A case-control study of two internal fixation methods in the treatment of comminuted fracture of inferior pole of patella / 中国骨伤

OBJECTIVE@#To compare the effects of tension band combined with patellar cerclage and memory alloy patellar concentrator fixation in the treatment of comminuted fracture of the lower pole of patella.@*METHODS@#From July 2015 to July 2019, 60 patients with distal patellar fracture were treated and were divided into two groups according to different operation methods. In group A, 30 patients were fixed with memory alloy patellar concentrator (NiTi PC), 17 males and 13 females, aged 20 to 71 (39.4±9.9) years, including 19 cases of falling injury, 9 cases of traffic injury and 2 cases of sports injury. The time from injury to operation was 10 to 75 (33.1±7.8) hours; 30 cases in group B were fixed with tension band andcerclage, 15 males and 15 females, aged 21 to 76 (38.6±10.2) years, including 17 cases of falling injury, 12 cases of traffic injury and 1 case of smashing injury. The time from injury to operation was 10 to 91 (34.5±9.1) hours. The curative effects of two groups were observed and compared.@*RESULTS@#All 60 patients were followed up for 9 to 30 months. There was no significant difference in intraoperative bleeding, operation time, follow-up time and fracture healing time between the two groups. Six months after operation, according to the Bostman function score of knee joint:30 cases in group A, the total score was 28.6±4.7, of which 26 cases were excellent and 4 cases were good. The total score of 30 cases in group B was 25.5±4.4, of which 20 cases were excellent, 8 cases were good and 2 cases were poor. There were significant differences in Bostman total score and curative effect evaluation between two groups (@*CONCLUSION@#Memory alloy patellar concentrator is strong and reliable in the treatment of inferior patellar fracture. It can take early rehabilitation exercise after operation, with good recovery of joint function and range of motion and less complications.

Posterior partial trochanteric osteotomy for the treatment of the roof involved acetabular fractures / 中国骨伤

<p><b>OBJECTIVE</b>To introduce a new trochanteric osteotomy,and evaluate the outcome of the procedure combined a posterior lateral approach in treating acetabular fractures which involving the roof.</p><p><b>METHODS</b>Between March 2007 and Novmber 2010,30 patients with displaced acetabular fractures involving the dome need trochanteric osteotomy were retrospectively reviewed. There were 21 males and 9 females,ranging in age from 18 to 70 years with an average of 35.2 years at the time of injury. According to Letournel-Judet classification, there were 10 posterior wall fractures,7 posterior column fractures,5 transverse fractures, 2 T-shape fractures, 1 transverse associated with posterior wall fracture, 3 posterior column and wall fractures and 2 bicolumn fractures. The standards of Matta,the modified Merle d'Aubigne-Postel, Medical Research Council were respectively used to evaluate the reduction result, function of hip joint and the strength of hip abduction.</p><p><b>RESULTS</b>All patients were followed up with an average time of 25 months (18 to 40) and all osteotomy sites obtained bone union with an average time of 8.4 weeks (6 to 12). No bone non-union, bone block displaceing, internal fixation looseing and breaking,infection of deep part were found. Seventeen patients got anatomic reduction, 12 got satisfied reduction, and 1 got unsatisfied result according to the criteria of Matta. At final follow-up, function of hip joint obtained excellent results in 11 cases, good in 15, fair in 3 and poor in 1. The strength of the abductors of 3 patients were grade 4 and 27 patients were grade 5.</p><p><b>CONCLUSION</b>Posterior partial great trochanteric osteotomy can enhance the exposure and provide a more accurate reduction and degrade the difficulty of acetabular fracture fixation without increasing the risk of complications. The method provide a new way for the treatment of the roof involved acetabular fractures.</p>

Application of cannulated compression screws for the treatment of tibial tubercle avulsion fractures of Ogden type III in adolescents / 中国骨伤

