Although fractures of distal radius are very common in clinic,new ideas,devices and methods in their treatment are constantly emerging.This review summarizes their classifications and treatment methods,including closed reduction and external fixation,percutaneous internal fixation,external fixation,open reduction and internal fixation,wrist joint arthroscopy and bone grafting.At last,the author puts forwards his opinions about the treatment based on AO classification:Close reduction and cast immobilization should be the first choice for type A fractures.Open reduction and internal plate fixation may be needed for type B and C1 ones when close reduction can not be satisfactory.Internal plate fixation and external fixation may be suitable for C2 and C3 ones.The locking compression plate may be used for old people with osteoporosis.The methods of treatment for distal radial fractures should vary according to the specific type of the fracture.Bone grafting may be considered on the condition of large bone defect or severe osteoporosis.

SUMMARY Peripheral nerve defects are still a major challenge in clinical practice,and the most com-monly used method of treatment for peripheral nerve defects is nerve transplantation,which has certain limitations and shortcomings,so new repair methods and techniques are needed.The peripheral nerve is elongated in limb lengthening surgery without injury,from which we got inspirations and proposed a new method to repair peripheral nerve defects:peripheral nerve elongation.The peripheral nerve could be elongated by a certain percent,but the physiological change and the maximum elongation range were still unknown.This study discussed the endurance,the physiological and pathological change of peripheral nerve elongation in detail,and got a lot of useful data.First,we developed peripheral nerve extender which could match the slow and even extension of peripheral nerve.Then,our animal experiment result confirmed that the peripheral nerve had better endurance for chronic elongation than that of acute elonga-tion and cleared the extensibility of peripheral nerve and the range of repair for peripheral nerve defects. Our result also revealed the histological basis and changed the rule for pathological physiology of peri-pheral nerve elongation:the most important structure foundation of peripheral nerve elongation was Fon-tana band,which was the coiling of nerve fibers under the epineurium,so peripheral nerve could be stretched for 8.5% -10.0% without injury because of the Fontana band.We confirmed that peripheral nerve extending technology could have the same repair effect as traditional nerve transplantation through animal experiments.Finally,we compared the clinical outcomes between nerve elongation and perfor-mance of the conventional method in the repair of short-distance transection injuries in human elbows, and the post-operative follow-up results demonstrated that early neurological function recovery was better in the nerve elongation group than in the conventional group.On the whole,all of these experimental re-sults revealed the physiological phenomenon of peripheral nerve elongation,and described the physiologi-cal change and stretch range in detail.The systematic research results have filled the blank in this field, which is very helpful for clinical limb lengthening surgery,the design of elongation surgery and the evalu-ation of the peripheral nerve stretch injury.Peripheral nerve elongation will become an innovative treat-ment technology in repairing peripheral nerve defects.

Fracture healing is regulated by a complex array of factors,of which calcitonin gene-related peptide(CGRP) has been shown to play an anabolic role in bone metabolism.It has been reported that CGRP-containing sensory nerve fibers increased apparently at bone fracture site.CGRP is an important sensory neuropeptides expressed in bone tissue,although the primary function of this neuropeptides is to induce vasodilatation and blood flow,substantial evidence has shown that targeted expression of CGRP to mouse osteoblasts increased bone density,stimulated cancellous bone formation in vivo,especially the presence of CGRP receptors on rat osteoblast provides further evidence for a direct role for CGRP in modulating the function and growth of bone.CGRP is also proved to be a neuropeptide with proinflammatory activities,it may play a direct role in initiating the local inflammatory cell infiltration in the fracture site.Although it has been recognized that CGRP plays an important role in bone repair and reconstruction,the mechanism of this activation still remains to be elucidated.

Objective To explore regional characteristics of road traffic injury in urban Beijing through analysis of the investigation by a single hospital. Methods Using Emergent Road Traffic Injury Questionnaire we designed, we performed a survey for 2 weeks on all the patients with road traffic injury who had sought medical care in the emergency department of our hospital. A comparison was made between them and other patients at the emergency department at the same period. Results From 8:00 on 25 April 2006 to 8:00 on 8 May 2006, 18 emergent cases of road traffic injury were treated. They accounted for 0.54% of all the emergency patients and 4.5% of all the trauma patients. They were 7 males and 11 females, with an average age of 48.3±14. 3 years. The average time to hospital was (26.8±14.4) rain. Seventeen cases of injury happened in the street, 1 in the highway;15 in Xicheng District, 1 in Haidian District, and 2 in the suburbs. They included 8 pedestrians, 9 riders, and 1 passenger. They were injured by 12 light vehicles, 2 heavy vehicles, 2 special vehicles, and 2 bicycles. Twelve patients had injury at extremity, 3 at spine, and 3 at multiple sites, They received treatment only in Emergency Department. No one was dead or hospitalized. Conclusions Contrary to common belief, road traffic injury patients seem to account for a small part of trauma patients and the injury tends to be moderate. Females and extremities may be more likely to get injured.

