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.

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 analyze the effect of meniscus tear on prognosis of tibial plateau fracture and the effect of fracture on meniscus healing by comparing the outcomes of simple tibial plateau fractures and the fractures combined with meniscus injury. Methods A retrospective analysis was conducted in 57 cases of tibial plateau fractures treated with internal fixation in our hospital from January 2004 to June 2006. Twenty-three of them were complicated with meniscus tear and received repairing. Knee joint functions were evaluated by the HSS (The Hospital for Special Surgery) score. The menisci were examined by Joint-line tenderness, McMurray, Apley and Thessaly tests. The femorotibial angle (FTA), tibial plateau angle (TPA) and posterior slop angle (PA) were measured on X-ray images. Results Fifty cases were followed up for an average Of 15 (6 to 24) months. The HSS scores for the simple tibial plateau fracture and the tibial plateau fracture combined with meniscus tear were 87.9 and 87.1, respectively. There were no statistical signifi-cances in HSS score(t=0.351, P=0.727), FTA, TPA and PA results between the 2 groups. No more positive physical signs of meniscus tear were found in the group of tibial plateau fracture combined with meniscus tear than in the other group. Conclusions Meniscus tear may not affect the postoperative re-habilitation of the knee joint with tibial plateau fracture; neither is there evidence that tibial plateau fracture may hinder meniscus healing.

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

BACKGROUND: Re-injury of organism and sufficient of materials exist in the autologous transplantation of tendon to treat defected tendon following trauma. Carbon fiber artifical tendon, human hair tendon and other artifical tendons are also proved to be transplantable. But immunological rejection and biomechanical inadaptability exist following artifical tendons are transplanted. Therefore, the development of new human tendon substitute is the major problem to be solved at present.OBJECTIVE: To observe the porcine small intestinal submucosa as artificial tendon to repair 2 cm tendon defect of the 3rd toe of the left and right feet of chicken, and the immunological rejection and biomechanical adaptability following repair.DESIGN: A randomized and controlled animal experiment.SETTING: Department of Orthopaedics, Sixth Hospital Affiliated to Shanghai Jiaotong University.MATERIALS: Totally 45 Leghorn chickens, aged 12 weeks, of either gender, with body mass of 4.0 to 4.4 kg, were chosen.METHODS: This experiment was conducted at the Department of Orthopaedics, Sixth Hospital Affiliated to Shanghai Jiaotong University from September 2002 to June 2003. ① Totally 45 Leghorn chicken, aged 12 weeks, were randomly divided into 3 groups. The third toe of the left and right feet was chosen from 20 chicken respectively of autologous transplantation group and porcine small intestinal submucosa group, flexor digitorum profundus muscle tendon was cut off at middle phalanx, and 2 cm tendon defect model was created. The defected tendon in the autologous transplantation group was performed in situ suture; the defected tendon in the porcine small intestinal submucosa transplantation group was repaired with porcine small intestinal submucosa; There was not any treatment on the 5 Leghorn chicken in the blank control group. ② Histomorphologyl, transplantation immunology, biomechanics and functional recovery were measured at 3,6 and 9 weeks following tendon transplantation.MAIN OUTCOME MEASURES: ① Gross observation of operated toes of chicken and optical observation of grafts in each group. ② White blood cell (WBC) differential count at 3 days preoperation,3 days postoperation,and 1 week and 2 weeks postoperation. ③ Biomechanical test and functional recovery test of chicken in each group.RESULTS: Totally 45 chicken entered the stage of result analysis. ① At 9 weeks after operation, morphology of porcine small intestinal submucosa was basically the same as that of normal tendon by naked eyes; Under optical microscope, fibroblasts on the porcine small intestinal submucosa arranged in order along long-axis and collagen extracellular matrix appeared.② Within 2 weeks after operation, there was no significant difference of WBC measurement between porcine small intestinal submucosa transplantation group and autogolous transplantation group (P ＞ 0.05), suggesting that porcine small intestinal submucosa, as xenogenic material, has no obvious immunological rejection. ③ In the biomechanical test, biomechanical adaptability at postoperative 12 weeks was superior in the porcine small intestinal submucosa group to in the autologous transplantation group [(22.22±0.90),(20.78±0.94) ,P ＜ 0.05]. ④ In the test of functional recovery, there was no obvious difference of activity of metecarpophalangeal joint (P ＞ 0.05), the activity of proximal interphalangeal joint was superior in the blank control group to in the porcine small intestinal submucosa group and autologous transplantation group [(21.0±1.6)°, (15.1±1.7)° , (16.0±2.1)° ,P ＜ 0.05].CONCLUSION: There is no evidence of immunological rejection after porcine small intestinal submucosa is transplanted into the body of chicken. Therefore, porcine small intestinal submucosa can be used as the xenogenic material to repair tendon defect.