The current state and prospect of open elbow arthrolysis for post-traumatic elbow stiffness / 中华创伤骨科杂志

The elbow is more susceptible to motion loss than other joints after trauma,and elbow stiffness leads to functional impairment in the upper limb and interferes with daily activities.Open arthrolysis is the most common and classical treatment for post-traumatic elbow stiffness.In this paper,we review the treatment protocols like preoperative clinical evaluation,arthrolysis strategies and postoperative rehabilitation program for post-traumatic elbow stiffness,discuss relevant issues and assess their prospects.

Current status and prospects of clinical scoring systems for elbow dysfunction / 中华创伤骨科杂志

Currently clinical scoring systems are the most popular functional measurements for orthopedic patients.However,unfortunately,the scoring systems so far for the elbow are not capable enough of fully assessing the joint motion capacities,symptoms and quality of life for the patients with elbow dysfunction.In this paper,we review the elbow scoring systems most commonly used for the patients with elbow dysfunction,analyze their insufficiency in evaluation of elbow dysfunction,and discuss how to develop a new scoring system specially for elbow dysfunction.

Using the contralateral reverse less invasive plating system for subtrochanteric femur fractures in elderly patients

In this retrospective study, we evaluated the efficacy of the reverse less invasive plating system [LISS] in the management of subtrochanteric fractures [STF] in elderly patients that are expected to be difficult to nail. Fifty-five patients with STF were treated from April 2005 to December 2007. Of these, 26 [16 females and 10 males, age >65 years, average 79.8 +/- 3] had nonpathologic fractures that were internally fixed with a LISS device. The average follow-up period was 24 months [range 15-30]. The main outcome measures evaluated were pain, union, varus deformity and implant failure. Radiographic and clinical evidence of functional outcome and complications were also evaluated. Mean perioperative blood loss was 120.5 +/- 12 ml [range 65-285], and mean postoperative hospital stay was 7.8 +/- 2 days [range 4-14]. Using the reverse LISS plates led to complete union of STF in all of the 26 elderly patients without additional procedures. Due to advantages like high union rate, early postoperative mobilization and short operation time, the reverse LISS device offers an alternative management of STF in elderly patients unsuitable for nailing procedures

Anatomy and application of free medial plantar perforator flap / 中华显微外科杂志

Objective To reports to anatomy and clinical application of the medialis pedis perforator flap. Methods The origin, course, distribution and out diameter of medial plantar perforators, which were located at the septums between the abductor hallucis muscle and the flexor digitorum brevis, and between the abductor hallucis muscle and the skeleton, were observed on 10 sides adult feet specimens perfused with red latex. 11 free medialis pedis perforator flaps were transferred for soft-tissue defect in hand. The areas of tissue defect ranged from 2 cm x 2 cm - 9 cmx 4 cm. Results The medial plantar artery sends 2 perforators with regular anatomy through the septum between the abductor hallucis muscle and the flexor digitomm bre-vis, and 2 perforators with regular anatomy through the septum between the abductor hallucis muscle and nav-icluar bone and the medial cuneiform bone. These perforators supply the medial plantar flap and medialis pedis flap respectively. All of the 11 cases of free medialis pedis perforator flap survived uneventfully. The flap areas ranged from 2 cm × 3 cm - 11 cm× 5 cm. The appearance and functional results were satisfactory with following up for 6 to 24 months. Conclusion The free medialis pedis perforator flap is a good method in repairing soft-tissue defect in hand.

Old distal humeral fractures of type B treated with hinged external fixators in combination with internal fixation / 中华创伤骨科杂志

Objective To evaluate the hinged external flxator in combination with internal fixation for treatment of old type B fractures of the distal humerus.Methods Eleven cases of old type B fractures of distal humerus treated in our department were studied retrospectively.They were treated with hinged external fixators in combination with internal fixation and evaluated according to Mayo elbow performance scores.Results All the patients were followed up for 10 to 18(mean, 12.5)months.The mean union time was 4.6(range, 3.5 to 6.0)months.The final range of flexion to extension of the elbow was 19.4°±6.5° to 124.2°±11.3°.The final ranges of pronation and supination were 72.8°±5.4° and 67.6°± 7.3°.By Mayo elbow performance scores, the post-operative functional outcome of the elbow was excellent in 5 patients, good in 4, and fair in 2.Conclusion The old type B fractures of distal humerus can be effectively treated with hinged external fixators in combination with internal fixation, for early rehabilitation and restoration of the elbow function can be facilitated.

