Surgical treatment of posterior pilon fracture through the posteromedial approach / 中华创伤骨科杂志

Objective To review the results and complications of open reduction and internal fixation (ORIF) through the posteromedial approach for posterior pilon fractures.Methods From March 2009 through November 2013,18 consecutive posterior pilon fractures were surgically treated through the posteromedial approach,involving 12 males and 6 females.Their ages ranged from 15 to 65 years (average,42 years).All of them were complicated with fracture of external malleolus,and 6 of them with fracture of anterior colliculus of medial malleolus.The time from injury to surgery ranged from 2 to 15 days (average,7 days).Results The patients were followed up for an average of 15 months (range,from 10 to 19 months).All the fractures healed after 11 to 16 weeks (average,13 weeks).No complications like neurovascular injury,implants failure,nonunion,or malunion occurred,except one case of superficial wound infection which responded to nonoperative management.According to the AOFAS (American Orthopaedic Foot and Ankle Society) evaluation system,15 cases were excellent,2 cases good and one case fair.Conclusion It is safe,reliable and effective to treat posterior pilon fractures using anti-rotation plate ORIF through the posteromedial approach.

Monitoring myocardial ischemia by EASI-derived 12-lead electrocardiogram in orthopaedic surgery / 中国医师进修杂志

Objecfive To investigate possibihty of monitoring myocardial isehemia by eontinuous EASI 12-lead ST-segment trend analysis during orthopaedic surgery and find its rules.Methods Three hundred and eleven consecutive patients who underwent orthopaedic surgery were monitored bv continuous EASI 12-lead ST-segment analysis during surgery.Results Among 311 patients 81 patients(26.0%) had myocardial ischemic events.The ischemie incidence of general anesthetics WaS signifieantly higher than local anesthetics(the spinal or epidural anesthetics and nerve-block anesthetics)(38.1%vs 23.0%.P＝ 0.01 5).During ischemie events the patients whose heart rate exceeded 90 beat per minute was 71.6% (58/81).Among the 177 isehemie events,the duration ofless than 5 minutes was 79.7%(141/177).ST-seg- ment deviation ofless than 0.15 mV was 71.2%(126/177).Conclusions During orthopaedic surgery EASt 12-lead electrocardiogram is the optimal approach for monitoring myocardial isehemia.The ischemic incidence of general anesthetics is significantly higher than local anesthetics.The myocardial ischemia events correlates with fast heart rate.The intraoperative myocardial ischemia events are more often transient.In most of these ischemic events ST-segment deviation is not very serious.