-derived bone for the control group. MAIN OUTCOME MEASURES: At 6 and 12 weeks after operation, all specimens were examined by X-ray and histological methods. RESULTS: The result analysis included all of 16 rabbit models. X-ray results showed that, osteotylus was seen in the whole defect area of experimental group at 12 weeks postoperatively, at this time osteogenesis was more obvious compared with 6 weeks, the bridge grafting of defect area was obviously visible. In the control group, osteotylus was only observed on two ends of the defects, no osteogenesis was found in the central part of defect area. Histological results showed that, new osteoid formation could be seen in internal porous zone of the experimental group at 6 weeks postoperatively, while in control group fibrous connective tissue filled internal porous zone and no new bone formed; at 12 weeks, much more woven bone-like tissues were visible and trabecular-like structure had formed in the experimental group, while osteoid tissue could be seen in bone defect area of control group. CONCLUSION: Both pure bio-derived bone and collagen bio-derived bone can enhance osteanagenesis, but collagen loaded bio-derived bone scaffold material is more effective.
ABSTRACT
Objective To investigate the effect of osteoinductive calcium phosphate ceramics (OICPC) on tendon healing in bone tunnels. Methods Anterior cruciate ligament reconstruction with semitendonous tendon was performed in the knee joints of 30 New Zealand rabbits by suspended fixation. OICPC grains were implanted into the bone tunnel of 15 rabbits which were the experimental group and the other 15 rabbits without OICPC implants severed as the control group. Specimens were collected four weeks, eight weeks and 12 weeks after surgery. Sections were stained with H. E., Sirius Red and Masson. Histological changes in the interface tissue between the bone tunnel and the tendon graft were observed, and the morphology of interface tissue was classified according to Yamakado method. Histomorphometry was done on Masson stain sections to measure new bone formation around the grafted tendon. Results In OICPC group, histological sections obtained four and eight weeks after surgery showed statistically greater new bone formation than those in the control group. Abundant penetrating Sharpey fibers appeared at eight weeks and direct connection was found at 12 weeks in the experimental group. On the other hand, Sharpey fibers appeared only at 12 weeks in the control group. Conclusion OICPC has a capability of enhancing biological fixation of a tendon to the bone tunnel.