Combination of Clavicular Hook Plate with Coracoacromial Ligament Transposition in Treatment of Acromioclavicular Joint Dislocation.

OBJECTIVE: To evaluate the clinical efficacy of Arbeitsgemeinschaft für Osteosynthesefragen (AO) clavicular hook plate (CHP) combined with coracoacromial ligament transposition for Rockwood III-V dislocation of AC joint, providing an alternative choice for AC joint dislocation treatment. METHODS: Twenty-five patients diagnosed with Rockwood III-V dislocation of acromioclavicular (AC) joint, including 18 males and seven females, aged 43.5 ± 2.4 years old on average, who had undergone open reduction and AO CHP in combination with coracoacromial (CC) ligament transposition between January 2010 and December 2015, were retrospectively analyzed. Among them, 17 cases were diagnosed as type III, five cases were type IV, and three cases were type V. The surgery mainly included three main steps: bone flap incision, drilling in the clavicle, and hook plate fixation and AC joint reposition. The treatment efficacy was evaluated through clinical examinations and imaging studies for the shoulder joint, including gross observation and measuring coracoid clavicle distance (CC-Dist) using orthophoria X-ray before and 1 year after the surgery, and University of California (UCLA) shoulder rating scale. RESULTS: All the patients were followed up three to four times in 18 months (12-24 months) on average, and the UCLA rating results showed that there were 17 excellent cases (68%), five good cases (20%), and three fair cases (12%). The CC-Dist values after the surgery reduced to 9.7 ± 0.7 mm, which was significantly (P < 0.05) lower compared to that before the surgery (15.8 ± 1.6 mm). Most (88%) of the cases showed almost normal joint function and good anatomical arrangement of the acromioclavicular joint, without any secondary dislocation, and for them, 12 ± 2 weeks on average were needed to regain the normal function of shoulder joint movement. CONCLUSION: Due to the stable fixation, fewer complications, and satisfactory therapeutic effect with great clinical value, the combination of AO CHP and CC ligament transposition is expected to be used for treating Rockwood III-V dislocation of AC joint.

Application of digital technology assisted free ALTPF in reconstruction of large-area soft tissue defect of limbs / 中华显微外科杂志

Objective:To explore the application value of digital technology in free transfer of ALTPF to repair large-area soft tissue defect of limbs.Methods:A total of 13 patients with large-area soft tissue defects of limbs treated from April 2017 to April 2020 were selected in the study, including 9 males and 4 females, aged 39-58 years old. The average age was (42.75±1.94) years old. The area of flap was 16 cm×10 cm-27 cm×18 cm. Before operation, CTA was performed on the donor and recipient areas, and the 3-dimensional image of arterial blood supply in the donor area was obtained by 3-dimensional digital reconstruction technology of CT angiography, so as to clarify the origin, course, classification, length vascular pedicle, of diameter and location of perforating fulcrum of the blood supply of ALTPF. According to the image parameters 3-dimensional, of the defect of the recipient area was reconstructed and designed with Mimics software, and the 3-dimensional digital designed flap was used accurately and standardized during the operation.Results:All the 13 flaps survived without a vascular crisis. The patients entered the follow-up for 6 to 24(mean 16) months by outpatient clinic visits combined with WeChat reviews. At the last follow-up, the surviving flaps had soft texture and good blood supply, the shape and colour of the flap were basically the same as those of normal skin. The limb function recovered well. According to Chinese Medical Association Upper Limb Function Evaluation (TAM) method and Maryland ankle function evaluation method: 8 cases were in excellent, 3 cases were in good and 2 cases were in fair.Conclusion:The preoperative application of digital technology to assist the reconstruction of large-area soft tissue defects of limbs with free ALTPF has high accuracy and standardisation. It improves the quality and success rate of free flap repair. This method is reliable, practical and with clinical value.

Effects of intramedullary nailing fixation on quality of life and joint function in patients with femoral neck fractures.

OBJECTIVE: This study intended to investigate the changes in quality of life and joint function after intramedullary nailing fixation in patients with femoral neck fractures. METHODS: A total of 38 patients with femoral neck fractures received surgical treatment from February 2016 to November 2018 were enrolled as study subjects, and were divided into the intramedullary nailing group (IIN group, n=13) and the plate fixation group (PO group, n=25). The efficacy, general surgical indices, postoperative complications, hip function scores and imaging results were compared between the two groups. RESULTS: The response rate of the IIN group was 100.00%, significantly higher than 72.00% of the PO group (P<0.05). The length of hospital stay, blood loss, and the length of the healing period in the IIN group were lower than those in the PO group (P<0.05). The incidence of infection, deformity, loosening of internal fixation, and failed internal fixation in the PO group were significantly higher those than in the INN group (P<0.05). At 3, 6, and 12 months after surgery, the INN group had higher Harris scores and SF-36 scores than the PO group (P<0.05). The response rates of Harris scores of patients in the IIN group were significantly higher than those in the PO group at 12 months postoperatively (P<0.05). CONCLUSION: Intramedullary nailing fixation in patients with femoral neck fractures has the advantages of a shorter time in bed and better functional recovery, lower incidence of complications and higher long-term joint function with better quality of life.

Locking Plate Combined With Endosteal Fibular Allograft Augmentation for Medial Column Comminuted Proximal Humeral Fracture.

