ObjectiveTo design an auto-compressive and anti-circumrotate intramedullary nail( ACACIN) and to evaluate the preliminary clinical efficacy on fixing adult femur fracture. Methods From January 1998 to June 2001, 23 patientswith femur fracture were stabilized with auto-compressive and anti-circumrotateintramedullary nail. 2-4 elastic blocks were installed into the proximal and distal different distance of quincunx nail to defend circumrotate and axis compress. Results Fracture healing were obtained in all 23 patients treated with auto-compresseiveand anti-circumrotate intramedullary nail, the time of fracture healing was 6-13 weeks in 21 cases and 15-22 weeks in 2 cases of old fracture. There was no complication related to infection, nail break, abnormal union and joint ankylosis. The results were excellent in 19 cases, good in 3 cases, and moderate in 1 case according Kolmert’s criterion for function ; the effective rate was 95.7%. Conclusion Auto-compressive and anti-circumrotate intramedullary nail has a suitable radian for adult femur, can afford stable fixation, anti-circumrotate andaxis compress.
ObjectiveTo explore the effectiveness of a new method to repair severe soft tissue defects of the leg, foot, and ankle with contralateral saphenous neurocutaneous vascular flaps combined with assembly external frisket for fixation in parallel-leg position. MethodsBetween August 2009 and August 2013, 29 cases with leg, foot, or ankle wound were treated. There were 18 males and 11 females, with an average age of 37.6 years (range, 11-65 years). The interval of injury and operation was 14-36 days (mean, 22.3 days). The locations were the planta pedis and heel in 5 cases, the dorsal foot in 2 cases, the ankle in 4 cases, middle and lower leg in 14 cases, and upper leg in 4 cases. The area of trauma ranged from 5 cm×3 cm to 19 cm×9 cm. The assembly external frisket was used for fixation in parallel-leg position; a bridge flap was transplanted to repair defects, and the area of flap ranged from 6 cm×4 cm to 22 cm×11 cm. The donor sites were directly sutured or repaired with skin graft. The pedicle of the bridge flap was cut off and the assembly external frisket was removed after 3-4 weeks. ResultsThe flaps in all patients survived completely; primary healing of wound and incision at donor site was obtained. The patients were followed up 6-18 months (mean, 13.2 months). The appearance of flaps was satisfactory, and the sensation of the heel recovered. Moreover, the patients had a comfortable feeling, and the ankle and knee joints can move freely, and had good function. ConclusionThe assembly external frisket in parallel-leg position instead of cross-leg can make patients comfortable position, and achieve reliable fixation. The saphenous neurocutaneous vascular flap has the advantages of no need for anastomosis vein and for sacrifice of the main vein. Contralateral saphenous neurocutaneous vascular flap combined with assembly external frisket for fixation in parallel-leg position is a favorite method to repair severe soft tissue defects of the leg, foot, and ankle.
Objective To study the effect of anterior plate fixation on the treatment of middle and lower thirds fractures of humerus and the possibility of operating without injuring the radial nerve. Methods Forty-nine patients with the middle and lower thirds fractures of the humerus were treated with anterior plate fixation from March 1998 to December 2002. Of the 49 patients, 27 were with new fractures, 12 with old fractures, and 10 with nonunion fractures. According to AO classification, of the 49 patients, there were 19 type A, 14 type B1, 9 type B2, 5 type B3, 2 type C1. Thirty-seven patients had closed fractures and 12 had open fractures. Of the 12 patients, 8 were type Gustilo Ⅰ, 4 were type Gustilo Ⅱ. Four out of the 49 patients were associated with radial nerve palsy. All patients were treatedwith anterior plate fixation through the anterior approach to the humerus. The radial nerves injured were explored. Results Of the 49 patients, 48 were followed up 6 to 48 months(28.7 months on average). All fractures were healed within 3 to 9 months(4.7 months on average). Fixed plates of 37 patients out of the 49 were removed. No iatrogenic radial nerve injury occurred in the82 times of the operations among the 49 patients. Conclusion The treatment of middle and lower thirds fractures of humerus by anterior platefixation through the anterior approach to the humerus does not interfere with the fracture healing and can prevent the iatrogenic radial nerve injury.
