[Augmenting locking plate with autologous bone graft for the treatment of nonunion of long bone fracture in the lower extremity with retaining of the original intramedullary nail].

OBJECTIVE: To explore clinical effect of attaching locking plate with bone grafting based on retaining the original intramedullary nail in treating non-union after intramedullary nail fixation of long shaft fractures of lower limbs. METHODS: A retrospective study was conducted on 20 patients treated with non-union fractures after intramedullary nailing of long shaft fractures of lower limbs from June 2015 to June 2020. All patients were treated with the original intramedullary nailing and bone grafting from the iliac bone, and were underwent open reduction plate internal fixation and bone grafting for old fractures. Among them, 14 were males and 6 were females, aged from 35 to 56 years old with an average of (42.2±9.6) years old. Nine patients were femoral shaft fracture and 11 patients were tibial shaft fracture. According to characteristics of fracture end nonunion, 6 patients were stable/atrophic, 9 patients were unstable/large, and 5 patients were unstable/atrophic. The nonunion time ranged from 8 to 12 months with an average of(9.8±2.0) months after the initial surgery. Visual analogue scale (VAS), knee range of motion, bone healing time, complications and fracture-end healing were recorded before and at the latest follow-up. RESULTS: All patients were followed up for 18 to 48 months with an average of (36.3±10.5) months. The incision of all patients were healed at stageⅠwithout complications such as infection or internal fixation ruptur. Healing time of femur and tibia was (8.5±2.6) months and (9.5±2.2) months. Knee joint motion increased from preoperative (101.05±8.98) ° to postoperative (139.35±8.78) ° at the latest follow-up (t=-12.845, P<0.001). VAS decreased from preoperative (5.15±1.72) to postoperative (0.75±0.96) at the latest follow-up (t=11.186, P<0.001). CONCLUSION: On the basis of retaining the original intramedullary nail, the addition of locking plate internal fixation and autogenous iliac bone grafting have advantages of simple operation, less trauma, fewer complications and high fracture healing rate. It is one of the effective surgical schemes for the treatment of nonunion after intramedullary nail fixation of long bone fracture of lower extremity.

Evaluation of Accuracy of Preoperative Planning of the Femurofibular Angle in Open-Wedge High Tibial Osteotomy for Mild Medial Knee Osteoarthritis.

OBJECTIVE: The purpose of this study was to evaluate the usefulness of preoperative planning of the femurofibular angle (FFA) in medial open-wedge high tibial osteotomy (OWHTO) for mild medial knee osteoarthritis. METHODS: Thirty-two patients (32 knees) with mild medial knee OA were retrospectively reviewed. The patients underwent preoperative planning of the FFA for OWHTO. For preoperative planning, a full-length weight-bearing X-ray photograph of the lower limb was opened within Adobe Photoshop Software, and a targeted corrective mechanical axis line of the lower limb and its intersecting point at the lateral tibial plateau surface was drawn using rectangle selection and filling tools. A frame, which encircled the tibia and fibula, was created around the predicted osteotomy plane and then rotated until the ankle center was on the targeted mechanical axis line. Subsequently, a distal femoral condyle line and a proximal fibula axis line were drawn, and the angle between the two lines was measured and defined as the femurofibular angle (FFA). During biplane OWHTO, the preoperatively determined FFA was used to complete the correction of the mechanical axis. During follow-up, the postoperative mechanical weight-bearing line (WBL) of the lower limb, the mechanical femorotibial angle (mFTA), and the FFA were measured and compared with the preoperatively determined values. RESULTS: The mechanical WBL shifted from a preoperative value of 25.36 ± 5.02% to a postoperative value of 56.19 ± 0.10% from the medial border along the mediolateral width of the tibial plateau, and it was 56.57 ± 0.08% at the final follow-up (P < 0.01). The preoperatively determined value was 56.25%, and no significant difference was found compared with postoperative week-one and final follow-up values (P > 0.05). The mFTA was corrected from a preoperative varus of 4.02 ± 0.63° to a postoperative week-one valgus of 2.37 ± 0.28°, and it had a valgus of 2.48 ± 0.39° at the final follow-up (P < 0.01). No significant difference in the valgus was found compared with the postoperative week-one, final follow-up and preoperatively determined valgus of 2.34 ± 0.26° (P > 0.05). The postoperative week-one and final follow-up FFAs were 90.34 ± 1.53° and 90.33 ± 1.52°, respectively, and no significant difference was found compared with the preoperatively determined value of 90.12 ± 1.72° and the intraoperative setting value of 90.25 ± 1.67° (P > 0.05). All corrected values were within the acceptable range of preoperative planning. CONCLUSION: Preoperative planning of the FFA may be useful in OWHTO for patients with mild medial knee OA. Satisfactory correction of the postoperative targeted mechanical axis line of the lower limb can be obtained.