<p><b>OBJECTIVE</b>To review the clinical outcome of the application of cannulated compression screws for the treatment of tibial tubercle avulsion fractures of Ogden type III in adolescents.</p><p><b>METHODS</b>From January 2003 to October 2010,11 adolescent patients with tibial tubercle avulsion fractures were treated with open reduction and internal fixation. There were 9 boys and 2 girls with an average age of 15.2 years old (ranged, 12.4 to 17 years old). According to Ogden classification, there were 9 patients with type IIIa and 2 patients with type IIIb. Postoperative functional exercise and regular follow-up were done and outcomes were evaluated by the Mosier clinical assessment system.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 7 to 69 months, with a mean of 25.5 months. All fractures healed at the first stage. According to the Mosier clinical assessment system, the final outcome was evaluated as excellent in all. One patient had infrapatellar hypoesthesia, and one patient had prominency of tibial tubercle without any symptoms.</p><p><b>CONCLUSION</b>The cannualted compression screws in the treatment of tibial tubercle avulsion fractures of Ogden type III in adolescents have an excellent outcome without deformity or functional loss.</p>

Treatment of comminuted fracture of tibial plateau with ni-ti shape memory alloy bow-teeth screws combined with locking plate internal fixation / 中国骨伤

<p><b>OBJECTIVE</b>To assess the clinical effects of Ni-Ti shape memory alloy bow-teeth screws combined with locking plate internal fixation in treating comminuted fracture of tibial plateau.</p><p><b>METHODS</b>From January 2003 to December 2008, 17 patients with comminuted fracture of tibial plateau were treated with Ni-Ti shape memory alloy bow-teeth screws and locking plate internal fixation. There were 9 males and 8 females with an average age of 33.7 years old (ranged, 23 to 48 years). All fractures were fresh and injured time less 3 weeks and 2 patients with common peroneal nerve injury. According to Schatzker typing, type V was in 1 case and type VI was in 16 cases.</p><p><b>RESULTS</b>All patients were followed up from 10 to 22 months with an average of 18 months and all incisions healed in one stage. At 3 to 12 weeks after operation, knee joint function of 16 cases arrived to the level of uninjured side and 1 case was poor in flexed function. All fractures obtained union at 3 to 5 months after operation, and internal fixtures were removed at 1 year after operation and no reduction lossing or refracture occurred. At final follow-up, no bone block shifting, internal fixture loosening and breakage was found. According to the standard of Xushanding's knee joint function, 9 cases got excellent results, 4 good, 4 fair.</p><p><b>CONCLUSION</b>The design of Ni-Ti shape memory alloy bow-teeth screws is adapt to irregular anatomic structure of comminuted fractures of tibial plateau,it can continuously pressurize and promote bone healing. Multi drop lockedup may avoid wide-ranging stripping local soft tissue, and form three-dimension fixation after combined with locking plate internal fixation, can effective recover anatomic structure of fracture. So Ni-Ti shape memory alloy bow-teeth screws combined with locking plate internal fixation is an effective method in treating comminuted fracture of tibial plateau.</p>

Application of Ni-Ti patellar concentrator combined with Herbert screw and wirerope for the treatment of comminuted patellar inferior pole fractures / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the surgical techniques and clinical effect of Ni-Ti patellar concentrator combined with Herbert screw and wirerope in treating comminuted patellar inferior pole fractures.</p><p><b>METHODS</b>From March 2008 to June 2010,34 patients with comminuted patellar inferior pole fracture were treated with Ni-Ti patellar concentrator combined with Herbert screw and wirerope. Of them, there were 19 males and 15 females with an average age of 38.6 years old(ranged from 22 to 75). Early functional exercise was guided postoperatively and the patients were regularly followed up and their outcomes were assessed.</p><p><b>RESULTS</b>All patients were followed up with an average of 13.5 months (ranged,7 to 20). All fractures healed. According to Böstman Clinical Rating System, the average score was 28.43 +/- 2.34,and excellent results in 21 cases,good in 13 cases and no poor case.</p><p><b>CONCLUSION</b>Ni Ti patellar concentrator combined with Herbert screw and wirerope for the treatment of comminuted patellar inferior pole fracture is an effective method and of great value to clinical application.</p>