The goal of this study was to evaluate the role of endosteal fibular allografts in the treatment of medial column comminuted proximal humerus fractures with a locking plate. The authors retrospectively analyzed the clinical outcomes of 63 patients (21 men and 42 women) who had proximal humerus fractures with a comminuted medial column and were treated at Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China, with a locking plate, either alone or in combination with a fibular strut allograft, between January 2013 and May 2017. Patients were divided into 2 groups: locking plate combined with fibular allograft (41 patients) and locking plate alone (22 patients). After an average follow-up of 16.3 months, all fractures were healed. Statistically significant differences were seen between the 2 groups in changes in the neck-shaft angle, humeral head height (P<.001), and overall incidence of complications (P<.05). However, no statistically significant difference was found in the Constant-Murley score. The use of a locking plate in combination with intramedullary fibular allograft augmentation can help to maintain reduction and reduce postoperative complications in the treatment of proximal humerus fractures that are complicated by medial column comminution. [Orthopedics. 2020;43(6):367-372.].

Evaluation of the application value of a three-dimensional digital model of the knee in clinical practice.

OBJECTIVE: To compare the knee shape and bone parameters between knee prosthesis products from overseas companies and a Chinese patient's knee, and to apply the anatomical basis for Chinese knee prosthesis design. METHODS: Three-dimensional digital models were built, including prosthesis products for a normal adult. The relevant anatomy index was measured, and physical parameter, radiographic, geometric, knee kinematic, and distal geometry data were collected on the femur and tibia. RESULTS: The width of the femoral condyle (WFC), width of the medial femoral condyle (WMFC), width of the lateral femoral condyle (WLFC), depth of the intercondylar fossa (DICF), sagittal length of the medial femoral condyle (SLMFC), sagittal length of the lateral femoral condyle (SLLFC), angle of the medial femoral condyle (AMFC), and angle of the lateral femoral condyle (ALFC) in the femur and the transverse diameter (ML) and anteroposterior diameter (AP) of the tibial bone were measured. These parameters were significantly lower in the normal group compared with the prosthesis product model group. CONCLUSION: When using an imported knee prosthesis, the osteotomy angle may not fit perfectly. Use of an imported prosthesis may be an important factor in the increasing failure of knee arthroplasty in China.

A finite element analysis of two internal fixation methods for unstable femoral neck fractures in young adults / 中华创伤骨科杂志

Objective:To compare internal fixation with 3 cannulated screws versus with an anteromedial support plate plus 3 cannulated screws using finite element analysis for unstable femoral neck fractures (Pauwels type Ⅲ).Methods:Recruited for this study was a 34-year-old male volunteer with a height of 173 cm and a weight of 75 kg. Continuous thin-layer helical CT was conducted to scan the segment from his hip joint to the middle shaft of his tibia. Digital medical software was used to establish three-dimensional models of the femur based on his femoral CT data. The digital femoral necks were dissected as necessary to simulate femoral neck fractures of Pauwels type Ⅲ. The fractures were fixated with 3 ordinary cannulated screws in a mode of inverted triangle (screw group) and with 3 ordinary cannulated screws in a mode of inverted triangle plus an anteromedial steel plate (screw-plate group). After the 2 groups of models were subjected to identical constraints and 3 kinds of load (slow walking, twisting and standing on one leg), they were compared in terms of distribution of Von Mises stress and deformation.Results:Under various loads in both groups, the maximum deformation occurred in the femoral head. In the condition of slow walking, the deformation in the screw-plate group was 1.97 mm, which was smaller than that in the screw group (2.26 mm). In the conditions of twisting and standing on one leg, similar deformations were observed in both groups. Under all kinds of load, the maximum stress occurred in the middle part of the bottom screw and the fracture line in all the models. In the screw group, the peak stresses were 318.09 MPa, 92.11 MPa and 147.21 MPa for conditions of slow walking, twisting and standing on one leg, greater than those in the screw-plate group (229.86 MPa, 86.94 MPa and 124.48 MPa).Conclusions:The cannulated screws plus an anteromedial support plate are a recommendable fixation method for young adults with unstable femoral neck fracture, because they can effectively share the stress on the cannulated screws, lead to better mechanical stability of the fracture ends than the fixation with merely 3 cannulated screws and effectively prevent shortening of the femoral neck.

Effects of Vacuum Sealing Drainage Combined with Ilizarov Bone Transport Technique in the Treatment of Tibial Traumatic Osteomyelitis.

BACKGROUND The aim of this study was to analyze the efficacy of vacuum sealing drainage combined with Ilizarov bone transport technique in the treatment of tibial traumatic osteomyelitis and risk factors for postoperative pin infection. MATERIAL AND METHODS We enrolled 78 patients with tibial traumatic osteomyelitis admitted at the First People's Hospital of Kashgar from January 2015 to September 2017 and treated with vacuum sealing drainage combined with Ilizarov bone transport technique. RESULTS After combined treatment, SAS and SDS scores decreased significantly, while SF-36 scores increased significantly. Comparisons showed that there were significant differences in the scores of patients after treatment (P<0.05). Univariate analysis showed that there were no significant differences in gender, BMI, hypertension, diabetes mellitus, COPD, smoking index, alcohol abuse history, or residence (P>0.05). There were significant differences in age, fracture type, fixation type, pin loosening, and indwelling time between the 2 groups (P<0.05). Multivariate logistic analysis showed that age, fracture type, fixation type, pin loosening, and indwelling time were independent risk factors for pin infection. Age, fracture type, fixation type, pin loosening, and indwelling time are independent risk factors for pin infection in patients with tibial traumatic osteomyelitis. CONCLUSIONS Combination of vacuum sealing drainage with Ilizarov bone transport technique can effectively improve the condition of tibial traumatic osteomyelitis, improve the quality of life of patients, and reduce the occurrence of adverse emotions of patients. Age, fracture type, fixation type, pin loosening, and indwelling time are independent risk factors for pin infection in patients with tibial traumatic osteomyelitis.