Application of cohesive elastic bandage after operative treatment of ankle fractures / 中华创伤骨科杂志

Objective To study the clinical effect of cohesive elastic bandage (CEB) after operative treatment of ankle fractures. Methods After surgery, 60 patients with ankle fracture were randomly as-signed to 2 even groups: CEB dressing group and common dressing group. Functional exercise started the next day after operation. Comparison was made between the 2 groups in drainage, displacement and swelling. Results In CEB dressing group, the volume of drainage was (34.6±18.1) mL, the rate of displacement 6.7%, and the swelling was slight in 21 patients, moderate in 5 and severe in 4. In common dressing group, the volume of drainage was (85.1±17.1) mL, the rate of displacement was 63.3%, and the swelling was slight in 7 patients, moderate in 12 and severe in 11. The differences were significance(P<0.05) . Conclusion Use of CEB after surgery for ankle fractures may alleviate swelling, reduce bleeding effectively, and benefit early functional exercise.

Compound nerve conduit promoting peripheral nerve regeneration in rats / 中华创伤骨科杂志

Objective To explore the role of compound nerve conduit, made of nerve growth factors (NGF) encapsuled by biodegradable core-shell nanofibers through coaxial electrospinning, in regeneration of injured sciatic nerves in rats. Methods The compound nerve conduits were developed from the core-shell structured biodegradable nanofibers with P(LLA-CL) as a shell and BSA/NGF or BSA as a core through coaxial electrospinning. Seventy-two Sprague-Dawley rats were randomly divided into 4 even groups. The middle segments (10 mm) of the sciatic nerve were excised and the defects were repaired with sciatic nerve autograft (group A), with P(LLA-CL) conduit (group B), with PLLA-CL conduit and one injection of NGF (group C), and with P(LLA-CL)/NGF controlled-release conduit (group D), respectively. Morphologic and functional evaluations of nerve regeneration were done by gross observation, sciatic function index, neural electrophysiological examination, resumption rates of triceps weight, histological and ultrastructural observa-tion respectively in 1, 2, 3 months after the operation. Results Three months after the operation, although partial biodegradation and small cracks could be observed, conduits remained intact in outline. Based on the functional and histological observations, nerve regeneration, nerve fibers arrangement, myelination and nerve function reconstruction in the P(LLA-CL)/NGF controlled-release conduit (group D) were similar to those in nerve autograft (group A) and significantly superior to those in groups B and C (P<0.05). Conclusion As the P(LLA-CL)/NGF-controlled release conduit has favorable mechanical properties and biocompatibility, it can effectively promote regeneration of the sciatic nerve in rats.

Minimally invasive osteotomy and cable osteosynthesis for treatment of adolescent cubitus varus / 中华创伤骨科杂志

Objective To explore the possibility and effectiveness of minimally invasive osteotomy and cable osteosynthesis for the treatment of adolescent eubitus varus. Methods Eleven cases of adolescent cubitus varns(2 cases complicated with internal rotation of 10°)were treated with minimally invasive supracondylar wedged osteotomy to preserve the integrity of the contralateral codex and periosteum.Two screws were inserted above and below the fracture line.They were fixed with cable after the greenstick fracture and internal rotation were adjusted.Plastic bandage was applied for 1 week postoperatively before rehabilitation. Results Bone fractures healed in the 11 cases in 36.3 days averagely,without infection or nerve palsy.Before operation,the mean angles of varus,flexion and extension were 35°±5°,125°±10°and 10°±5°respectively.After a mean follow-up of 33.5 months,the mean valgus angle of the elbow was improved to 8°±2°(t=16.632,P<0.05),flexion to 130°±8°and extension to 8°±3°(P>0.05).Internal rotation deformity was also ameliorated in the 2 cases. Conclusion It is practical and effective to treat adolescent eubitus varus with minimally invasive osteotomy and cable osteosynthesis,for it can lead to stable fixation,short healing time,and does not affect the flexion and extension of the elbow joint.

