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.

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.

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.

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 discuss clinical outcomes of extraperitoneal pelvic packing (EPP) plus external fixation for hemodynamically unstable pelvic fractures. Methods We used EPP plus external fixation to control 15 cases of hemodynamically unstable pelvic fractures from further damage. They were 6 males and 9 females. Their average age was (44. 0 ± 1.2) (38 to 56) years old. Their injury was caused by a traffic accident (13 patients) and falling from a great height (2 patients). According to the Tile classification,there were 3 cases of type B1, 2 cases of type B2-2, 5 cases of type C1, 3 cases of type C2, and 2 cases of type C3. All the 15 patients were hemodynamically unstable and had a hypovolemic shock. Results There was a statistically significant increase in systolic blood pressure, hematocrit and hemoglobin measured immediately after EPP( P < 0. 05) . However, the units of RBC transfusion significantly decreased( P <0.05) and there were no significant difference in pulse rate( P > 0. 05) . The average operation time was (32.0 ± 2.6) min(30 to 40 min). Five patients died (72. 0 ± 4.2) h after operation ( 1 to 7 d). There was no significant difference between the survivors and the non-survivors in systolic blood pressure, pulse rate,hemoglobin, ISS score, hematocrit and blood transfusion( P > 0. 05). But there was significant difference in age and time between injury and EPP ( P < 0. 05). Conclusions In emergency treatment of patients with the hemodynamically unstable pelvic fracture, especially those combined with hypovolemic shock, EPP plus external fixation can effectively control the massive venous (presacral venous plexus) and bone hemorrhage.The blood pressure and pulse rate can be restored by fluid replacement and blood transfusion. Consequently,this method may significantly improve the hemodynamical parameters and decrease the mortality.

Objective To compare and analyze the biomechanical strengths of 4 different fixations for the posterolateral shearing tibial plateau fracture. Methods The posterolateral shearing fracture models were created in 40 synthetic tibia (SYNBONE, right) and randomly assigned into 4 groups. Group A was instrumented with 2 lag screws, group B with anteromedial LC-DCP, group C with lateral locking plate,and group D with posterolateral buttress plate. Vertical displacements of the posterolateral fragments and failure loads were measured under axial loads from 500 N to 1500 N. Results The vertical displacements in groups A, B, C and D were respectively(0. 459 ±0. 045) mm, (0. 365 ±0. 035) mm, (0. 264 ±0. 025)mm and (0. 128 ± 0. 018) mm under axial loads of 500 N, (1. 058 ± 0. 091 ) mm, (0. 882 ± 0. 053 ) mm,(0.551±0.053) mm and (0.440±0.068) mm under 1000 N, and (1.559±0.097) mm, (1.466±0. 079) mm, (1. 291 ±0. 077) mm and (0. 832 ±0. 130) mm under 1500 N. The differences between the 4 groups were statistically significant ( P ＜ 0. 05) . The loads to failure in groups A, B, C and D were respectively (1870 ± 156) N, (2520 ± 186) N, (2816 ± 190) N and (3465 ±210) N. The differences between the 4 groups were statistically significant ( P ＜ 0. 05 ). Conclusion The posterolateral buttress plate may be the biomechanically best fixation method for the posterolateral shearing tibial plateau fracture.

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.

Objective To describe the operative procedures.fracture patterns and clinical outcomes of treatment of posterior column tibial plateau fractures.Methods From February 2005 to August 2006,36 patients with posterior column tibial plateau fracture were operated on.Twenty patients were treated with open reduction and buttress plate fixation via a posterior approach.They were 13 males and 7 females,with a mean age of 38.5(ranging from 29 to 52)years.The other 16 patients were operated on via anterior plus posterior approaches.They were 11 males and 5 females,with a mean age of 37.3(ranging from 27 to 49) yeam. Results All were followed up for an average of 14.5(ranging from 12 to 15)months.All frac- tures got united with an average radiographic bone union time of 15.7(ranging from 11 to 16)weeks and an average full weight-bearing time of 17.6(range from 13 to 21)weeks.The mean HSS(The Hospital for special surgery)score of all these patients at 12 months postoperatively were 83.4(ranging from 68 to 92). There were 1 case of inferior medial genicular vessel injury during the operation,1 wound dehiscence and 1 partial incision necrosis postoperatively which were all eventually healed with conservative treatments.Three cases of numbness within the posterior lower part of the calf occurred postoperatively.No screw toggle,slide, dislodging or fixation failure was found during follow-up.There were no significant differences both between TPA and PA on radiographies and between immediately after operation and 12 months psstoperatively. Conclusion Open reduction and internal fixation with buttress plates via a posterior or anterior plus posterior approaches is appropriate for treatment of posterior column tibial plateau fractures.

Objective To analyze the validity and safety of using a novel posteromedial approach whose L-shaped incision is reversed in treatment of posterior fractures of the tibial plateau. Methotis Anatomical research was performed on 4 fresh-frozen cadaveric specimens with 8 normal knees. All specimens were dissected by the posteromedial reversed L-shaped approach. Parameters of the important structures were measured. Results two important structures were involved in the novel approach. Including medial saral artery and vein and inferior medial genicular artery. The average distance between the eruptive site of medial sural artery and articular surface was 45.29 mm, and the average length ofmedial sural artery was 36.28 mm. The average distance between the eruptive site of inferior medial genicular artery and articular surface was 10.12 mm. The main posterior structures of the proximal tibia were all surveyed by the single approach, including the posterior bi-condyles and the tibial insertion of the posterior crueiate ligament. Conclusion The posteromedial reversed L-shaped approach is an effective approach for treating posterior fractures of the tibial plateau or posterior injuries of the proximal tibia, because it is less invasive, highly safe, simple in anatomy, direct and sufficient in exposure.