Case-control study on two methods for the treatment of calcaneal fractures / 中国骨伤

<p><b>OBJECTIVE</b>To investigate clinical results of percutaneous reduction and hollow screw internal fixation for the treatment of calcaneal fractures, and to compare therapeutic effects between close reduction hollow screw internal fixation and open reduction plate internal fixation.</p><p><b>METHODS</b>From August 2007 to May 2010, 53 patients with calcaneal fractures were retrospectively analyzed. All the patients were divided into two groups, 25 patients in group A (PR group) treated with percutaneous reduction and hollow screw internal fixation, including 17 males and 8 females, with an average age of (39.4 +/- 9.9) years. While 28 patients in group B (OR group) treated with open reduction and plate internal fixation, including 18 males and 10 females, with an average age of (38.6 +/- 10.2) years. According to Sanders classification, there were 18 patients with type II fractures, 29 patients with type III and 6 type IV. In both groups, operative time, blood loss, postoperative complications and radiology were recorded. Functional recovery was evaluated by Maryland score.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from nine months to thirty-five months (averaged 20.4 months). There were no significant differences in sex, age, fracture type, fracture classification, initial Böhler angle, or late complications between the two groups. But significant difference can be seen between operative time, blood loss, and skin complications (in group A no nonunion and skin complications occurred, but subtalar posttraumatic arthritis occurred in 1 case; in group B, 3 patients had complications of skin necrosis, 1 patient suffered from a delayed union due to large defect filled with artificial bone, and 1 patient got subtalar posttraumatic arthritis). No difference were found in the latest X-ray film. According to Maryland score, in group A, 8 got an excellent result and 12 good. In group B, 10 got an excellent and 14 good. There were no significant differences between the two groups in Margland score.</p><p><b>CONCLUSION</b>The results of this study suggest that in comparison with open reduction, percutaneous reduction and hollow screw internal fixation minimizes complications and achieves good results. Further study of this technique is needed.</p>

Surgical treatment for posterior malleolus in complicated external rotation ankle fracture / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the indications, surgical techniques and clinical effects of the fixation of posterior malleolus in complicated external rotation ankle fractures and illuminate the importance of anatomical reduction and rigid internal fixation of posterior malleolar fracture.</p><p><b>METHODS</b>From July 2007 to June 2009, 32 patients were treated with open reduction and internal fixation,involving 21 males and 11 females with an average age of 36 years old (ranged from 19 to 68 years old). According to Lauge-Hansen classification: 13 cases of pronation-external rotation type (IV), 7 and 12 cases of supination-external rotation type (III and IV). Postoperative functional exercise and regular follow-up were done and outcomes were assessed.</p><p><b>RESULTS</b>All the patients were followed up,and the duration ranged from 7 to 20 months,with an average of 14.5 months. According to Ankle Hindfoot Clinical Rating System of the American Orthopaedic Foot & Ankle Society (AOFAS), 23 patients got an excellent result, 7 good, 2 fair, 0 poor.</p><p><b>CONCLUSION</b>Anatomical reduction and rigid internal fixation of posterior malleolar fracture as well as early functional exercise have significance in restoring ankle joint function and reducing the incidence of traumatic arthritis.</p>

Treatment of syndesmosis diastasis with shape memory staple fixation in ankle fractures / 中国骨伤

<p><b>OBJECTIVE</b>To explore operative method in the treatment of syndesmosis injury of ankle fractures.</p><p><b>METHODS</b>Twenty-four patients with ankle fractures and syndesmosis diastasis were treated with shape memory fracture staples, including 10 males and 14 females ranging in age from 19 to 71 years, with an average of 43 years. All patients were diagnosised with history, body examination and image data and were operated according to classification of Lauge-Hansen.</p><p><b>RESULTS</b>All patients were followed up from 6 to 28 months with an average of 16 months, and all fractures healed, with a mean time 9.2 (8 to 14) weeks. Only one case had radiological and clinical manifestations of traumatic arthritis, but no breakage of shape memory fracture staple in all cases. Sixteen patients got excellent results, good in 5, fair in 2, poor in 1.</p><p><b>CONCLUSION</b>Shape memory staple fixation for the treatment of syndesmosis diastasis in ankle fractures not only can perseve the physical motion of ankles, but also be remove earlier before weight bearing.</p>

