Objective To discuss the effect of damage control applied for an earthquake pelvic fracture. Methods One case of pelvic fracture in the 5.12 Wenchuan earthquake was treated by damage control in May, 2008. The patient was managed with anti-shock measures and temporal fixation of fracture in the first stage and minimally invasive surgery under fluoro-navigation system in the second stage. Results After two-stage damage control, the patient obtained stable vital signs, satisfactory reduction and internal fixation with no complications. Conclusion Damage control strategy for the earthquake pelvic fractures can improve the survival of patients and decrease their complications.

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.

The criterion of injury severity is an important part of evaluation,which can affect the treatment for closed fracture.The reaction in soft tissue healing process contains microvascular responses and inflammation.Take soft tissue with low immunity as a incision will lead to wound dehiscence and deep infection.Therefore,realization of injury severity lays a foundation for effective treating with closed fracture.Many treatment methods,such as splint fixation,cryotherapy,compression or delayed operation,can prevent soft tissue from a second injury,and promote self-repair ability prior to operation.The newly development surgical tech-nique can improve efficacy of therapy,meantime,decrease the incidence of complications.

Objective To report the clinical results of treatment of tarsometatarsal joint injuries by close reduction and percutaneous screw fixation. Methods From January 2003 to June 2005, 26 cases of tarsometatarsal joint injuries were treated with close reduction and percutaneous screw fixation. They were 13 cases of middle column injury, seven cases of medial-middle column injury and six cases of three-column injury according to Myerson’ s classification. Results In this series all the wounds healed primarily with a mean operative time of 40 min ( 30 to 70 min) and a mean incision length of 5 mm. A mean follow-up of 11.4 months (ranging from 6 to 17 months) revealed a mean score of 87 according to American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scoring system. All the patients returned to normal daily life after a mean time of 5.3 months (3 to 11 months). Conclusions Tarsometatarsal joint injuries can be treated well by close reduction and percutaneous screw fixation with less operative lesion and lower incidence of soft tissue complications. Reduction of the middle column with screw insertion along the direction of the Lisfranc ligament is the key to reestablishment of the stability of the tarsometatarsal joint complex.

Objective To report and evaluate the treatment results of unstable distal radial fractures with volar locking compression plate (LCP). Methods 46 cases of unstable fractures of distal radius were treated with open reduction and LCP fixation through volar approach from April 2002 to May 2004. 14 of which underwent bone graft and 12 postoperative immobilization with plaster sprint. Results A follow-up of 6 to 30 (mean 21) months revealed bone union in all cases with a mean volar deviation angle of 9.7?and a mean ulna deviation of 21.3?of the distal radius. The wrist functions were evaluated by the modified Gartland and Werley system only to find 32 excellent cases, 11 good ones, 2 fair ones, and 1 poor one. Conclusions The unstable distal radial fractures can effectively be treated with open reduction and LCP fixation through volar approach. The subsidence of the radial articular surface can well be prevented and bone healing accelerated with supplementary bone graft.

[Objective]Tibial plateau fracture may be combined with soft tissue injuries including menisci injuries, but what tibial plateau fractures influence on meniscus healing has never been reported. This study is to observe the influence on menisci healing caused by knee variation when tibial fracture occurred by making animal models.[Method]Lateral tibial plateau fracture models and non-full-thickness laceratin and perforation defect of menisci models were made in 12 New Zealand rabbits, along with control group without fractures. The differences of menisci healing between two groups were observed with morphological and light microscopic observation after 12 weeks.[Result]No menisci repair in avascular portion could be found in both groups, menisci laceration within vascular portion had repaired the fissures in both groups, and hardly been distinguished from normal tissue. Perforation defect in one third of lateral side coulc be partially filled with protein clot in tibial plateau fractures group.[Conclusion]No evidence revealed that fracture could prevent menisci healing when tibial plateau fractures combined with menisci injury, however, defects of menisci may get advantage of filling tissue from fracture. It still need further research whether it is good for menisci healing or not.

