[Treatment of tibiofibular diastasis without ankle fracture with endobutton device].

OBJECTIVE: To investigate the clinical effects of Endobutton device in the treatment of tibiofibular diastasis without ankle fracture. METHODS: From January 2009 to January 2011, a total of 8 patients with tibiofibular diastasis without ankle fracture were treated with Endobutton device. There were 6 males and 2 females with an average age of 34 years (ranged, 25 to 44 years). All the patients with ankle injured history and ankle pain, swelling, ecchy-mosis were diagnosed by radiology and then operated with Endobutton device. The clinical effects were evaluated according to Baird-Jackson scoring system and radiological evaluated parameters comprised of tibiofibular overlap,total clear space and medial clear space. RESULTS: All the patients were followed up, and the duration ranged from 6 to 24 months,with an average of 12 months. Radiographic results were detailed as follows: tibiofibular overlap averaged (3.83 +/- 0.37) mm in preoperative and (7.46 +/- 0.14) mm in postoperative; mean total clear space (7.90 +/- 0.22) mm in preoperative and (3.39 +/- 0.07) mm in postoperative; medial clear space averaged (5.08 +/- 0.34) mm in preoperative and (3.16 +/- 0.07) mm in postoperative. There was significant difference above data between preoperative and postoperative one. The lastest Baird-Jackson score results: 6 cases obtained an excellent result, 1 good and 1 fair. The main score was (94.63 +/- 3.66). CONCLUSION: Endobutton device for the treatment of tibiofibular diastasis without ankle fracture has advantages such as simple and minimally invasive, no need of second operation for implant removal, recover the ankle function better and less complications, which should be popularized and applied to clinical widely.

The anatomic study of clival screw fixation for the craniovertebral region.

PURPOSE: To study the anatomic parameters related to clival screw and establish reference data concerning the craniovertebral fixation technique. METHODS: Morphometric measurement of the clivus and the surrounding anatomic structures were obtained on 41 dry bone specimens. Then, 2-D CT reconstruction of the craniovertebral region of 30 patients (19 men and 11 women, ranging in age from 20-64 years with an average age of 38.8 years) were performed to measure the safety range for a 3.5-mm screw placement. Nine entry points were evaluated. Finally, one male fresh cadaver specimen (age 46 years) was dissected to observe the craniovertebral region. RESULTS: The clivus faces the basilar artery, the V ~ XII cranial nerves, the pons, and ventral medulla oblongata at its intracranial surface. The longitudinal diameter of extracranial clivus was 25.87 ± 2.64 mm. The narrowest diameter of the clivus was 12.84 ± 1.08 mm, the distance between the left and right hypoglossal canal was 32.70 ± 2.09 mm at its widest part. The distance between the left and right structures, the maximum value was 49.31 ± 4.16 mm at carotid canal, the minimum value was 16.54 ± 2.04 mm at the occipital condyle. The measurement of clival screws placement simulation via 2-D CT reconstruction images shows the maximum upper insertion angle of three components the optimal entry points, the candidate points, the limit entry points was 130.19°, 125.23° and 85.72°, and the total mean screw length was 7.57, 10.13 and 15.6 mm at the vertical entry angle, respectively. CONCLUSIONS: Clival screw placement is a viable option for craniovertebral fixation. There is a safe scope for the screw length and angle of the screw placement. And, these parameters obtained in the present study will be helpful for anyone contemplating the use of clival screw fixation.

[Application of elastic intramedullary nail in treating bilateral femoral shaft fractures in children].

OBJECTIVE: To explore the curative effects and complications of elastic intramedullary nail in treating children's bilateral femoral shaft fractures. METHODS: Form February 2005 to March 2008, 7 patients with bilateral femoral shaft fractures were treated by closed reduction and internal fixation with elastic intramedullary nail. There were 5 males and 2 females. The age ranged from 3 to 13 years with the mean of 8.3 years. Six injuries caused by road accident and 1 injury caused by fall from high. Two cases associated with pulmonary contusion, 3 cases brain injuries, 1 case fracture of calcaneus and 1 case bladder injuries. All the cases were closed fractures without nerve and blood vessel injury. A cast external fixation had been used after operation for a month in two cases. RESULTS: All the patients were followed up for 21-37 months with an average of 30.3 months. No infecton of incisional wound, displacement fracture, internal fixation fail, delayedunion and malunion were found. All fracture obtained healing for 7-12 weeks with an average of 8.7 weeks. Inequality of lower limb was found in 1 case (length differences was 5 mm). According to Flynn scoring,all fractures were excellent. CONCLUSION: Treatment of femoral shaft fractures in children with elastic intramedullary nail according with biological principle. The method has little trauma, less complication, outstanding effect and it is a good way to treat bilateral femoral shaft fractures result from high-energy injuries.