Objective To explore the biomechanical difference between the different fixations of cortical bone plate allograft. Methods Twenty-seven cadaveric femurs were harvested and were made into the simulated fracture models, which were equally divided into Groups A, B and C. In Group A, the models were fixed with 2 bone plate allografts (110 mm×10 mm×3 mm); in Group B, the models were fixed with 2 struts (110 mm×10 mm×3 mm) and 5 bone screws; in Group C, the models were fixed with 1 strut (110 mm×10 mm×3 mm) and 5 bone screws. The biomechanical tests for the three-piont bending, torsion, and compression were performed. The parameters studied included the values of the displacements in the three-piont bending tests and the compression tests, and the maximum loads during the bending, the compression, and the torsion. Results As for all the stiffness parameters tested, Group A showed the greatest displacements among the threegroups（P＜0.05）, except the compressive stiffness parameter, which was similar to that in Group B. The maximum loads of the three-point bending, the torsion, and the compression in Group A were 1.65±0.34 kN, 554.3±49.34 N, and 7.78±0.82 Nm, respectively; in Group B, they were 1.12±0.37 kN, 428.00±37.40 N,and 3.39±0.22 Nm, respectively; in Group C, they were 0.71±0.46 kN, 218.67±36.53N, and 1.74±0.12 Nm, respectively. Group A had a significantly greater strengththan the other 2 groups(P＜0.05). Conclusion The strength of the cortical bone plate allograft is related to its different fixations. The two cortical bone plate allografts have a greater strength and stiffness than the struts fixed with the bone screws, which can meet the clinical requirement.
Objective To evaluate the effectiveness of reamed versus nonreamed intramedullary nailing for femoral fractures. Methods Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) were identified from MEDLINE (1966-2004.5), EMBASE (1966-2004.5), Cochrane Library (Issue 2, 2004), Cochrane Musculoskeletal Injuries Group Database (2004.5), and CBM disc (1979-2004.5). We handsearched Chinese Journal of Orthopaedy (from establishment to May 2004) and Orthopaedic Journal of China (from establishment to May 2004) . RCTs and CCTs were included. Data were extracted by two reviewers with designed extraction form. RevMan 4.2.3 software was used for data analysis. Results Five RCTs and two CCTs were included. The combined results of meta-analysis showed that reamed intramedullary nailing for femoral fractures can reduce the rate of nonunion (RR=0.38, 95%CI 0.17 to 0.83, P=0.01) and the rate of implant failure (RR=0.42, 95%CI 0.20 to 0.89, P=0.02). Conclusions Compared with nonreamed intramedullary nailing for femoral fractures, reamed intramedullary nailing can reduce the rates of nonunion and implant failure. However, the relation between reaming or pulmonary complications, the time of union, infection, malunion, operative time, and blood loss needs further study.
ObjectiveTo investigate the classification and treatment strategies of symptomatic severe osteoporotic vertebral fracture and collapse. MethodsBetween August 2010 and January 2014, 42 patients with symptomatic severe osteoporotic vertebral fracture and collapse were treated, and the clinical data were retrospectively analyzed. According to clinical symptom and imaging materials, 23 cases were classified as type I (local pain, limitation of motion, no neurological symptom, and no obvious deformity), 12 cases as type II (slight neurological symptom and kyphotic Cobb angle ≤ 30°), and 7 cases as type III (severe neurological symptom and kyphotic Cobb angle <30°). In 23 type I patients, 17 underwent percutaneous vertebral augmentation, 6 underwent posterior pedicle screw fixation strengthened with bone cement combined with percutaneous vertebral augmentation. In 12 type II patients, they were treated with local spinal decompression and internal fixation strengthened with bone cement. In 7 type III patients, 5 underwent posterior osteotomy, and 2 underwent one stage posterior approach of vertebral resection and reconstruction. The visual analogue scale (VAS), Oswestry disability index (ODI), and local kyphotic Cobb angle were used to evaluate the neurological function. The complications were recorded. ResultsThe operation was successfully completed in all patients. Wound infection and ketoacidosis secondary to stress blood glucose rise occurred in 1 case of type III patients respectively, and were cured after corresponding treatment; primary healing of wound was obtained in the other patients. The patients were followed up from 6 to 36 months (mean, 11.6 months). The nerve function was improved in 17 cases, and micturition disability was observed in 2 cases. Asymptomatic cement leakage occurred in 13 cases (30.95%) (7 cases in type I, 4 cases in type II, and 2 cases in type III). No bone cement dislocation and internal fixation failure were found during follow-up. The VAS score, ODI, and the local kyphotic Cobb angle at 1 week and last follow-up were significantly improved when compared with preoperative ones (P<0.05), but no significant difference was found between at 1 week and last follow-up (P>0.05). ConclusionIn order to improve the effectiveness and reduce the risk and complications of operation, individualized strategies should be performed according to different types of severe osteoporotic vertebral fracture and collapse.