The distally based cross-leg anterolateral thigh flap for reconstruction of soft tissue defects in middle and distal thirds of the contralateral leg / 中华显微外科杂志

@#Objective To report the technique and effect of distally based, cross-leg, anterolateral thigh flap for reconstructing the soft tissue defects in middle and distal thirds of the contralateral leg. Methods Five patients of soft tissue defects in lower legs associated with injuries to the eontralateral legs were treated with distally based, cross-leg, anterolateral thigh flaps of the contralateral limbs. Results After the pedicle division at 6 weeks postoperatively, the 5 flaps all survived. And the blood supply of flaps remained steady when followed up for 12 to 15 months. The flaps possessed favorable contours, and allowed successful secondary repair of injured bones or tendons. The donor sites healed primarily, and no influence was observed to the donor limbs. Conclusion For the soft tissue defects in middle and distal thirds of leg associated with damage to the surrounding tissues and arterial injury of the contralateral leg, cross-leg transplantation of the contralateral distally based anterolateral thigh flap is a good option of reconstruction.

Treatment of adversity congenital pseudarthrosis of the tibia by anastomosis vascular fibular transplantation / 中华显微外科杂志

Objective To explore the feasibility and effects of one stage vascular free fibular transplantation or combination of bone transport two-stage technique for reconstruction of adversity congenital pseudarthrosis of the tibia. Methods Vascularised free fibular reconstruction operations for adversity congenital pseudarthrosis of tibia were performed in 16 cases, including male in 9 and female in 7,age ranged from 6 to 14 years with the mean in 8.5 years. 2 to 6 operations history were documented in all cases with the mean in 3.2 before went to our hospital, with 3 to 12 cm and mean 5.8 em short of the tibia. Mean9.2 cm (from 6.0 to 16.0 cm) vascular free fibular were harvested and transplanted to reconstruct the bone frame in 16 cases, bone transport operation were performed in 4 cases 1 year later. Results Fourteen cases were followed up for mean 4.5 years, bone union could be found by radiology examination, mean 7.8cm (from 4.0 to 11.5 cm) elongation of the low limb were obtained in 4 cases. Basic walking function was obtained in all cases. Conclusion It is an effective method to treat adversity congenital psuedarthrosis of the tibia by thoroughly resection of the focus and enough length of vascular fibular transplantation, deficiency of low limb can be ameliorated by bone transportation technique in those patients.

Surface heparinization and blood compatibility modification of small intestinal submucosa for small-caliber vascular regeneration with hypothermic plasma technique / 中国组织工程研究

BACKGROUND:Thrombogenesis is the most common cause of failure in the implantation of tissue engineered small-caliber vesselgrafts.And immobilizing heparin onto the surfaces of vascular scaffoidgrafts is often applied to improve their blood compatibility and patency.OBJECTIVES:To investigate the small intestinal submucosa(SIS)surface after heparinizadon with hypothermic plasma technique,to ireprove the blood compatibility of SIS and to explore the possibility for the construction of small-caliber vascular grafts with modified SIS seaffolds in vivo.DESIGN:Single exponent study.SETTING:Department of Orthopaedics,the Six People's Hospital Affiliated to Shanghai Jiao Tong University;ShanghaiInstitute for Microsurgery of Extremities.MATERIALS:This study was performed in the Shahghai Institute for Microsurgery of Extremities from January to October 2006.The jejuna were taken from farm pigs.METHODS:The SIS surface of pigswere processed by argon plasma(20mL/min)technique at different time periods(0,2,4,6,8,10,12,and 14 s),which were then immediately immerged in heparin sodium solution for 24 hours.Dogs were divided into two groups.The SIS films were sewn into a 3-mm diameter tube and implanted into the defect of a canine femoral by anastomosis as a vascular graft.The observation lasted for 6 weeks.MAIN OUTCOME MEASURES:The surface morphologies of SIS were observed under scanning electron microscope(SEM).The antithrombogenicity of SIS films was tested by water contact angle,blood coagulation time and platelet adherence observation by SEM.The efficiency of the SIS graft was evaluated by the patency in the circulation of blood with colour doppler detection and histology.RESULTS:Heparinized SIS showed great different surface morphology comparing with untreated SIS.Untreated SIS surface looked like wrinkled film,but on heparinized SIS surface spread with uniform micro-dots,which looked like a layer of heparin adhesion.Water contact angle decreased with the increase of plasma irradiation time.Prothrombin time (PT),partial thromboplastin time(APTT),and thrombin time(TT)of the SIS films modified with heparin were prolonged.Platelets adhered much more on untreated SIS film than on heparinized SIS film.Vascular graft from SIS embolized in the lumina completely at day 3 after anastomosis.Heparinized SIS graft kept patency for six weeks,and the inner surface of graft was covered with full endothelial cells.CONCLUSION:Hydrophilicity and antithrombogenicity of heparinized SIS are increased obviously after hypothermia plasma treatment.

