[Application of Taylor spatial frame combined with computer-assisted closed reduction in the treatment of tibiofibular fractures].

Objective: To explore the effectiveness of Taylor spatial frame (TSF) in the treatment of tibiofibular fractures and computer-assisted closed reduction. Methods: The clinical data of 30 cases of tibiofibular fractures with soft tissue injury treated with TSF between January 2015 and September 2017 was retrospectively analyzed. According to different reduction methods, the patients were divided into control group (15 cases, open reduction in TSF external fixation) and trial group (15 cases, closed reduction in 1-3 days after TSF external fixation). There was no significant difference in the general data such as gender, age, affected side, cause of injury, AO classification of fracture, time from injury to operation between the two groups ( P>0.05). The operation time, intraoperative blood loss, fracture healing time, and removal time of external fixator were recorded and compared between the two groups. At 3 months after removal of external fixator, the limb function was evaluated according to Johner-Wruhs criteria for evaluating the final effect of tibial shaft fracture treatment. Results: Both groups were followed up 9-16 months, with an average of 14 months. The operation time, intraoperative blood loss, fracture healing time, and removal time of external fixator in the trial group were significantly shorter than those in the control group ( P<0.05). There were 2 cases of superficial infection of the external fixation (1 case in each group), 1 case of incision infection (control group), 1 case of delayed fracture healing (control group), 2 cases of traumatic arthritis (1 case in each group); no significant difference was found in the incidence of complications between the two groups ( χ2=0.370, P=0.543). The wounds of soft tissue defect healed by the first intension in both groups. At 3 months after removal of the external fixator, the limb function results in the trial group were excellent in 3 cases, good in 9 cases, fair in 2 cases, and poor in 1 case, and the excellent and good rate was 80.0%; in the control group, the results were excellent in 3 cases, good in 8 cases, fair in 3 cases, and poor in 1 case, and the excellent and good rate was 73.3%. There was no significant difference in incidence of complication between the two groups ( χ2=0.917, P=0.821). Conclusion: Compared with intraoperative open reduction, postoperative computer-aided closed reduction can shorten the operation time, reduce the intraoperative blood loss, reduce the risk of long-term operation, avoid to destroy the blood supply of fracture end, shorten the healing time of fracture and the wearing time of stent, and alleviate the pain of patients after TSF treatment of tibiofibular fracture.

[The dynamization of external fixation for treatment of open tibia and fibula fractures].

Objective: To evaluate the effects of dynamization of external fixation on open tibia and fibula fracture union. Methods: The clinical data of 26 cases of open tibia and fibula fractures treated by external fixation were retrospectively analysed. According to different postoperative treatment methods, the patients were divided into elastic dynamic group (group A, n=13) and constant elastic fixation group (group B, n=13). There was no significant difference in gender, age, and fracture type between 2 groups ( P>0.05). The removal time of external fixator in group B was evaluated by fracture healing time, X-ray film, and doctor's experience. In group A, the growth of callus was examined based on X-ray film at 12 weeks after operation; the axial mechanical load ratio was tested, and dynamic loading was carried out when the axial mechanical load ratio was 5%-10%. The using time of external fixator, fracture healing time, and incidence of complications were compared between 2 groups. Results: All patients were followed up 4-13 months, with an average of 5.7 months. During the treatment, there was no complication such as loosening or breaking of the external fixator, fracture displacement, or re-fracture in 2 groups. The using time of external fixator in group A was (24.77±1.42) weeks and the fracture healing time was (23.04±1.30) weeks, which were all significantly reduced when compared with those in group B [(34.38±1.71) weeks and (32.46±1.66) weeks] ( t=16.10, P=0.00; t=15.58, P=0.00). In group A, there were 2 cases of needle tract infection and 1 case of muscle weakness, the incidence of complication was 23.1%; in group B, there were 3 cases of needle tract infection, 1 case of muscle weakness, and 1 case of delayed union of fracture, the incidence of complication was 38.5%; there was no significant difference in the incidence of complication between 2 groups ( P=1.000). Conclusion: Dynamization of external fixation can promote union of open tibia and fibula fractures with a high security.

[The assessment of the application of Taylor spatial frame in treatment of intermediate or distal tibiofibula fractures].