Inhibitory properties of Chinese Herbal Formula SanHuang decoction on biofilm formation by antibiotic-resistant Staphylococcal strains.

The aim of this study was to explore the effect of Chinese herbal SanHuang decoction (SH) on biofilm formation of antibiotic-resistant Staphylococci on titanium surface, and to explore its mechanism. Biofilm-forming ATCC 35984, ATCC 43300 and MRSE 287 were used in this study. The MICs of SH and vancomycin against Staphylococci were determined by the broth microdilution method. Six groups were designed, namely control group (bacteria cultured with medium), 1/8MIC SH group (1MIC SH was diluted by 1/8 using TSB or saline), 1/4MIC SH group, 1/2MIC SH group, 1MIC SH group and vancomycin group (bacteria cultured with 1MIC vancomycin). The inhibitory effect on bacterial adhesion and biofilm formation were observed by the spread plate method, CV staining, SEM, and CLSM. Real-time PCR was performed to determine the effect of SH on the expression levels of ica AD and ica R gene in ATCC 35984 during the biofilm formation. The strains were found to be susceptible to SH and vancomycin with MIC of 38.75 mg/ml and 2.5 µg/ml, respectively. SH with 1 MIC and 1/2 MIC could inhibit the bacteria adhesion, showing only scattered adhesion from SEM. CLSM showed that SH with 1 MIC and 1/2 MIC inhibited the biofilm formation. The quantitative results of the spread plate method and CV staining showed that there was significant differences between the SH groups (P < 0.05). Further, with an increase in SH concentration, the inhibitory effect became more obvious when compared with control group. Among the groups, vancomycin had the strongest inhibitory effect on bacterial adhesion and biofilm formation (P < 0.01). With an increase in SH concentration, the expression levels of ica AD decreased, and the expression of ica R increased correspondingly (P < 0.05). In conclusions, SH can inhibit the biofilm formation of antibiotic-resistant Staphylococci. Its probable mechanistic activity may be through the inhibition of polysaccharide intercellular adhesin synthesis by down-regulating the expression of ica AD gene.

[Clincal observation of non-absorbable suture cerclage combined with patella claw fixation for treatment of inferior patella fractures].

OBJECTIVE: To investigate the effectiveness of non-absorbable suture cerclage combined with patella claw fixation for the treatment of inferior patella fractures. METHODS: Between September 2016 and January 2019, 22 patients with inferior patella fractures were treated. There were 12 males and 10 females, with a mean age of 49.1 years (range, 32-67 years). The causes of injury were traffic accident in 8 cases, falling in 12 cases, and other causes in 2 cases. The interval from injury to operation was 3-7 days (mean, 4.4 days). For the operation, 3 or 4 longitudinal tunnels were drilled backward from the surface of the proximal fracture fragment with Kirschner wires; under the guidance of lumbar puncture needles and steel wires, non-absorbable suture passed through the tunnels and encircled the inferior fracture fragment, then tighten to achieve a satisfactory reduction of the fracture; finally, the patella claw was used to strengthen the fixation. During the follow-up, complications were observed, maximum motion range of the knee joint was measured, X-ray examination was performed and fracture healing time was recorded. The knee function was evaluated according to Böstman scores. RESULTS: All the 22 patients were followed up 12-36 months (mean, 19.4 months). No infection, joint stiffness, bone nonunion, loss of reduction, or displacement of internal fixation occurred. All fractures were clinically healed, and the bone healing time was 2-3 months (mean, 2.6 months). At last follow-up, the maxium motion range of knee joint was 130°-135°, with an average of 132.6°. The Böstman score of the affected knee was 28-30 (mean, 29.2). All cases were graded as excellent results. CONCLUSION: Non-absorbable suture cerclage combined with patella claw fixation for inferior patella fractures has the advantages of simple operation, reliable fixation, and few complications, and the clinical results are satisfactory.

