Objectve The purpose of the study was to evaluate the surgical treatment method and outcomes of capitellar fractures. Methods From December 2004 to December 2006, sixteen patients with a capitellar fracture were included in the study. There were eight males and eight females. According to Bryan and Morrey classification, there were eight type Ⅰ fractures, one type Ⅲ fracture and seven type Ⅳ fractures. In three of type Ⅳ, a separate trochlear fracture fragment with impaction was seen. Distal lateral column posteroinferior metaphyseal comminutiou and/or impaction was observed in association with three fractures including two type Ⅳ fractures and one type Ⅲ fracture. One Mason type Ⅰ radial head fracture occurred in association with an ipsilateral type Ⅳ capiteilum fracture. The patients ranged from sixteen to sixty-five years old, with an average age of 44.9 years. An extensile lateral exposure and articular fixation with cannu-lated compression screws were performed within five days of injury. Clinical, radiographic, and functional el-bow index rating scale of Broberg-Money were evaluated retrospectively. Results The follow-up time ranged from 24 to 36 months,with the mean of 29 months. All fractures healed at an average of 7.9 (range, 6 to 11) weeks without radiographic evidence of osteonecrosis of the fracture fragment. Average arc of motion was 125.8°±16.8° in flexion-extension and 163.1°±10.62° in pronation-supination. The mean Broberg-Mor-rey was 92.0 points, with eight excellent results, seven good results, and one poor result. There were one pa-tient with a minimum of grade 1 radio-capitellar arthrosis.Fifteen of the sixteen adults were able to continue their former professional activities. The patient had persistent postoperative stiffness with a flexion contrac-ture at the last postoperative visit. Conclusion Prompt treatment with anatomic reduction and internal fixa-tion with lag screws followed by early rehabilitation can lead to functional arc and satisfactory outcome.

Objective To explore the classification and surgical treatment of scapular neck frac-tures. Methods A retrospective analysis was done based on the clinical data of 18 patients (including 12 males and 6 females) who accepted operation in Tianjin Hospital from January 2000 to December 2007. The average age of the patients was 41 years (17-62 years). All patients accepted CT examina-tion. According to Hardegger classification, there were 10 patients with anatomical neck fractures and eight with surgical neck fractures. According to Miller system, there were five patients with type II A fractures, six with type II B fractures, six with type II C fractures and one with type II B + IIC fracture. Of all, 15 patients had associated injury. The operative approach included posterolateral approach in nine patients, modified Judet approach in six and anteroposterior conjoint approach in three. Reconstruction plates and lag screws were applied to fix the fractures. Results All patients were followed up consecu-tively with an average period of 25. 5 months (6-70 months). The mean Constant-Murley score was 73 points (35-95 points, meadian 75.5 points) after treatment. There were two patients with malreduction,one with shoulder instability and three with traumatic arthritis postoperatively. Conclusions The indi-cations for early operation include: (1) angular deformity in horizontal or coronal planes of fractures, ie,glenopolar angle (GPA) <20°(2) fracture displacement =10 mm;(3) associated with floating shoul-der injury or superior suspensory shoulder complex injury. The major factors influencing prognosis are as-sociated injuries, quality of fractures reduction, fixation stability, injury of rotator cuff and postoperative rehabilitation.

[Objective]To analize the complications in the treatment of the fractures around the knee joint with less invasive stabilization system(LISS).[Method]From July 2005 to October 2007,89 patients with 91 fractures around knee joint were treated with the LISS,including 45 fractures of distal femur and 46 fractures of proximal tibia.[Result]All patients were followed up for 13 to 29 months.The average time to union was 16 weeks(ranged,11-25 weeks).The functional outcome: 45 had an excellent result,35 had a good result and 11 had a fair result,with 87.9% excellent to good results.There were 10 patients(11%) with symptomatic hardware irritation,2 of them had soft-tissue disruption.Seven cases(8%) had malalignment,2(2%) loss of reduction,1(1%) delayed union,1(1%) failed fixation,1 superficial peroneal nerve injury and 1 profound peroneal nerve injury.Cold-welding occurred in 9 cases(10%) which resulted in difficult removal.[Conclusion]LISS is one of the reliable and effective methods in fixation of the fractures around the knee joint.However,its operation indications and operating instructions should be strictly followed.

