Subtalar distraction osteogenesis for posttraumatic arthritis following intra-articular calcaneal fractures.

BACKGROUND: The most common treatment for old calcaneal fractures accompanied by subtalar joint injury is the use of subtalar in situ arthrodesis and subtalar distraction bone-block arthrodesis or osteotomy. This article describes the introduction of a novel surgical treatment, gradual subtalar distraction with external fixation and restoration of the calcaneal height, and presents an assessment of its efficacy. METHODS: The protruding lateral calcaneus and the articular surfaces and subchondral bone of the posterior facet of the subtalar joint were surgically removed. An external fixator, attached with 2 pins in the subcutaneous tibia and 2 pins in the posterolateral calcaneus, was used to fix the subtalar joint for 7 to 10 days followed by gradual subtalar distraction at 1 mm/d. The lengthening procedure was stopped when the calcaneal height was restored according to radiography. The external fixator was removed after bone fusion. Seven cases of old calcaneal fractures accompanied by severe subtalar joint injury (8 feet) were treated using this method. Average follow-up was 14.3 months (range, 7-36 months). RESULTS: In all 7 cases (1 case of both feet), the postoperative wound healed primarily. The calcaneal heights of all 8 feet were partially restored. Subtalar joint bone fusion was completed within 4 to 6 months after the operation. The average preoperative American Orthopedic Foot & Ankle Society (AOFAS) hindfoot score was 25.3, and the average postoperative AOFAS score was 76.3. CONCLUSION: Subtalar distraction osteogenesis with external fixation was a novel and effective method for the treatment of old calcaneal fractures accompanied by severe subtalar joint injury in this small group of patients. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Comparison of interface contact profiles of a new minimum contact locking compression plate and the limited contact dynamic compression plate.

In this study, we investigated whether or not a new minimum contact locking compression plate (MC-LCP) can provide advantages over the limited contact dynamic compression plate (LC-DCP) in the context of interface contact area and force. Six matched pairs of cadaveric bones were used for each of three bone types of the humerus, radius and ulna. For each bone type, one of two bone plates was fixed to either of two matched cadaveric bones at the middle of the diaphysis. The interface contact area and force of the plate fixed to three types of human cadaveric bones were evaluated using Fuji prescale pressure sensitive film. Data were quantitated using computer-assisted image analysis. Results showed that the average force between the MC-LCP and humerus or radius was about half of that of the LC-DCP. And the average force between the MC-LCP and ulna was one third less than that of the LC-DCP. Meanwhile, the interface contact area between the MC-LCP and humerus or radius was also about half of that of the LC-DCP, and the interface contact area between the MC-LCP and ulna was less than one third of that of the LC-DCP. These results indicate that the MC-LCP has lower interface contact area and lower average force than that of the LC-DCP. Thus, the MC-LCP system may be a good alternate to treat forearm diaphyseal fractures.

[The comparative study of patients with severe polytrauma treated by damage control orthopedits in normal time and in earthquake].

OBJECTIVE: To compare the outcome of damage control in patients with severe polytrauma in normal time and in the earthquake of 2008 Sichuan China. METHODS: In the retrospective study, 26 cases with severity polytrauma in peacetime and 24 cases with severe polytrauma who have mainly sustained in the earthquake of 2008 Sichuan China were involovd. The patients' demographics, the methods and effects of damage control were evaluated. RESULTS: In the earthquake group, 24 cases succeeded in the rescuing life; among whom, 3 patients needed the further debridement and dermoplasty. In the normal time group, 26 cases succeeded in the rescuing life; among whom, 19 patients had returned to their former work and 3 patients needed the further treatment. There was no difference between two groups in therapeutic effects (P > 0.05). CONCLUSION: Both in earthquake and in normal time, treating the severity polytrauma by damage control orthopedics can acquire satisfied effect.

Damage control orthopaedics in 53 cases of severe polytrauma who have mainly sustained orthopaedic trauma.