[Arthroscopic reconstruction of medial patellofemoral ligament combined with medial displacement of lateral hemitibial tuberosity for treatment of recurrent dislocation of patella].

OBJECTIVE: To observe the effectiveness of arthroscopic reconstruction of medial patellofemoral ligament (MPFL) with a single bundle of autogenous half peroneal longus tendon, and medial displacement of lateral hemitibial tuberosity for the treatment of recurrent dislocation of patella. METHODS: Retrospectively analyse the clinical data of 24 patients (24 knees) with recurrent patellar dislocation with tibial tuberosity-trochlear groove distance (TT-TG) values more than 15 mm who were admitted between September 2014 and September 2018. Of which 7 were male and 17 were female; aged 16-35 years old with an average of 25.8 years. The disease duration ranged from 15 to 46 months, with an average of 26.7 months. All patients had a history of knee trauma, and a positive result of apprehension test on the affected knee. All patients underwent the surgery of arthroscopic reconstruction of MPFL with a single bundle of autogenous half peroneal longus tendon, and medial displacement of lateral hemitibial tuberosity. Before and after operation, Kujala score was used to evaluate patellofemoral joint function, Lysholm score was used to evaluate knee joint function; CT and MRI were used to measure and compare the changes of congruence angle (CA), patellar tilt angle (PTA), and lateral patella displacement (LPD) in order to evaluate patella stability. RESULTS: All incisions healed by first intention, and no infection or neurovascular injury occurred. Deep vein thrombosis of the lower extremities occurred in 2 cases at 4 and 7 days after operation respectively, and the thrombosis disappeared after symptomatic treatment. All the 24 patients were followed up 12-14 months (mean, 12.9 months). During follow-up, no patellar dislocation reoccurred in the affected knee. At last follow-up, the apprehension test was negative in every patients. The TT-TG, CA, PTA, and LPD were significantly improved when compared with those before operation ( P<0.05). The Kujala score and Lysholm score at 1 month and last follow-up were significantly better than those before operation, and the above scores at last follow-up were significantly better than those at 1 month after operation ( P<0.05). According to Lysholm score, the patients' knee joint functions were excellent in 13 cases, good in 10 cases, and fair in 1 case, and the excellent and good rate was 95.8%. CONCLUSION: Arthroscopic reconstruction of MPFL with a single bundle of autogenous half peroneal longus tendon combined with medial displacement of lateral hemitibial tuberosity has the advantages of minimal invision and reliable effectiveness. It can be used as one of the effective surgical methods for the treatment of recurrent dislocation of patella.

Arthroscopic pie-crusting release of the posteromedial complex of the knee for surgical treatment of medial meniscus injury.