[Objective]To study the correction of deformity with major bone defect by lengthening with different external fixators and to evaluate the results.[Method]From August 2000 to March 2004,7 patients suffering from deformity with major bone defect were treated by external fixators including Ilizarov, Orthofix LRS,and Hybrid external fixators combined with Orthofix LRS.Linar or wedged osteostomy was carried out at the deformity site.Wedged osteotomy and callus distraction were used for the cases of deformity with limb shortening,and compression of dock site combined with bone transport was used for those of deformity with bone defect and shortening.[Result]The cases corrected were: 1 femur with anterior angular deformity and 7cm shortening,and 6 tibiae including 2 varus deformities,2 posterior angular deformities,and 2 complex deformities.The average length was 5.3cm(4.5～7 cm),with an average distraction time of 3.5 months and followed by an average time of external fixation of 7 months.There were no obvious complications,such as vascular and nerve injuries.The function of the adjacent knee and ankle was not affected.[Conclusion]External fixators including Ilizarov,Orthofix LRS and Hybrid external fixators may provide one of good alternatives for correction of deformity with major bone defect.Compared with Ilizarov,Orthofix LRS and Hybrid external fixators are more conventional,more advantaged,and preferred,especially for its distinct clamp which can provide multi-plane fixation and correct the deformity simultaneously with limb lengthening.

Objective To explore the clinical result of fixation on the distal femur and/or proximal tibia with LISS(Less Invasive Stabilization System), and to analyze the related factors during the operation. Methods From July 2003 to March 2005, 16 patients(17 fractures) were treated with LISS (Mathys, Swiss). There were 11 males and 5 females, with an average age of 39 years (mean, 19-58 years), including 9 distal femoral fractures and 8 proximal tibial fractures, while 1 patient sustaining distal femoral and proximal tibial fracture on the ipsilateral side. The LISS plates were inserted beneath the periosteum through a small incision after closed reduction(except the intraarticular fractures). The locking screws were inserted through stab incisions, and by monocortical fixation. Only 1 patient underwent the bone graft who accepted the open reduction 21 days after injury. Results All the patients achieved bone union during the follow up from 5 to 25 months ( mean, 15 months ). 3 patients had their implants removed. The function of the knee was evaluated according to Karlstr?觟m score system based on both the subjective feeling and objective PE, and there were 10 excellent and 3 good, and 3 fair, the good-excellent rate was 81%. Secondary reduction loss occurred in one patient, but bone union and the function of the knee were not compromised. There was also neither infection nor implant pull-out and breakage. Conclusion The unique designed LISS has the advantages of protecting the blood supply of bone fragments and the periosteum, optimizing bone union and function recovery. LISS provides an alternative for treatment of distal femoral or proximal tibial fractures. However, as a new designed system, not only conception but the procedure as well should be demanded strictly.

Objective To research the operative methods and their comments on the lower leg, ankle and the foot soft tissue defects. Methods From June 1997 to December 2005, 43 cases of the lower leg, ankle and the foot soft tissue defects were treated with nine different kinds of pedicle flaps transplant. The patients included 38 males and 5 females, with an average age of 35 years (range from 7 to 63 years). The areas of flaps were from 4 cm?3 cm to 25 cm?15 cm. 9 kinds of flaps were underwent in all patients, which includes medial or lateral gastrocnemis myocutaneous pedical flaps in 2 cases; anteromedial cross leg flaps in 2 cases; medial cross leg flap with saphenous nerve in 1 case; medial reverse flow island leg flap with posterior tibial artery in 1 case; medial distal leg fascia flaps in 2 cases; reversed sural neurocutaneous island flaps in 17 cases; reversed saphenous neurocutaneous island flaps in 14 cases; supra extramalleolus reversed island flaps in 2 cases; and medial pedes distal island flaps in 2 cases. Results 37 flaps of 43 cases were completely survived, 1 case with superficial necrosis and 5 cases with distal edge partially necrosis and these 6 cases all healed after short time dressing change. All the cases were followed up 3 months to 7 years, with an average of 16 months, and none recurred. The flaps completely survived even in some special cases such as diabetes mellitus, dorsal artery of foot defect combined venous varicose, sural nerve injury, Gustilo ⅢC open fracture and serious degloving injury of lower leg and foot. Conclusion In order to achieve the desired results, it is important to grasp the surgical indications of various kinds of flaps and keys for the operation. The sural and saphenous neurocutaneous island flaps could be a satisfactory method to treat the soft tissue defects in lower leg, ankle and foot.