Effects of exogenous basic fibroblast growth factor on in-sheathed tendon healing and adhesion / 中国组织工程研究

BACKGROUND: Basic flbroblast growth factor (bFGF) can promote tendon proliferation, collagen secretion,and out-sheathed tendon healing; however, effects on in-sheathed tendon are still unknown.OBJECTIVE: To explore the effects of exogenous bFGF on in-sheathed tendon healing and adhesion formation. DESIGN,TIME AND SETTING: A randomized controlled animal study, which was carried out in Experimental Animal Center, Shanghai Sixth People's Hospital from May 2004 to February 2005.MATERIALS: Ninety Leghorn chickens were randomly divided into 3 groups with 30 animals for each, and the right third digitorum longns tendon of the chicken was transected. METHODS: In the control group, the tendon was sutured in situ after transection. In the fibrin group,the tendon was sutured after 0.6 μL fibrin sealant (FS) was applied at repair site. In the bFGF group,the tendon was sutured after 0.6 μL FS mixed with 500 ng bFGF was applied at repair site. MAIN OUTCOME MEASURES: At 1,2,4 and 8 weeks postoperatively, the tendons of 6 chickens in each group were harvested for morphological and histological evaluation.Another six specimens of each group was obtained for biomechanical test at 8 weeks.RESULTS: There were no significant differences between control group and fibrin group. In bFGF group compared with control and fibrin groups, appearance of the angiogenesis,fibroblast proliferation and collagen production in the sheath, epitenon and parenchyrna at repair site occurred earlier and were more in quantity,the gliding excursion of the tendon was shorter, and the work of flexion and the ultimate tensile strength of the tendon were greater. CONCLUSION: The exogenous bFGF at tendon repair site can facilitate in-sheathed tendon healing, but also increase the tendon adhesion.

Treatment of tibial osteomyelitis by transfer of distally based sural nerve compound flaps / 中华创伤骨科杂志

Objective To explore the possibility of treating tibial osteomyelitis with transfer of a compound flap composed of the sural nerve fasciocutaneous flap and the lateral gastroenemius muscle.Methods We observed in cadaver specimens the anatomical structure of the sural nerve fasciocutaneous flap and the lateral gastrocnemius muscle to design a compound flap. Fifteen cases of tibia] osteomyelitis were treated with sinus excision and thorough debridement before the skin defect area was covered with a sural nerve compound flap whose muscle was stuffed into the tibia] channel. Plates were replaced with unilateral fixators in 3 cases of tibial nonunion. Results We observed 5 to 6 perforating branches of blood vessels between the sural nerve fascioeutaneous flap and the lateral gastroenemius muscle, indicating that the two can be harvested simultaneously in one compound flap. The transferred compound flaps survived in 15 cases. Tibial os-teomyelitis was completely cured in 14 cases, 1 case healed after second debridement, and 3 cases of tibial nonunion healed 6 months later after a second stage iliac bone graft. No recurrence was found after a mean follow-up of 18 (10 to 26) months. Conclusion A compound flap composed of the sural nerve fascio-cutaneous flap and the lateral gastrocnemius muscle can be used to treat tibia] osteomyelitis effectively.