OBJECTIVE: To discuss damage control orthopaedics in 53 cases of severe polytrauma who have mainly sustained orthopaedic trauma. METHODS: The data of 53 cases of severe polytrauma who had mainly sustained orthopaedic trauma were retrospectively analyzed. And the methods and timing of damage control orthopaedics were discussed in this study. RESULTS: We succeeded in rescuing the lives of all the 53 patients, and 38 patients returned to their former work. CONCLUSIONS: Injury Severity Score (ISS(90)) should be 17 in severe polytrauma patients, but in severe polytrauma patients who have mainly sustained orthopaedic trauma, the ISS(90) of bone and joint injuries should be 16. We recommend that primary minimally-invasive external fracture stabilization should be made for extremities and pelvis in these patients to avoid additional surgical trauma and that definitive secondary fracture care should be performed after medical stabilization for these patients in intensive care unit (ICU).

[Testis homotransplantation: a report of 12 cases].

OBJECTIVE: To evaluate the effect of testis homotransplantation in the treatment of androgen deficiency and infertility. METHODS: We retrospectively analyzed 12 cases of testis homotransplantation. RESULTS: Surgical success was achieved in 11 cases, all with a significantly increased level of serum testosterone, and markedly improved secondary sex characteristics and sexual function. CONCLUSION: Testis homotransplantation is highly effective for the treatment of androgen deficiency in males, but has little effect on spermatogenesis.

Application of injury severity score to multiple injuries headed by spinal cord injury.

OBJECTIVE: To evaluate the application of injury severity score ( ISS) to multiple injuries headed by spinal cord injury. METHODS: The data of 55 cases (40 males and 15 females, aged 17-69 years, mean equal to 41 years) of multiple injuries headed by spinal cord injury treated in our hospital from January 2000 to December 2004 were reviewed and analyzed with ISS (Version of AIS-2005) to explore their relationship. RESULTS: The ISS values increased with the number of injured regions, so did the complications. The recovery rate was negatively related to ISS values. During the period of immunity observation, the patients with ISS larger than 25 could undergo planned operations safely. CONCLUSIONS: Treatment for multiple injuries headed by spinal cord injury closely depends on the general and local conditions of the patients. ISS may provide useful data for the choice of treatment methods.

Primary total hip arthroplasty for acetabular fracture.

OBJECTIVE: To explore the operative indications and operative methods of primary total hip arthroplasty for acetabular fracture and to observe the clinical curative effect. METHODS: We retrospectively summarized and analyzed the traumatic conditions, fracture types, complications, operative time, operative techniques, and short term curative effect of 11 patients (10 males and 1 female, with a mean age of 42.4 years) with acetabular fracture who underwent primary total hip arthroplasty. RESULTS: The patients were followed up for 6-45 months (mean=28 months). Their average Harris score of postoperative hip joint was 78. CONCLUSION: Under strict mastery of indications, patients with acetabular fracture may undergo primary total hip arthroplasty, but stable acetabular components should be made.

Surgical treatment of infected arterial injuries of the major limb.

OBJECTIVE: To analyze retrospectively the surgical treatment of 21 cases of infected arterial injuries of the major limb hospitalized from 1989 to 2003 in our department. METHODS: After a radical debridement and drainage, an autologous vessel bypass reconstruction, simple vessel ligation or amputation were carried out respectively according to each patient's condition. In order to make a better milieu for the grafts, local musculo-cutaneous flaps were translocated to cover the wounds in 9 cases. RESULTS: 1 case (4.8%) died during the treatment. 5 cases (5/21, 23.8%) underwent amputations. Blood supply reconstruction was successful in 15 cases (15/21, 71.4%). 93.3% (14/15) of the cases were successful in getting an unobstructed vessel at early stage. Thrombosis occurred in 1 case (1/15, 6.7%) and a sound result was obtained after a second operation. CONCLUSIONS: Radical debridement combined with bypass vessel reconstruction with autologous vein and with musculo-cutaneous flap translocation is an effective treatment for infective limb vascular injuries.