Proximal tibial fractures, especially high energy ones, can incur unique challenges in clinical treatment. Soft tissue is injured from both fracture and surgical dissection; the fracture often brings with it neurovascular problems; it is difficult to reduce and stabilize proximal fragments. Treatment strategies of dealing with associated injuries, accurate diagnosis, and selection of individualized method for reduction and fixation are emphasized. Soft tissue protection should always be kept in mind during operation.

Complex Pilon fracture is always a challenge to orthopaedic surgeons. Careful assessment of the injury, especially the soft tissue condition, is essential for a proper treatment planning. Classification of the fracture is also important for evaluation of the prognosis. Treatment planning includes: timing of the surgery, selection of the fixation method and postoperative protocols. In this article, on the basis of literature review and personal experience, the author suggests criteria for injury assessment and postoperative treatment. A brief comparison of different kinds of fixation is made and the principle of implant selection is discussed in the text.

It is a clinically tough problem to repair compound tissue d efects of limbs. Application of microsurgical technique with autologous pedicel or free tissue grafts has saved numerous invalid limbs with tissue defects, and is still an essential method to restore compound tissue defects of limbs and res love effectively many difficult problems, such as larger solf tissue defects,seg mental bone defects, bone-skin compound defect, and etc. Microsurgical repair i n emergency has special value in treating compound tissue defects of hand. Altho ugh the resource of autologous tissue graft as donator is limited, tissue engine ering and gene technology hold the promise of revolutionary advances in repairin g compound tissue defects of limbs. Because of the achievements made in the fiel ds of trauma repair and tissue regeneration, both structure and function will be hopefully restored.

Objective To investigate the functional changes of osteoblasts in female SD rats in vivo at different phases following ovariectomy and to analyze their mechanism. Methods 40 female SD rats aged 6 months were randomly divided into 2 groups: the sham operated group and the ovariectomized (OVX) group. During the 4-month experiment, 10 rats from each group were sacrificed to have the serum and the 4th lumbar vertebrae specimens at the end of the 2nd week and the 16th week respectively. Serum bone gla protein (BGP), serum bone specific alkaline phosphatase (BALP) were measured. The excretive function and morphologic changes of the osteoblasts were observed under TEM (Transmission Electronic Microscope). Results In the OVX group, the levels of BGP and BALP all increased at the end of the 2nd week, but showed no significant difference from those in the control group at the end of the 16th week. TEM indicated osteoblasts were activated at the end of the 2nd week, but tended to be inactivated in the ovariectomized group at the end of the 16th week. Conclusions When estrogen decreases in ovariectomized rats, osteoblasts experience a short activated period, but their capacity of bone formation decreases in the end. Abnormal function of osteoblasts may play an important role in pathogenesis of osteoporosis.

Objective To evaluate effects of minimal invasive plating for treatment of mid-distal humeral shaft fractures.Methods From May 2004 to December 2007, 20 patients with isolated unilat-eral mid-distal third humeral shaft fractures were surgically treated with close reduction and internal fixation using a 4.5 mm dynamic compression plate which was anteriorly inserted through 2 small incisions on the anterior aspects of proximal and distal parts of the arm, away from the fracture site.The postoperative function of the radial nerve and the musculocutaneous nerve, the postoperative alignment of the main fragments on the anteroposterior radiographs, the bone healing time and muscle strength of biceps muscles were measured and recorded, Results Four patients complained of numbness at the area innervated by the lateral ante-braehial cutaneous nerve in the affected forearm after the surgery.No signs of iatrogenic radial nerve palsies occurred after the surgery.A completely normal alignment was achieved in 7 patients, but varus of 11° was found in 2 cases and varus of 2°, 3°, 4°, 5°, 6°, 7° and 10° in one each.Valgus deformity was noticed in 4 cases, and valgus of 3°, 4°, 6° and 7° in one each.The mean follow-up of 10.4 months for 19 patients re-vealed bony union of all the fractures.The average bone healing time was 13.4 weeks.At the latest follow-up, the biceps muscle strength of all the patients was 5 degrees.Hardwires were removed in 5 patients without any complications.Conclusions Minimally invasive anterior plating is a safe alternative osteosynthesis for mid-distal third humeral shaft fractures.However, this technique may interfere with the function of the lateral antebrachial cutaneous nerve.