Objective To understand the mechanism of extracts of Hedysarum ploybotrys hand Ma22 on Schwann cell,we studied the effects of the extracts on protein tyrosine kinase (PTKs) in vitro Methods Getting sciatic nerve by operation from SD rats and cultured them in PRMI 1640 medium with 15% embryo bovine serum and with Hedysarum Ploybotrys Hand Ma22 at rate of 1∶1 600,1∶3 200,1∶6 400,1∶12 800 or with nerve growth factor (NGF) NGF as positive control and normal medium as negative one After 48,72 and 96 hours cultures,the sciatic nerve been captured separately and used to examine the activity of PTKs by [? 32 P] ATP incorporation test using protein tyrosine kinase assay system Result In normal culture condition,there are no active PTKs Cultured with NGF and Hedysarum Ploybotrys Hand Ma22,the activity of PTKs increases notable The peak of NGF group appears at 48th hours and 96th hours were 0 0636 and 0 1548 respectively. Hedysarum Ploybotrys Hand Ma22 at 48th hours were 0 4460,0 3326 and 0 4169 at concintration of 1∶1 600,1∶3 200,1∶6 400, and decrease after it. Rank sum test show the correlations to time were negative ( P

Objective To analyze epidemiologie and injury characteristics of traffic injuries in Shenzhen through emergency department. Methods A questionnaire was pre-designed to collect data of patients admitted to six general emergency departments of six district in Shenzhen from January 2007 to December 2007 for clinical analysis. Results There were 1 328 patients with road traffic injuries, at age range of 2-84 years (average 31 years). According to occupation, most patients were local workers and migrant workers (57.8%). The accidental vehicles were mostly cars (48.5%). Most accidents (78.6%) occurred in urban streets. As for time distribution of traffic injuries, most injuries happened on Friday and Saturday (accounting for 17.8% and 18.7% respectively), especially on Friday (r = 0.166 0, P <0.01). There was central tendency around 15:35 p.m. in one day (r = 0.285 6, P < 0.01). The age of male was (32.36±8.70) years and that of female (29.96±4.32) years, with statis-tical differences (P < 0.05). Of patients followed up, 84.4% patients could work on their original jobs, 8.5% needed ehange of their jobs and 7.1% lost the ability of work. Conclusions It is neeessary to strengthen road safety education among local workers and migrant workers to improve their awareness of road safety. Traffic administrators and road safety marks should be added in the chief period and districts where road traffic injuries happen most frequently. Controlling the number of small cars may be effective to reduce traffic accidents.

Proximal femur consists of femoral head, femoral neck and trochanter. The neck and trochanteric parts of femur are easy to get fractured under conbolution forces. As the conservative treatment tends to cause high rates of complication and mortality, more and more surgeons vote for early internal fixation in recent years. The best treatment for femoral neck fracture is now internal fixation with cannulate screws, especially for the patients with good bone density, fundus and intertrochanteric fractures as well as the type I, type Ⅱand part of type Ⅲfractures in Gardon's classification. Although intertrochanteric fractures are relatively stable, but internal fixation is necessary for good results and prevention of complications. DHS(dynamic hip screw)are advisable for A1, part of A2 and A3 intertrochanteric fractures in AO classification, especially for A1 cases. PFN (proximal femoral nail) is designed for intertrochanteric fractures, inversion and elevation intertrochanteric fractures. In order to get better prognosis in patients older than 70 years and with serious osteoporosis and A2 3, A3 3 fractures, we designed a special kind of prosthesis for them and therefore get satisfactory results.

