Humeral condylar fracture is one of the common clinical fractures,the treatment is difficult for it often accompanied with their joint surface injury,Learn from past experience combined with our department for humeral condylar fracture treatment,this article was designed to review the different treatment of humerus fractures,analyze the advantages and disadvantages of each treatment and indications for detail,with an emphasis on the application of artificial elbow Joint replacement in the humeral fractures.With a view to enhance the understanding to the treatment of Humeral condylar fracture.

Objective To investigate the effects of artificial semi-shoulder joint replacement for humerus proximal fractures in the aged patients. Methods From January 2004 to February 2007, 42 elderly patients who had been diagnosed as three or four-part fractures of proximal humerus received humeral head replacement. The rotor cuffs were repaired during operation, and the lesser tuberosity and greater tuberosity were reconstructed. Early functional exercise was carried out according to the Neer rehabilitation principles. Results All the patients were followed up for 10 to 28 (mean, 12.7) months postopera-tively. Their shoulder functions were assessed by the ASES (American Shoulder and Elbow Surgeon) score. Obvious pain relief was observed. Eleven cases were excellent, 24 good, 4 fair and 3 poor. The good-to-excellent rate was 83.3%. No prosthetic loosening was noted in this group, but upward shift of the shoulder prosthesis occurred in 3 cases, slight limitation of upward movement in 1 case and absorption of lesser or greater tuberosity in 4 cases. Conclusion Artificial semi-shoulder replacement can be applied for three or four-part fractures of proximal humerus in the aged patients.

Objective To discuss the application value of external fixator to treat the fractures of children according to the characteristics of the fracture of chidren. Methods 25 cases of different complicated fractures of children were treated with external fixator from Jan,1999 to Aug.2001, and given function exercises in the earlier periode after operation. Results The mean follow up time was 10 months. All the fractures healed.The recovery of function was excellent in 88%cases.The long effect is to be observed. Conclusions Using of external fixator to treat the complicated unstable fractures of children can make definite reduction,help to observe and manage the limb and skin after operation,and greatly meet the needs of the fractures of children.The external fixator has a great clinical application value in treating different complicated fractures of children.

Objective To evaluate the clinical outcome of surgical treatment of comminuted and intra articular fractures of the distal radius. Methods Forty two cases of comminuted and intra articular fractures of distal radius encountered from January 1999 to January 2001, were operated upon either with internal fixation with the Titanium screw plate or with external fixator according to the types of fracture. Patiens data: there were 14 male and 28 female patients with age of 21-69 years and an average of 36 years; fractures on the left side in 18 and right side in 24 cases. The fractures were categorized according to the AO classification of distal radial fractures: 3 cases of type B1; 8 cases of type B2(dorsal Barton fracture); 4 cases of type B3(volar Barton fracture); 14 cases of type C1; 8 cases of type C2 and 5 cases of type C3. Types B1, B2, B3 and C1 with unsatisfactory closed manipulation were treated primarily with open reduction and internal fixation with an oblique T shaped pure Titanium plate and screws; types C2 and C3 were primarily treated with external fixators; depending upon the condition of reduction during surgery; Kirshners wires were applied accordingly. Twenty six cases were treated with oblique T shaped pure Titanium plate and screws, 9 with open reduction and external fixator, 7 cases were treated with Kirshners wires and external fixator. According to the types of fracture, the pure Titanium plate and screws, simple internal fixation+external fixator, and only external fixator was used accordingly. Results All 42 patients were followed up regularly. According to AO evaluation of the wrist joint movement, 83.3%(35 cases) of the patients had satisfactory functional outcome, 14.3%(6 cases) had quite satisfactory results and only 2.4%(1 case) had unsatisfactory functional outcome. Conclusion The reduction of the distal radial fractures should include the maintenance of the relative length of the radius and ulna, the smoothness of the articular surface and the palmar and ulnar deviation angles. The shortening of the radius results in the pain with movement and the restriction of function, and hence is considered to be the most important factor affecting the joint function. The ulnar deviation is quite easy to restore, and its mal angulation is rare. The reduced palmar deviation angle results in the restriction of the wrist flexion. For the comminuted and intra articular distal radial fractures, the surgical reduction for the maintenance of the relative length of the radius and ulna, a good reduction of articular surface, reduction of palmar and ulnar deviation angle are the key points for a successful outcome. Early functional exercise is equally important for the best recovery of wrist function.