Design of ABC damage variable and positioning system for acetabular fractures and 1122 cases multi-center statistic analysis / 中国骨伤

<p><b>OBJECTIVE</b>To design ABC damage variable and positioning system for acetabular fracture and explore the feasibility and clinical practical value of the system through the multi-center analysis of 1122 acetabular fractures.</p><p><b>METHODS</b>According to acetabular three-column conception, and pelvic ring lesions damage direction caused by acetabular fracture domino effect and injury degree of proximal femur joint, it defined class A as any column acetabular fracture; class B as any two-column acetabular fracture; class C as front, dome and posterior mixture acetabular fracture. Lower case English letters a, m, p represented front, dome, posterior fracture, respectively. Acetabular damage variables: 1 was simple displaced fractures; 2 was comminuted fractures; 3 was compression fractures. Pelvic ring lesions damage variables: alpha was sacroiliac joints or sacroiliac fracture horizontal separation deflection; beta was sacroiliac joints or sacroiliac fracture vertical separation deflection; gamma was pubic symphysis separation/superior and inferior ramus of pubis fracture deflection; alpha beta gamma delta was compound floating damage. Proximal humerus joint damage variables: I was femoral head fracture; II was femoral neck fracture; II was intertrochanteric fractures of femur; IV was I to III compound fracture. The ABC damage variable positioning system for acetabular fracture was made up by the above-mentioned variables. The statistics from March 1997 to February 2010 showed 1122 cases acetabular fractures with 18 cases of double side acetabular fracture and 1140 cases of acetabular fractures. The pelvics anterior-posterior view, ilium and obturator oblique view, and 2/3D-CT materials were analyzed and researched.</p><p><b>RESULTS</b>Each damage variables distribution situation in 1140 cases of acetabular fracture involved A in 237 cases (20.8%), B in 605 cases (53.1%), C in 298 cases (26.1%);front column fracture in 808 cases(70.9%), dome fracture in 507 cases (44.5%), posterior fracture in 1026 cases (90%). Acetabular variables: variabe 1 in 203 cases of simple displaced fracture (17.8%); variabe 2 in 516 cases of comminuted fracture(45.3%); variabe 3 in 421 cases of compression fracture (36.9%); 249 cases of pelvic ring lesions damage (21.8%), 75 cases femoral head fracture (6.6%); 18 cases of double side acetabular fracture and relative pelvic ring and proximal humerus joint variables (1.58%). Key part and curative effect elements of 1140 cases acetabular fracture: 507 cases of dome or posterior acetabular fracture (44.5%); 421 cases of compression fracture (36.9%); 249 cases of pelvic ring variables (21.8%); 75 cases of proximal humerus joint variables (6.6%); 486 cases of simple Aa/pl/2,Bapl/2 acetabular fracture (42.6% ).</p><p><b>CONCLUSION</b>Compression fracture, especially defected compression fracture, takes important part in acetabular damage variables, and also presents that acetabular fracture with pelvic ring and proximal femoral damage variables are not rare at all. The relationship of the acetabular fracture damage variables, and its percentage shows the key points and elements in clinical treatment: weight-bearing to dome accounts for 44.5%; compression to defects account for 36.9%, pelvic ring to float accounts for 21.8%; dome fracture to double side fracture account for 6.6%. The system has significant guiding effects on clinic in terms of evaluation of injury severity, anatomic localization, difficulty index, alternative strategy, operative approach, effect of treatment,and prognosis. And the most important thing is that the system creates the comparison of damage variables in same type of fracture and the communication of homo-language and explores a new method.</p>