Objective To observe the relationship between position of normal central fixation and the position of the optic disc, and to find out the features of stability of fixation. Methods The position of central fixation of 120 eyes of 60 healthy adults was determined by MP-1 microperimeter. The position of central fixation relative to the position of the optic disk was measured. The relationship between the central fixation and the age or refraction was analyzed statistically. The difference between the right and left eye in each individual was analyzed with t test. Results The central fixation located at the retina with the horizontal distance of 14.48deg;plusmn;1.85deg; and vertical distance of －2.14deg;plusmn;1.26deg; from the temporal edge of the optic disk. In the 120 eyes, 90% of the central fixation located in a bivariate normal ellipse. The normal eyes usually kept in a slightly moving condition when a normal person fixing on a subject. The median of horizontal and vertical deviation was 0.4deg; and 0.3deg; respectively. Conclusion The distribution of central fixation in healthy adults is a bivariate normal ellipse. When fixing on a subject, the moving extent of the eyes in the horizontal direction is larger than that in the vertical direction.
ObjectiveTo investigate the effectiveness of a modified surgical treatment of old Monteggia fracture. MethodsBetween March 2006 and December 2013, 40 cases of old Monteggia fracture were treated with modified operation. Modified operation procedure included expanding excision of pedicled forearm fascia flap for reconstruction of the annular ligament and repair of elbow radial lateral collateral ligament complex and extending osteotomy of the ulna, callus replantation, and internal fixation with steel plate. There were 26 boys and 14 girls, aged 2-10 years with an average age of 4 years. Injury was caused by falling in 24 cases, by traffic accident in 8 cases, and by falling from height in 8 cases. The disease duration was 2-11 months (mean, 4 months). Four patients had combined radial nerve palsy. ResultsIncision healed by first intention after operation, without early complication of radial nerve palsy, fascial compartment syndrome, or decreased hand extensor muscle strength. All the children were followed up 1-5 years (mean, 2.5 years). X-ray films showed fracture healing, and the healing time was 10-20 weeks (mean, 15 weeks). During follow-up, 3 cases had re-dislocation. Neither hand dysfunction caused by hand muscle adhesion nor radial head bottleneck shape change was found. On the basis of the functional evaluation criteria by Mackay, the results were excellent in 32 cases, good in 5 cases, and poor in 3 cases; the excellent and good rate was 92.5% at last follow-up. ConclusionThe modified surgical treatment of old Monteggia fracture is an effective method, with good matching of humeroradial joint and without internal fixation of the humeroradial joint.
Objective To evaluate the clinical results of bioabsorbable interference screw in knee ligament reconstruction. Methods From April 2002 to August 2004, 39 patients with knee ligament injury were treated, including 33 males and6 females with a median age of 25 years (15 to 65 years). The involved ligament included 29 anterior cruciate ligament of knee(ACL), 6 posterior cruciate ligament of knee(PCL)，4 combined ACL and PCL, 3 medial collateral or lateral collateral ligaments of knee point and 1 posterolateral complex injury of knee. All of patients underwent anatomic ligament reconstructions under arthroscopy or open surgery by autografts and fixation with bioabsorbable interference screw. Results All 34 patients were followed up 6 to 28 months (mean 13.7months). The patients were evaluated by Lysholm knee functional scales, the knee scores were 43.6±13.4 before operation and 85.4±16.3 after operation, showing significant difference (Plt;0.05). There was no limitation of rangeof motion and loosening of the screw. However, one case suffered from infection, and 3 cases suffered from effusion and synovitis after surgery and recovered after management. Conclusion Bioabsorbable interference screw fixation is a reliable method in knee ligament reconstruction and is effective to restore knee joint stability.
Objective To investigate the distribution of the preferred retinal locus (PRL) of eccentric fixation in eyes with high myopia.Methods A total of 40 highly myopic patients (54 eyes ) with eccentric fixation were examined by MP1 microperimeter to identify the PRL. The position of PRL relative to the fovea was estimated using the 90% confidence ellipse of normal adult foveal fixation. The differences of visual acuity between ldquo;desirablerdquo; and ldquo;undesirablerdquo; PRL were tested by analysis of variance.Results In 54 eyes with high myopia, 24 eyes (44.44%) had PRL of eccentric fixation below the scotoma after loss of central vision; 19 eyes ( 35.19% ) had a leftfield PRL; 6 eyes ( 11.11% ) had an upperfield PRL; and 5 eyes ( 9.26% ) had rightfield PRL. In 14 patients who had binocular eccentric fixation, 13 had the same fixation pattern in both eyes, including lowerfield PRL in 7 （50.00%）, leftfield PRL in 5 （35.71%）, and upperfield PRL in 1 patient （7.14%）. The difference of visual acuity between lower and leftfield PRL group and right and upperfield undesirable PRL group was not statistically significant（F=0.144, Pgt;0.05）. Conclusions The eccentric fixation in eyes with high myopia is usually situated as near as possible to the fovea. The optimal PRL is inferior visual field.