Objective To investigate the short-term outcome of vacuum sealing drainage (VSD) in the treatment of infection early after tibiofibular fracture surgery.Methods A retrospective analysis was performed on 19 patients sustaining early infection after tibiofibular fracture surgery from December 2012 to December 2014.The patients consisted of 13 males and 6 females,aged from 26 to 57 years [(37.0 ± 5.3) years].There were 4 cases of isolate tibial fracture,2 isolate fibular fracture,and 13 tibial and fibular fracture.Open fractures were noted in 13 cases and close fractures in 6 cases.Infection occurred 14-21 days [(18.0 ± 3.3) days] after open reduction and internal fixation and was treated with gentamicin and VSD.Parameters were monitored dynamically after operation,including white blood cell count (WBC),C-reactive protein (CRP),erythrocyte sedimentation rate (ESR) and limb perimeter.Results The wound was basically debrided 7-10 days after VSD.Eighteen cases had one-stage wound closure with instrumentation preservance,and one case with progressed infection from soft tissue to bone marrow had instrumentation removal and wound suture.VSD decreased markers of inflammation including WBC,CRP,and ESR as well as limb perimeter.A follow-up of 6-24 month [(11.0 ± 2.3)months] showed fracture healing,without complications of detectable deformity growth,dysfunction,or chronic osteomyelitis.Conclusion VSD results in sufficient wound drain,reduction of swelling,decreased levels in CRP and ESR and controlled wound infection,which facilitates wound closure.

Objective To compare the clinical effect of digital orthopedic three-dimensional visualization technology combined with image-based computer navigation and simple image-based computer navigation for percutaneous screw fixation of acetabulum anterior column fractures.Methods A retrospectivecase-control analysis was made on 19 cases undergone percutaneous screw fixation of acetabular anterior column fractures under image-based computer navigation from January 2015 to 2016 March.There were 12 males and 7 females,aged from 21 to 66 years (mean,39.3 years).AO fracture classification was A3 type in 17 cases and B1 type in 2.Based on the application of three-dimensional digital programming,the cases were assigned to two groups:group A (n =9),virtual three-dimensional model was reconstructed and the virtual screw were inserted to uninjured side by software Mimics and group B (n =10),patients were only prepared for routine preoperative preparation.Time of anterior column screw insertion,intraoperative bleeding,intraoperative fluoroscopy frequency,fracture reduction and Majeed score were compared between the two groups.Results All cases were followed up for mean 8.4 months (range,3-12 months).There were no significant differences between groups A and group B in iutraoperative bleeding [(14.1 ± 3.0) ml,(15.1 ± 2.2) ml],good to excellent rate of reduction (89％,80％),good to excellent rate of Majeed score (89％,80％) (P ＞ 0.05).Time of anterior column screw insertion [(22.4-± 3.4) min] and intraoperative fluoroscopy frequency [(24.9 ± 3.8)times] in group A were significantly less than those[(29.4 ± 4.5)min,(30.5 ± 5.8)times] in group B (P ＜ 0.05).Conclusion Digital orthopedic three-dimensional visualization technology is associated with shortened time of anterior column screw insertion and reduced intraoperative fluoroscopy frequency,indicating an effective adjuvant technique for percutaneous screw fixation of acetabulum anterior column under navigation.

Objective To investigate the clinical application of pedicle screw placement technique for pelvic external fixation.Methods A retrospective review was made on 63 patients (37 males and 26 females;23-67 years of age) managed with anterior or combined anterior and posterior external fixation of pelvic fracture between February 2011 and May 2014.According the ways of screw insertion,the study was divided into two groups:observation group (screw was inserted using the pedicle screw placement technique,n =36) and control group (screw was inserted directly,n =27).Tile fracture classification was 11 patients with type B1,7 type B2,7 type B3,5 type C1,3 type C2 and 3 type C3 in observation group,and 9 patients with type B1,7 type B2,4 type B3,4 type C1,2 type C2 and 1 type C3 in control group.Operation time,rate of the penetration,X-ray fluoroscopy times,screw loosening rate,and postoperative complication rate were documented.Radiologic evaluation of the pelvis was detected with the Matta' s criteria.At the final follow-up,functional evaluation of the pelvis was evaluated with the score proposed by Cole et al.Results Period of follow-up was (14.7 ± 3.2)months in observation group and was (13.8 ± 3.1) months in control group.A total of 190 screws were placed in observation group and 138 screws in control group.Better results were found in observation group than in control group with respect to operation time [(18.8 ± 4.1) min vs.(22.6 ± 5.4) min],rate of the penetration (1.6％ vs.8.7％),X-ray fluoroscopy times (1.6 ± 0.8 vs.2.2 ± 0.9),and screw loosening rate (1.6％ vs.6.5％).There were no significant difference between observation and control groups in percentage of good to excellent reduction(89％ vs.85％) and function score [(35.6 ±3.0) points vs.(34.8 ± 3.9) points] (P ＞ 0.05).After operation,3 patients with lateral femoral cutaneous nerve paralysis and none with wouud infection were found in observation group;3 patients with lateral femoral cutaneous nerve paralysis and one patient with wound infection were found in control group.Conclusion Either the pedicle screw placement technique or conventional technique achieves satisfactory clinical effect,but the former owns better results in operation time,screw insertion accuracy,fluoroscopy frequency and rate of screw loosening,suggesting a fast,safe,and effective screw placement method in pelvic external fixation that should be widely applied.

Chemical cleaning and disinfection are crucial steps for eliminating infection in root canal treatment.However,irrigant selection or irrigation procedures are far from clear.The vapor lock effect in the apical region has yet to be solved,impeding irrigation efficacy and resulting in residual infections and compromised treatment outcomes.Additionally,ambiguous clinical indications for root canal medication and non-standardized dressing protocols must be clarified.Inappropriate intracanal medication may present side effects and jeopardize the therapeutic outcomes.Indeed,clinicians have been aware of these concerns for years.Based on the current evidence of studies,this article reviews the properties of various irrigants and intracanal medicaments and elucidates their effectiveness and interactions.The evolution of different kinetic irrigation methods,their effects,limitations,the paradigm shift,current indications,and effective operational procedures regarding intracanal medication are also discussed.This expert consensus aims to establish the clinical operation guidelines for root canal irrigation and a position statement on intracanal medication,thus facilitating a better understanding of infection control,standardizing clinical practice,and ultimately improving the success of endodontic therapy.