Treatment of Seinsheimer type V subtrochanteric femoral fractures with dynamic hip screw and shape memory alloy bow-teeth screw / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effect of Seinsheimer type V subtrochanteric femoral fractures with dynamic hip screw and shape memory alloy bow-teeth screw.</p><p><b>METHODS</b>Twelve patients with Seinsheimer type V subtrochanteric femoral fractures were retrospectively analyzed. There were 8 males and 4 females with an average age of 53 years (range 31 to 65 years). Seven cases were caused by traffic accident, 4 cases by falling from hight, 1 case by heavy object. According to the Seinsheimer classification, all the cases were type V fractures. All the cases accepted the surgical treatment with dynamic hip screw and shape memory alloy bow-teeth screw fixation.</p><p><b>RESULTS</b>The mean period of follow-up was 28 months (range 20 to 38 months). All the cases obtained bone union in average 3.3 months (from 3 to 4.5 months). There were no complications such as deep infection, deep vein thrombosis, pulmonary embolism and bone nonunion. The results of clinical evaluation according to Merle d'Aubigne scores were 16.75 +/- 1.14 and excellent in 4 cases, good in 8 cases.</p><p><b>CONCLUSION</b>Application of dynamic hip screw and shape memory alloy bow-teeth screw as a superior option can get satisfactory reduction with reliable fixation and will be one of a better choice for fixation of Seinsheimer type V subtrochanteric femoral fractures.</p>

Application of PHILOS plate with injectable artificial bone for the treatment of proximal humeral fractures in elderly patients / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effects of PHILOS plate with injectable artificial bone for the treatment of proximal humeral fractures in elderly patients.</p><p><b>METHODS</b>From March 2007 to March 2009,17 patients who suffered from proximal humeral fractures were retrospectively studied. There were 7 males, 10 females, with an average age of 71 years (ranged, 66 to 81 years). Nine patients were caused by falling, seven patients were caused by traffic accidents,and one patient was hit by heavy object. According to the Neer classification, 9 patients were type III and 8 patients were type IV. All the patients were treated with PHILOS plate internal fixation combined with injectable artificial bone. Assessment was based on the Constan-Murley shoulder score and percentage Constant-Murley score.</p><p><b>RESULTS</b>The mean period of follow-up was 16 months (ranged, 8 to 25 months). All the patients obtained bone union in an average of 3 months (2.5 to 3.5 months). There were no complications such as deep infection, nonunion or failure of fixation. The Constant-Murley score of the injured side was mean (86.50 +/- 10.50) (ranged, 75 to 95). The clinical outcomes were excellent in 9 cases, good in 6 cases, moderate in 2 cases.</p><p><b>CONCLUSION</b>The treatment of proximal humeral fractures in elderly patients with application of PHILOS plate combined with injectable artificial bone can get satisfactory clinical effect especially suitable for osteoporosis and comminuted proximal humeral fractures.</p>