[Objective]To study the surgical treatment of thoracolumbar fractures in multiple injured patients.[Method]Data from 12 consecutive patients with thoracolumbar fractures and multiple trauma were reviewed retrospectively.Three patients with thoracolumber fractures were complicated by pelvic(acetabular) fracture,11 by lower extremity fracture and 6 by upper extremity fracture.All the patients were treated operatively.The spinal injury and pelvic fractures were first treated.The operation time,bleeding volume as well as Frankle score were recorded.[Result]The average operation time was(202?52)min and the blood loss was(500?325)ml per patient,and the average operation time was 59 min and blood loss was 146 ml for an injury.The average Frankle score increased from 2.8 preoperatirely to 3.5 at 3 months after operation.Bone reunion or fusion was achieved in 8 patients at a one-year follow-up.[Conclusion]Damage control orthopedics should be emphasized for severe polytrama.The operation timing and techniques depend on the characteristics of fractures and the general conditions of the patients.Minimally invasive technique is useful in reducing the operation time and injury reaction,promoting early mobilization and lessening complications.

Objective To report the short-term result of unicompartmental knee arthroplasty (UKA) for osteoarthritis and spontaneous osteonecrosis of the knee, and discuss the indications and surgical pitfalls for the procedure as well. Methods From April 1999 to July 2000, unicompartmental knee arthroplasty were performed in 20 cases (24 knees). Osteoarthritis in 18 cases (20 knees) and spontaneous osteonecrosis in 2 cases (2 knees); 10 males (12 knees) and 10 females (12 knees). The range of motion (ROM), femorotibial angle (FTA) and JOA score were adopted as main parameters to evaluate the outcome of the operation. The mean age of the patients at the time of operation was 73.3?7.1 years,and 75.0?6.8 years at the final follow-up. The mean follow-up period was 25.7?15.0 months. The prostheses used in the group were unicompartment sleigh shaped artificial joint of Link Endomodel Sled Knee, Waldemar Link or YCMK. Results Before operation, the mean ROM was from 5.4??6.1?(extension) to 120.0??15.0?(flexion), the flexion deformity was significantly corrected after operation. The average extension was 2.1??2.5? at the time of follow-up, significantly improved comparing with 5.4??6.1? of pre-operation (P

Objective To introduce the experience of treating high energy P il on fractures with an articulated external fixator. Methods From March to June 20 01, twelve patients (13 fractures) suffered from high energy Pilon fractures wer e treated with an articulated external fixator (Orthofix, Italy). The fixators w ere placed medially across the ankle joint, if necessary, fixation of fracture w as enhanced with combination of limited internal fixation. The main injury was c aused by traffic accident and high altitude dropping. The distal two pins were i nserted into the neck of the talus and the tuberosity of the calcaneus so that s ubtalar joint was treated as an axis during ankle movement. At approximately pos toperative two weeks, the articular hinge was released and the patient began ank le exercises. The clinical outcomes and complications were investigated and the postoperative of X-ray examination of ankle were also evaluated. Results Twelve patients were followed up with a mean period of 12 months. No infections of woun d and pin sites and no neurovascular complication was found. According to Teeny & Wiss ankle joint scoring system, the symptom and functional evaluation of the ankle was scored from 74 to 94 (average 87). Clinical results demonstrated 2 exc ellent, 7 good, 4 fair. Quality of reduction of the articular surface showed 7 g ood and 6 fair using system of Marsh classification of reduction of the articula r surface of the ankle. Conclusion External fixation with an articulated fixator combined with limited internal fixation is a satisfying technique to treat high energy Pilon fractures. This technique helps to effectively decrease both wound and bone healing complications. With advantage of restoring anatomical articula r surface and enabling early ankle joint motion, this technique also helps to pr event ankle joint stiffness after fixation. The short term result of the above-m entioned fixation is encouraging.