ObjectiveSystematically evaluate the clinical efficacy and complications of olecranon osteotomy and bilateral approach through triceps brachii for the treatment of intercondylar humeral fractures. MethodsTo search the domestic and foreign literatures published from January 1980 to March 2008 about the treatment of intercondylar humeral fractures, which use olecranon osteotomy approach and bilateral ap-proach through triceps brachii. Systematically evaluate these literatures using the methods of systematic re-view provided by the Cochrane collaboration. ResultsAfter the screening and evaluation to the literatures, 33 published literatures that met the inclusive criteria of this study were collected. There were a total of 876 cases of patients whose follow-up data was integrity (olecranon osteotomy approach group for 509 cases;bilat-eral approach through triceps brachii group for 367 cases) and these cases had provided the postoperative scores of elbow joint function. The excellent and good rates of postoperative score of elbow joint function for the type C2 and C3 fracture patients in the olecranon osteotomy approach group were 82.32% and 79.38% respectively; while those in the bilateral approach through triceps brachii group were 70.59% and 64.71% respectively. The former was significantly higher than the latter. The excellent and good rate of the type C1 fracture patients between two approaches groups showed no statistical significant. Fourteen literatures provid-ed the data about postoperative complications, the incidence of complications of patients that received ole-cranon osteotomy approach was 4.72%(95%CI 4.70%-4.74%), and the results also showed that compared with bilateral approach through triceps brachii (8.17%, 95%CI 8.13%-8.21%). ConclusionTo treat inter-condylar humeral fractures, postoperative efficacy of olecranon osteotomy approach is better than that of the bilateral approach through triceps brachii. Using olecranon osteotomy approach can get adequate exposure, easy open reduction and internal fixation, quick recover and less complication.

Objective To evaluate the clinical outcome of surgical treatment of comminuted and intra articular fractures of the distal radius. Methods Forty two cases of comminuted and intra articular fractures of distal radius encountered from January 1999 to January 2001, were operated upon either with internal fixation with the Titanium screw plate or with external fixator according to the types of fracture. Patiens data: there were 14 male and 28 female patients with age of 21-69 years and an average of 36 years; fractures on the left side in 18 and right side in 24 cases. The fractures were categorized according to the AO classification of distal radial fractures: 3 cases of type B1; 8 cases of type B2(dorsal Barton fracture); 4 cases of type B3(volar Barton fracture); 14 cases of type C1; 8 cases of type C2 and 5 cases of type C3. Types B1, B2, B3 and C1 with unsatisfactory closed manipulation were treated primarily with open reduction and internal fixation with an oblique T shaped pure Titanium plate and screws; types C2 and C3 were primarily treated with external fixators; depending upon the condition of reduction during surgery; Kirshners wires were applied accordingly. Twenty six cases were treated with oblique T shaped pure Titanium plate and screws, 9 with open reduction and external fixator, 7 cases were treated with Kirshners wires and external fixator. According to the types of fracture, the pure Titanium plate and screws, simple internal fixation+external fixator, and only external fixator was used accordingly. Results All 42 patients were followed up regularly. According to AO evaluation of the wrist joint movement, 83.3%(35 cases) of the patients had satisfactory functional outcome, 14.3%(6 cases) had quite satisfactory results and only 2.4%(1 case) had unsatisfactory functional outcome. Conclusion The reduction of the distal radial fractures should include the maintenance of the relative length of the radius and ulna, the smoothness of the articular surface and the palmar and ulnar deviation angles. The shortening of the radius results in the pain with movement and the restriction of function, and hence is considered to be the most important factor affecting the joint function. The ulnar deviation is quite easy to restore, and its mal angulation is rare. The reduced palmar deviation angle results in the restriction of the wrist flexion. For the comminuted and intra articular distal radial fractures, the surgical reduction for the maintenance of the relative length of the radius and ulna, a good reduction of articular surface, reduction of palmar and ulnar deviation angle are the key points for a successful outcome. Early functional exercise is equally important for the best recovery of wrist function.

Objective Study the biologic compatibility of the membrane of biologic conduit made of chitin and Schwann cells in vitro Methods Cultured Schwann cells with the membrane,then observed their attachment,spread and growth Results Around the membrane,the shape,amounts and growth of Schwann cells in the experimental groups were same with the control group.Schwann cells can lived on the membrane,and their amounts were larger on the membrane precoated with collagen (rat tail) than on the simple membrane Conclusion The membrane of biologic conduit made of chitin have good biologic compatibility with Schwann cells and have better nerve cell affinity after being precoated with collagen.