Repair and tissue engineered reconstruction of finger joint damage / 中国组织工程研究

BACKGROUND: The articular surface of interphalangeal joint and metacarpophalangeal joint is destroyed or defected, that would remain serious sequela in many patients and affect patient's routine work and living. Therefore, therapeutic efficacy of finger joint damage determines the functional recovery of hands. Tissue engineering provides a novel pathway for finger joint damage. OBJECTIVE: To summarize the research progress on the repair and reconstruction of finger joint damage. RETRIEVAL STRATEGY: The researcher of this article used the computer to retrieve literatures of Pubmed database with docuterms of "Interphalangeal joints fractures, Metacarpophalangeal joints fractures, Finger osteoarticular, Reconstruct", and the language was defined to English. Meanwhile China Academic Journals Full-Text Database from 2000 to 2007 was also retrieved with docuterms of "Interphalangeal joints, Metacarpophalangeal joints, Fractures, Repair and reconstruct", and the language was defined to Chinese. Totally 106 correlated articles were screened out and the data were firstly checked. Inclusion standard: ①closely correlated to the repair and reconstruction of finger joint damage; ②those published in the near future or authorized journal in the same field were preferred. Exclusion standard: repetitive investigation. LITERATURE EVALUATION: The resource of literatures was the clinic empirical studies of the repair and reconstruction of finger joint damage. Among 32 included articles, 3 of them were reviews and the others were clinic or empirical studies. DATA SYNTHESIS: The homogeneity variant bone-joint transplantation has got some successes in clinic, but how to prolong the survival time of transplanting joints would be a new research topic. Autoallergic joint transplantation is a good method to treat the defects of finger joints, but how to make handling conveniently, diminish secondary damage and search new donor site, all deserve to research. The ideal therapeutic efficacy of the finger joint damage is anatomical reset of the joint profile, that can reduce traumatic arthritis and anchylosis at the minimal level. But it is still a tough problem in the fingers joint's repairs, because of the multiple structure of bone-joint in hands and trauma factors. Open reduction and internal fixation, skeletal traction, arthroplasty, fusion of joint, prosthetic replacement of joint, articular transplantation and bone-joint tissue engineering have all obtained success, but none can fully succeed or be generally adopted. CONCLUSION: There are many treatments of the finger joint damage, but their results are not very well. With the research of homogeneity variant bone-joint transplantation, autoallergic joint transplantation and tissue engineering development, bone-joint transplantation will have a wide prospect in treatment of finger joints damage.

Anatomical characteristics of the fifth carpometacarpal joint of the hamatum / 中国组织工程研究

0.01). CONCLUSION: The 5th CMC joint of the hamatum can be considered to be a new and well joint donor site, and it can be used to repair and reconstruct the base joints of the proximal phalanx.

Therapeutic effect of micro-anchor in chronic mallet finger deformity / 中国矫形外科杂志

Objective To introduce the method of treating chronic mallet finger using Micro Arc bone Anchor, and investigate the feasibility of this method with the clinical effects.MethodFourteen chronic mallet fingers were treated with Micro Arc bone Anchors. During the operation, a "?" skin incision over the dorsum of the DIP joint was made to expose the extensor tendon and resect the scar tissue between the disrupted ends. Then the DIP joint was made at extending position was immobilized with a 1mm Kirschner wire and the ends of extensor tendon was sutured with horizontal mattress suture method. After that,the Micro Arc bone Anchor was sutured into the dorsal base of the distal phalanx,the suture thread attached the end of anchor was tied to the proximal end of the extensor tendon to reinforce the former suture. External fixation on the anterior face of forearm was applied to immobilize the wrist at 30?of extention and the metacarpophalangeal and interphalangeal joints and extending position for 3 w, and Kirschner wire fixation was taken out 6 w postoperatively. Functional exercises were performed after the Kirschner wires were removed.ResultAll the cases were followed up for 6 months to 1 year, and excellent results were obtained in 10 cases, good in 2, fair in 2 and poor in 1 according to Dargan's functional assessment system, with dysfunction of flexion in DIP joint in 1 case, and recurrence of abnormity in 1 case.The total rate of excellent and good results was 85.7%.ConclusionMicro Arc bone Anchor is a convenient and effective alternative for the treatment of chronic mallet finger deformity with many advantages such as the high suturing intensity,low recurrence rate of abnormity, convenient for operation and reliable effect.