Objective: To determine the effectiveness and the safety of the Taylor spatial frame in treatment of intermediate or distal tibiofibula fractures. Methods: The clinical data of 74 patients with intermediate or distal tibiofibular fractures treated between January 2015 and January 2017 were retrospectively analyzed. According to fixation methods, they were divided into internal fixation group (26 cases) and external fixation group (48 cases). There was no significant difference in the age, gender, cause of injury, type of fracture, time from injury to operation between 2 groups ( P>0.05). The intraoperative blood loss, fracture healing time, fixator removal time, and complications were recorded and compared. The final function evaluation criteria of Johner-Wruhs humeral shaft fracture were used to evaluate the function of the affected limb. The lower limb force line recovery after operation was evaluated according to the standard evaluation of LUO Congfeng et al. Results: Both groups were followed up 6-22 months (median, 14 months). All patients obtained the fracture healing. The intraoperative blood loss, fracture healing time, and fixator removal time were significantly higher in the internal fixation group than those in the external fixation group ( P<0.05). There were 1 case of plate exposure, 1 case of delayed fracture healing, and 1 case of plate fracture in the internal fixation group; and there were 2 cases of delayed fracture healing and 4 cases of soft tissue defect in the external fixation group; no significant difference was found in the incidence of complications between 2 groups ( χ2=0.015, P=0.904). The function of the affected limb was evaluated by Johner-Wruhs standard at 10 months after operation, the results was excellent in 19 cases, good in 5 cases, and fair in 2 cases in the internal fixation group, with an excellent and good rate of 92.3%; the results was excellent in 42 cases, good in 3 cases, and fair in 2 cases in the external fixation group, with an excellent and good rate of 95.7%; showing no significant difference between 2 groups ( χ2=0.392, P=0.531). The lower limb force line recovery after operation was evaluated according to the standard evaluation of LUO Congfeng et al.at 4 months after operation, the results was excellent in 24 cases, fair in 1 case, poor in 1 case in the internal fixation group, with an excellent and good rate of 92.3%; the results was excellent in 46 cases, fair in 1 case, poor in 1 case in the external fixation group, with an excellent and good rate of 95.8%; showing no significant difference between 2 groups ( χ2=0.520, P=0.471). Conclusion: The use of Taylor spatial frame in the treatment of the intermediate or distal tibiofibular fractures can obviously reduce the healing time and complications than the internal fixation of the plate. It can reduce the fracture treatment cycle and is beneficial to the fracture healing and limb function recovery, which is relatively safe and reliable.

[Effect of axial stress stimulation on tibial and fibular open fractures healing after Taylor space stent fixation].

Objective: To investigate the effect of axial stress stimulation on tibial and fibular open fractures healing after Taylor space stent fixation. Methods: The data of 45 cases with tibial and fibular open fractures treated by Taylor space stent fixation who meet the selection criteria between January 2015 and June 2016 were retrospectively analysed. The patients were divided into trial group (23 cases) and control group (22 cases) according to whether the axial stress stimulation was performed after operation. There was no significant difference in gender, age, affected side, cause of injury, type of fracture, and interval time from injury to operation between 2 groups ( P>0.05). The axial stress stimulation was performed in trial group after operation. The axial load sharing ratio was tested, and when the value was less than 10%, the external fixator was removed. The fracture healing time, full weight-bearing time, and external fixator removal time were recorded and compared. After 6 months of external fixator removal, the function of the limb was assessed by Johner-Wruhs criteria for evaluation of final effectiveness of treatment of tibial shaft fractures. Results: There were 2 and 3 cases of needle foreign body reaction in trial group and control group, respectively, and healed after symptomatic anti allergic treatment. All the patients were followed up 8-12 months with an average of 10 months. All the fractures reached clinical healing, no complication such as delayed union, nonunion, or osteomyelitis occurred. The fracture healing time, full weight-bearing time, and external fixator removal time in trial group were significantly shorter than those in control group ( P<0.05). After 6 months of external fixator removal, the function of the limb was excellent in 13 cases, good in 6 cases, fair in 3 cases, and poor in 1 case in trial group, with an excellent and good rate of 82.6%; and was excellent in 5 cases, good in 10 cases, fair in 4 cases, and poor in 3 cases in control group, with an excellent and good rate of 68.2%, showing significant difference between 2 groups ( Z=-2.146, P=0.032). Conclusion: The axial stress stimulation of Taylor space stent fixation can promote the healing of tibial and fibular open fractures and promote local bone formation at fracture site.