Solitary plasmacytoma of spine: a clinical, radiologic and pathologic study of 13 cases / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinical, radiologic and pathologic features of solitary plasmacytoma of spine.</p><p><b>METHODS</b>The clinical, radiologic and pathologic features, as well as treatment and follow-up data, of 13 solitary plasmacytoma of spine cases were retrieved and analyzed. Immunohistochemical study using EnVision method for LCA, CD19, CD20, CD79a, CD3, CD7, PC, MUM1, CD138, IgG, IgM, kappa, lambda and Ki-67 was carried out.</p><p><b>RESULTS</b>All the tumours were primarily located in the vertebrae (including 9 cases in thoracic vertebrae and 4 cases in lumbar vertebrae). The male-to-female ratio was 3.3:1. The age of the patients ranged from 42 to 69 years (mean age = 56 years). The commonest symptom was pain in the surrounding regions. The degree of neurologic disturbance mostly depended on the extent of vertebral destruction and structural instability of the spine. Radiologic examination showed mainly osteolytic lesions in vertebrae. Magnetic resonance imaging demonstrated the presence of heterogeneous intensity inside the involved vertebrae (low in T1 weighted and high in T2 weighted images). Histologic examination showed diffuse infiltration by malignant cells. In well-differentiated plasmacytomas, the tumor cells resembled normal plasma cells. In poorly differentiated examples, the cellular morphology mimicked that of the centroblasts. The interstitial stroma was scanty and contained plenty of vessels, sometimes with formation of blood lakes. Amyloid deposition was present in some of the cases. Immunohistochemical study showed that the tumor cells were positive for CD79a and negative for CD20. Light chain restriction was detected in all the 13 cases studied. Plasma cell marker PC was expressed in all cases, while IgG was positive in 5 cases, IgM in 1 case, MUM1 in 10 cases and CD138 in 8 cases. Ki-67 index varied from 10% to 50%. All cases were operated, with adjuvant chemotherapy and radiotherapy given.</p><p><b>CONCLUSIONS</b>Correlation of clinical, radiologic and pathologic features is important in diagnosis of solitary plasmacytoma of spine. The possibility of multiple myeloma needs to be excluded. Early detection by radiologic examination, local surgical resection, post-operative chemoradiotherapy and long-term follow-up are prudent for successful management of this condition.</p>

Treatment of severe crush syndrome caused by earthquake: a report of 35 cases / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the diagnosis and treatment of the crush syndrome in the earthquake.</p><p><b>METHODS</b>Thirty-five patients with crush syndrome caused by earthquake were involved the retrospective study. The role of nutritional support, active wound treatment and hemodialysis on the patients' recovery was observed.</p><p><b>RESULTS</b>The function of the heart and kidneys were gradually improved by the planned removal of the necrotic tissue, which laid a foundation for the further repair of the wound.</p><p><b>CONCLUSION</b>The removal of necrotic tissue, which can decrease the toxic absorption, will improve the success rate for treatment of the crush syndrome patients when being assisted with the hemodialysis.</p>

Analysis of traumatic conditions on casualties evacuated from Wenchuan earthquake area / 中国骨伤

<p><b>OBJECTIVE</b>To investigate and analyze the traumatic conditions on the casualties evacuated from Wenchuan earthquake area.</p><p><b>METHODS</b>Traumatic conditions of 34 patients evacuated to Changhai hospital were investigated. Meanwhile, classification of traumatic conditions and therapeutic methods was analyzed.</p><p><b>RESULTS</b>By organized emergency medical treatment,classification and transmission of casualties, selected application of external fixation,active repair of soft tissue injury, positive psychological assessment and intervention, healing rate was efficiently rasied and complications were decreased.</p><p><b>CONCLUSION</b>The summary of traumatic conditions and therapeutic experiences on wounded people of Wenchuan earthquake area can provide the primary basis and treatment methods for the wounded people with earthquake injury.</p>

Treatment of the aged wounded patients evacuated from Wenchuan earthquake area / 中国骨伤

<p><b>OBJECTIVE</b>To explore the therapeutic strategies of the aged wounded patients evacuated from Wenchuan earthquake area.</p><p><b>METHODS</b>The characteristics of traumatic conditions and therapeutic methods of 14 aged wounded patients evacuated from Wenchuan earthquake area were retrospectively analyzed.</p><p><b>RESULTS</b>All cases accepted the effective treatment for 4 to 8 weeks and attained good recovery. There was no anesthetic and surgical complications, deep venous thrombosis, hypostatic pneumonia, pulmonary embolism, bed sore, stroke and other complications happened. When discharged, all medical disorders of the patients were under control and both psychological condition and nutritional status were improved obviously.</p><p><b>CONCLUSION</b>Assessment of traumatic condition and general status,cooperative nursing, active nutritional support, positive symptomatic treatment and necessary psychological intervention are the key to improve effectively the curative effect of the aged wounded patients in earthquake.</p>