Objective To report the clinical results of the treatment of proximal humeral fractures with a locking proximal humeral plate (LPHP) through a small skin incision on the anterolateral shoulder. Methods In the period from May 2004 to June 2005, 17 cases of proximal humeral fractures were treated in our department. There were 3 Neer two-part fractures, 10 Neer 3-part ones and 4 Neer 4-part ones. Starting from 1.5cm anterior to the acromion, the skin was incised for 6 cm in length and the deltoid muscle was separated along the muscle fibers to expose the fracture fragments. Under direct vision the indirect reduction of the fracture was performed and the fragments were temporarily fixed with K-wires. The LPHP was inserted distally beneath the deltoid muscle and the position between the distal plate and the humeral shaft was adjusted through another small skin incision on the lateral upper arm. 4 locking screws were inserted to the proximal plate to fix the fracture fragments while screws were percutaneously inserted to the distal plate to fix it to the humeral shaft. Results This series experienced a primary wound healing, a mean operation time of (128?35) min, a mean intraoperative blood loss of 65?19 mL, and an average hospitalization of 4 days. A follow-up of mean 6.1 months, ranging from 3 months to 14 months, was performed in 12 cases of the 17 and revealed fracture union in all, with a mean healing time of 15.7 (ranging from 12 to 24) weeks. The final follow-up demonstrated a normal sensation on the lateral arms and a motion range in shoulder abduction of 80?to 150?and flexion of 80?to 160?. Conclusion The treatment of proximal humeral fractures by open reduction and internal fixation with LPHP through a small skin incision on the anterolateral shoulder has the advantages of simplifying operative maneuver, reducing tissue damage, decreasing blood loss, shortening bone healing time and improving functional recovery.

BACKGROUND:Forceful fixation and enough blood supply in fracture site are the fundament for treating bone nonunion. OBJECTIVE:To investigate the outcome of autologous lilac bone-grafting and plate fixation in treatment of the ununited distal ulnar fracture with osseous defects. DESIGN,TIME AND SETTING:The own control study was performed at the Department of Orthopaedics,Sixth People's Hospital,Shanghai Jiao Tong University from August 2002 to May 2006. PARTICIPANTS:Of 21 cases of the ununited distal ulnar fracture with osseous defects,13 cases were induced by ulnar and radial fracture,and 8 cases were induced by ulnar fracture. There were 15 cases of open fracture and 6 cases of closed fracture of first onset. Bone defects were 1.5 cm-5.0 cm,averagely 3.1 cm. METHODS:Bone defects were filled with intercalary lilac grafts. Length and axial ray of ulna were controlled. Ulna was fixed utilizing 5-8 wells 1/3 tubular plate,reconstruction plate or locking compression plate. At least two screws were used at the distal end,and 3 or 4 screws were fixed in the proximal end,FoUow-up was conducted once per month to observe clinical appearances and radiograph in each patient. MAIN OUTCOME MEASURES:Fracture nonunion,dorsal extension and palmer flexion of wrist joint,pronation and supination of the forearm were measured. RESULTS:All 21 cases were followed up for a mean time of 14.7 months. All the patients obtained bony union,and a mean time of 4.6 months (ranged 3 to 7 months). The distal ulnar healed with < 10° of angular deformity in a coronal plane in one patient and with 15° of angulation in a sagittal plane in another one,while others (19 patients) obtained satisfactory alignment. The excellent and good rate was 90.5％. CONCLUSION:Intercalary bone-grafting with autologous lilac and secure fixation for treating the ununited distal ulnar fracture with osseous defects can reconstruct ulnar length,correct deformities,and obtain good bone healing and functional recovery.

Objective To observe and analyze the outcomes o f open reduction and Y plate internal fixation in treatment of intra-articular calcaneal fractures.Methods Open reduction and Y plate internal f ix-ation by the extended L-shaped lateral approach were performed in 68pati ents with 82cases of intra-articula r calcaneal fractures under X-ray.Results82cases were followed up for an avera ge of 26months,and the clinical results were evaluated wit h the Maryland Foot Score.58cases ac hieved excellent results,16good,6fair,with the rate of excellent and good re sults being 90.24%.Conclusion Open reduction and Y plate internal fixation can obtain good clinical re sults in treatment of intra-articul ar calcaneal fractures.[

Objective To investigate the combination appr oach used to treat the complex acetab ular fractures.Methods Form January 1998to August 2001,31c ases of acetabular fractures were tr eated through combination of Kocher-Langenbeck a nd ilioinguinal approaches.26case s of them resulted from traffic injur ies,and 5from fall injuries.The average interval from injure to operation wa s 17.6days.The average blood loss wa s1890ml.The average operative duration was 252minutes.According to the classification of Letournel and Jud et,associated fracture types accounte d for 27cases,and simple type 4cases.They were fixed by the reconstructi ve plates and /or plates +lag screws.Results The average follow-up was 20.2month s.According to criteria of Matta,of the 20cases who underwent a natomic reduction,10were satisfac tory while 1unsatisfactory.21case s had excellent and good clinic results,8fair,2poor.Conclusion Because of the advantages of excelle nt ex-posure,convenient reduction,rigid fixation and lower heterotopic ossification,the combination approach is good to treat the complex acetabular fractu res involved the two columns.[

0.05) .It was significantly higher when the concentration was 1?10-12 mol/L than the control group(P