BACKGROUND: An arthroscopic narrow posteromedial gap of the knee may cause failure of a meniscus operation. The posteromedial complex (PMC) of the knee, including the posterior part of the medial collateral ligament (MCL) and the posterior oblique ligament (POL), has a restrictive effect on the opening of the posteromedial gap of the knee in the half-extension position. Thus, we evaluated the radiological and clinical results of pie-crusting release of the PMC for arthroscopic meniscal surgery in tight knees. METHODS: Sixty patients with posterior injury of the medial meniscus were reviewed. All patients accepted arthroscopic pie-crusting release of the PMC. Fourty patients accepted meniscoplasty, and 20 patients accepted meniscal suturing. To evaluate the arthroscopic opening of the medial gap in 20° half-extension under 11-kg valgus stress, the width of the medial space before and after release were measured. During follow-up, the medial stability was evaluated by radiographic measurements of the joint space width (JSW) in 20° half-extension. Magnetic resonance imaging (MRI) was conducted to evaluate healing of the MCL and meniscus. Knee functions were evaluated using VAS (visual analogy score), Lysholm, IKDC (International Knee Documentation Committee) and Tegner scoring systems. RESULTS: In all patients, meniscus operations were performed without iatrogenic cartilage injury. After PMC release, the arthroscopic width of the medial space was 5.7 ± 0.5 mm, larger than that before release (2.5 ± 0.5 mm, p < 0.01). The follow-up time was 21.93 ± 7.04 months, there was no residual valgus laxity of the knee. The radiographic JSW was 5.97 ± 0.8 mm preoperatively, 9.2 ± 1.1 mm in the 1st week postoperatively, and 6.1 ± 0.9 mm by the 3rd postoperative month, showing no differences between preoperative and 3 months postoperative measurement (p > 0.05). For sutured meniscus, MRI showed healing in 15 patients while five had two-grade abnormal signals. VAS, Lysholm, IKDC and Tegner scores were 1.80 ± 0.51, 80.08 ± 3.74, 82.17 ± 4.64 and 5.48 ± 0.59, respectively, showing significant differences compared with the preoperative scores (5.57 ± 0.69, 48.17 ± 4.22, 51.42 ± 4.02 and 3.20 ± 0.68, respectively, p< 0.01). CONCLUSIONS: Pie-crusting release of the PMC can increase the posteromedial space and improve the visual field of the knee under arthroscopy, while neither causing no residual valgus instability of the knee nor affecting the clinical outcome at the final follow-up.

Pre-operative simulation using a three-dimensional printing model for surgical treatment of old and complex tibial plateau fractures.

To investigate the clinical efficacy of pre-operative simulation using a three-dimensional (3D) printing model for surgical treatment of old and complex tibial plateau fractures. Forty-two patients with old and complex tibial plateau fractures were retrospectively reviewed from January 2014 to January 2018, which were divided into a conventional planning group (n = 22) and a planning with 3D printing group (n = 20). In the planning with 3D printing group, preoperative equal-ratio fracture models prepared using the 3D printing technique were used to perform pre-operative simulation and guide the real surgical operation. In the conventional planning group, the operation was performed based on pre-operative computed tomography (CT) images. Surgery duration, blood loss and the number of fluoroscopy during operations were recorded. During follow-up, the quality of fracture reduction and complications were also recorded. Knee functions were evaluated using the hospital for special surgery (HSS) scoring system. The operation time, blood loss and the number of fluoroscopy during operation in the planning with 3D printing group were less than that in the conventional planning group (P < 0.01). All patients were followed up for mean of 24.38 ± 7.62 months. The rate of excellent fracture reduction in the planning with 3D printing group and conventional planning group was 75% and 45.45%, respectively (P = 0.05). The complication rate was 15% in the planning with 3D printing group and 31.82% in the conventional planning group. At the final follow-up evaluation, the mean HSS score was 86.05 ± 7.67 in the planning with 3D printing group and 79.09 ± 6.75 in the conventional planning group (P = 0.003). The rate of excellent results in the planning with 3D printing group was 70% and in the conventional planning group was 45.45% (P = 0.083). In conclusion, pre-operative simulation using a 3D printing model may be helpful for the treatment of old and complex tibial plateau fractures, which may be conducive to the pre-operative planning and to making the surgical procedure accurate and personalized. However, its clinical effectiveness need to be further assessed by a prospective randomized-controlled study.