[CLINICAL APPLICATION OF AXIAL LOAD MECHANICAL TESTING IN REMOVING EXTERNAL FIXATOR AFTER TIBIA AND FIBULA FRACTURES SURGERY].

OBJECTIVE: To explore the efficacy and safety of the axial load mechanical testing for removing external fixator. METHODS: Between January 2014 and August 2015, 27 patients with tibia and fibula fractures caused by trauma underwent an external fixation. Of 27 patients, 21 were male and 6 were female with the average age of 45 years (range, 19-63 years), including 7 cases of closed fracture and 20 cases of open fracture. X-ray film results showed spiral unstable fracture in 4 cases and comminuted unstable fracture in 23 cases. All patients underwent an external fixation. Bone nonunion occurred in 3 cases because of infection, and bone nonunion combined with bone defect occurred in 1 case, who received tibial osteotomy lengthening surgery. When X-ray film showed continuity high density callus formation at fracture site, axial load mechanical test was performed. If the axial load ratio of external fixator was less than 10%, the external fixator was removed. RESULTS: At 21-85 weeks after external fixation (mean, 44 weeks), axial load mechanical test was performed. The results showed that the axial load ratio of external fixation was less than 10% in 26 cases, and the external fixator was removed; at 6 weeks after removal of external fixator, the patients could endure full load and return to work, without re-fracture. The axial load ratio was 14% in 1 case at 85 weeks, and the X-ray film result showed that fracture did not completely heal with angular deformity; re-fracture occurred after removing external fixator, and intramedullary fixation was used. CONCLUSIONS: External fixator axial load mechanical testing may objectively reveal and quantitatively evaluate fracture healing, so it is safe and reliable to use for guiding the external fixator removal.

Manganese-Mediated Carbon-Carbon Bond Formation in Aqueous Media: Chemoselective Allylation and Pinacol Coupling of Aryl Aldehydes.

The use of manganese as a mediator for allylations and pinacol couplings in aqueous media was investigated. The combination of manganese and copper is found to be a highly effective mediator for the allylation of aryl aldehydes in water. Such a combination is found to be more reactive than other previously reported metals in aqueous media. No reaction was observed with either manganese or copper alone as the mediator. Only a catalytic amount of copper is required for the proceeding of the reaction. The uses of Cu(0), Cu(I), and Cu(II) as the copper source are all effective. The use of a catalytic amount of manganese combined with a stoichoimetric amount of copper led to the failure of the reaction. Allyl chloride is found to be more effective than allyl bromide for the corresponding reaction. The use of substituted allyl halides gave a mixture of regio- and diastereoisomers. Aromatic aldehydes reacted chemoselectively in the presence of aliphatic aldehydes. An exclusive selectivity was also observed when both an aliphatic and an aromatic aldehyde functionalities are present in the same molecule. In the presence of acetic acid or ammonium chloride, manganese was found to effect the pinacol-coupling reaction in water. The reaction proceeds selectively with aryl aldehydes.

Addition of Bromine to Ketenes and Bisketenes: Electrophilic Attack at Carbonyl Carbon and Neighboring Group Participation.

Addition of bromine to bisketene (Me(3)SiC=C=O)(2) (1) gave the fumaryl dibromide E-7, whose stereochemistry was proven by X-ray structure determination. Upon warming, E-7 rearranged to the furanone 8, and this process was faster in the more polar CD(3)CN compared to CDCl(3), consistent with an ionization pathway for the rearrangement. The bromination of 1 in CH(2)ClCH(2)Cl followed second-order kinetics with a rate constant (2.1 +/- 0.1) x 10(4) M(-)(1) s(-)(1) at 25 degrees C. The first-order dependence of bromine addition to 1 on [Br(2)] is attributed to intramolecular nucleophilic assistance by the second ketenyl moiety in an initial complex of 1 and Br(2) to give E-7. A transition structure for this process has been calculated by ab initio methods. By contrast PhMe(2)SiCH=C=O 11 and gamma-oxoketene 16 underwent bromination by third-order kinetics, second order in [Br(2)], indicating the absence of neighboring group participation in the rate-limiting step. The bisketene Me(2)Si(CH=C=O)(2) (13) underwent bromination by mixed kinetics with both first- and second-order terms in [Br(2)].