Treatment of radial head fractures by replacement with floating cup radial head prosthesis / 中华创伤骨科杂志

Objective To report the preliminary clinical results of treatment of severely comminuted radial head fractures by replacement with floating cup radial head prosthesis. Methods In the period from August 2002 to June 2005, replacement with floating cup radial head prosthesis was performed to treat 10 cases of Mason Ⅲ , Ⅳ radial head fractures, of whom 9 were acute fractures and 1 old. Results All the patients were followed up for 6 to 40 months (mean 14.9 months). The mean flexion/extension of the elbow was 133.5? /9.0? , while the mean pronation/supination of the forearm was 78.5? /84.0? . There were 3 cases of mild pain, 1 case of mild valgus instability in the elbow and 3 cases of mild weakness. The Broberg and Morrey elbow scores averaged 93. The result was excellent in 6 cases, good in 3 and fair in 1, the excellent and good rates were 90% . Conclusion The replacement with floating cup prosthesis shows satisfying preliminary clinical outcome in the treatment of radial head fractures unable to be reduced, while its long- term result needs further follow- up

Advances in research of metacarpophalangeal joint implantation / 中华创伤骨科杂志

Progress in the metacarpophalangealgeal joint implantation has drawn increasing attention to its role in treatment of chronic arthritis of the hand. This paper summarizes the biomechanic research and devolvement of the prosthesis, preoperative evaluation and plan for metacarpophalangealgeal joint implantation and the clinical results of different designs of the MCP prosthetic joint in the past decade. With improvement of prosthesis designs and operative technology, the MCP implantation will play a better role in clinical treatment of chronic arthritis of the hand, such as relief of pain, rectification of abnormality and functional recovery of the hand.

Segmental arterial hydrolic dilation in free tissue transplantation / 中华骨科杂志

Objective To observe the patency and the rate of arterial spasm in different time periods following segmental hydrolic dilation during the course of tissue transplantation; also the influence of arterial dilation to arterial structure was studied with histological examinations. Methods Fifty seven patients with thumb or finger defects were treated with thumb reconstruction using thumb nail flap free transplantation in 41 cases, thumb reconstruction using free transplantation of the second toe in 6 cases and 10 cases had finger reconstruction using the second and third toe free transplantation. Following complete tissue isolation, and prior to vascular anastomosis, heparin+normal saline was injected into the dorsal pedal artery, the first metatarsal artery and the digital artery of the big toe or the second for segmental dilation with the pressure of 300 mmHg. The dorsal pedis arteries were taken for histologic studies after hydrolic dilation. Results 1)The temperature of transplanted tissues were 0.16 ℃ higher than the health side. 2)The immediate arterial patency rate was 100% after anastomosis and the rate of spasm was 0. Vascular crisis took place in one case 24 hours after the operation, and was relieved after removal of the hematoma. There was one failure due to the extensive thrombosis formation in the capillaries. 3)Histologic study showed: there were 15% of the arterial endothelium exfoliated following hydraulic dilatation, resulting in looseing of the internal elastic membrane, a basically normal muscular layer of different thickness; without hydraulic dilatation, 7% of the arterial endothelial cells exfoliated, with homogeneous thickness of the internal elastic membrane and intact muscular layer. Conclusion 1)Segmental hydrolic dilation is one of the effective methods to prevent and treat vascular spasm and it is a safe and effective method to increase the successful rate of free tissue transplantation. 2)Hydrolic dilation within a certain range(300 mmHg) had no obvious effect on arterial structure.

Histologic changes of arteries after hydraulic dilation / 中华骨科杂志

Objective To study the histologic changes of arteries dilation under different hydraulic pressure. Methods Right carotid arteries were dilated by using hydraulic method with different pressures (40, 80, 120 kPa) normal saline. The endothelial cells, internal elastic membrane (IEM), smooth muscle (SM) and adventitia of the arteries were studied under microscope. The arterial calibre, thickness of tunica intima and smooth muscle were measured under TJTY-300 automatic medical photograph analyser. Results 1) The calibre of the dilated arteries increased. 2) When the pressure was 40 kPa, there were mild injuries of endothelial cells, internal elastic membrane and smooth muscle; all the injuries recovered to normal 1 week later. 3) The degree of injury of the individual layers of the arteries gradually aggravated as the pressure raised up to over 80 kPa. The repair also required long periods of time and was found imperfect. The proliferation of fibres of connective tissues took place one week later. Conclusion 1) Blood flow could be increased after hydraulic dilation of the artery, and the strength of washing away the small thrombosis over the site of anastomosis could be increased. 2) For safety, the hydraulic pressure of arterial dilation should be better kept within 40 kPa.