[Objective]To analysis the factors influencing the results and complications of displaced intra-articular calcaneal fractures treated with open reduction and internal fixation or sledging.[Method]Twenty-seven cases,29 displaced intra-articular calcaneal fractures treated with open reduction and internal fixation or sledging were reviewed and followed with 7～60 months.The postoperative results were evaluated with AOFAS.[Result]The scores were between 53 and 100 with average 87.2,with good results.The functional results of Sanders Ⅲ and Ⅳ fractures were worse than type Ⅱ fracures.[Conclusion]The patients with displaced intra-articular calcaneal fractures should be treated with operation.With less invasive manipulation,extensive lateral L incision hasn't more relation to infection.The degree of initial injury and the operative quality are important factors influencing prognosis.

[Objective]To observe the clinical effects and the comments of the circular external fixator on the treatment of spiral and oblique fractures of distal one-third of tibia-fibular.[Method]Fifteen patients(11 males,4 females),with a mean age of 38.5 years(range 21 to 57)with spiral and oblique fractures of distal 1/3 of tibia-fibular were treated with circular external fixator from August 2005 to October 2008.The aetiologies of the fractures were as follows:8 cases,motor vehicle accident;5 cases,falls;2 cases,crush.All the fractures were closed.Nine cases had skin and soft tissue contusion on the distal leg and ankle.[Result]All patients were followed up and acquired the bony union.The mean follow-up time was 10.5 months(range 6～30 months).The mean framing time was 4.5 months(range 2.5～9 months).None of the patients had soft tissues infection and osteomyelitis.None of the patients suffered from the complications such as shortness,angulation,rotation deformity.None of the patients suffered from refracture after removal of the frame.Three patients had pin tract infection and were treated by oral antibiotics.Four patients had loss of range of motion in the ankle after the removal of the frame.These 4 patients had loss of mean 5-degree dorsiflexion and mean 10-degree plantar-flexion.All the patients had full knee function.[Conclusion]The circular external fixator may be used as an alternative method in the treatment of spiral and oblique fractures of distal 1/3 of tibia-fibular and the patients can avoid suffering from the removal of internal fixators.

[Objective]To investigate the clinical effects of Ilizarov external fixator combined pedicle flaps transfer on the treatment of infective fracture nonunion with soft tissue defects in legs.[Method]Fiftecn patients aged 20-58 years(mean age 40 years) were treated with Ilizarov external fixator combined pedicle flaps transfer from July 2005 to September 2008.The areas of flaps were 6 cm?5 cm-15 cm?10 cm.[Result]All patients were followed up.The mean follow-up time was 13 months(range 8-33 months).Fourteen patients achieved fracture union.One patient had partial flap necrosis and recurrent infection and healed aafter a repeat operation.The average tibia fracture healing time was 6.5 months.The mean framing time was 7.0 months.[Conclusion]Ilizarov external fixator combined pedicle flaps transfer can effectively treat infective fractures nonunion with soft tissue defects in legs.In order to achieve the desired results,proper surgery timing and surgical indications are important.

Objective To study the effect on bone formation by intermittent administration of simvastatin. Methods Seventy three month old virgin female rats, weighted (200?10) g each had been divided into two groups ovariectomized (50 rats) and pseudo ovarectomized (20 rats). Ten rats each of Group A and Group B were sacrified at the 30 th day for the confirmation of successful establishment models of the osteoporosis. Then the remaining animals were re divided into 5 groups: Group A, pseudo ovarectomized control, 10 rats; Group B, ovarectomized control, 10 rats; Group C, given Nylestriol 0.1 mg/(kg?d), 10 rats; Group D, 10 rats, given calcium 10 mg and vitamin D3 2 IU/(kg?d); Group E, 10 rats given simvastatin 5 mg/(kg?d) for 14 days; and the drug was suspended for 28 days, then simvastatin was given for another 14 days. All of the animals were given the agents through gastric tube 30 days after surgery. At 120 th day all the rats were sacrified for the measurements of bone mineral content and bone mineral density by the dual energy X ray absorptiometry for bone mophometrical study. Results The average of bone mineral content was (46?11.34) mg (P