Objective To explore the surgical treatment of ankle fractures and observe the postoperative rehabilitation. Methods Of 120 cases (68 males and 52 females, age range 18-72 years, average 26.8 years), there were 55 cases with injury on the left ankle and 65 on the right. Eight cases had only medial malleolus fracture, 21 pure lateral malleolus fracture, 58 bimalleolar fracture and 33 trimalleolar fracture.According to Danis-weber's classification, there were eight cases belonging to type A, 78 type B and 34 type C. The lag cancellous screw and tension band were used for medial malleolus and the pure titanic plate and screw for lateral malleolus fractures. The compression screw for 4.5 mm was inserted from anterior part to fixate the posterior malleolus fractures with defects bigger than 1/4 of the joint surface. The criterion was anatomic reduction under naked eyes. Postoperative function exercise was performed with no plaster for external fixation. Results A followed up for 6-12 months showed that 113 cases (94.2%) could walk as normal, 7 (5.8%) felt ache at the culf and uncomfortable at the ankle when walking and 116 satisfied with the results with satisfaction rate of 96.7%. Conclusions Exact reduction,stable internal fixation and active postoperative rehabilitation can help the joint recover to normal function in most cases with ankle fractures.

[Objective]To analyze 29 cases of vertebral fractures treated with percutaneous vertebroplasty(PVP).[Method]Twenty-nine patients(35 vertebral bodies) undergoing percutaneous vertebroplasty from March 2006 to June 2007 and followed-up for 8-24 months(average 16 months) were observed and analyzed.[Result]The ratio of M line(middle height of the vertebral body)of fractured vertebra to P line(post edge height of the vertebral body) of fractured vertebra and the ratios of A line(anterior edge height of the vertebral body) and M line to NM line(M line of the next vertebral body) had statistical differences(P

Objective To evaluate the treatment method and clinical outcome of the aged distal radius fractures. Methods 171 cases with fractures of distal radius from January 1999 to March 2004 were analysed. There were 31 males and 140 females(mean age, 67.3 years; range, 60-76 years). The fractures were classified according to the AO classification of distal radial fracture: 7 B1, 12 B2, 8 B3, 27 C1, 22 C2 and 19 C3. The operation group included 95 patients, 19 males and 76 females(mean age, 69.1 years; range, 60-76 years). 45 were on the left side and 50 on the right side. The non-operation group included 76 patients, 12 males and 64 females(mean age, 65.1 years; range, 60-69 years). 34 were on the left side and 42 on the right side. The fractures type were the following: 35 A2, 24 A3, 5 B1, 4 B2, 3 B3, 2 C1, 1 C2 and 2 C3. For the type A fractures, the priority of treatment was the close reduction and plaster immobilization; for the type B and C1 fractures, it was the open reduction and "T" titanium plate fixation when the close manipulation failed; for the type C2 and C3 fractures, the "T" titanium plate fixation would take the precedence of other methods; and when the fractures were closed to the joints, the external fixator would take the place of plate. Furthermore, the locking compression plate could be selected for the severe osteoporosis. Results Only 22 cases of patients were followed-up in the non-operation group(mean 7 months; range, 4-22 months); but all of 95 operated patients were followed-up(mean 6.5 months; range, 3-20 months). The fractures all healed on X-ray. According to Aro's evaluation of the distal radial fracture, in the non-operation group, there were 11 excellent, 9 good, 1 fair and 2 poor, the good-excellent rate was 86.9%; while in the operation group there were 46 excellent, 40 good, 7 fair and 2 poor, the good-excellent rate was 90.6%. Conclusion The different methods of treatment should be used for distal radial fracture according to the patient types. In case of the fracture and deformity in the articular surface or severe comminuted fracture in the metaphysis of the distal radius, the operation is indicated; and the manipulation can be used in simple metaphysis fractures with a good bone quality.

Proximal femur consists of femoral head, femoral neck and trochanter. The neck and trochanteric parts of femur are easy to get fractured under conbolution forces. As the conservative treatment tends to cause high rates of complication and mortality, more and more surgeons vote for early internal fixation in recent years. The best treatment for femoral neck fracture is now internal fixation with cannulate screws, especially for the patients with good bone density, fundus and intertrochanteric fractures as well as the type I, type Ⅱand part of type Ⅲfractures in Gardon's classification. Although intertrochanteric fractures are relatively stable, but internal fixation is necessary for good results and prevention of complications. DHS(dynamic hip screw)are advisable for A1, part of A2 and A3 intertrochanteric fractures in AO classification, especially for A1 cases. PFN (proximal femoral nail) is designed for intertrochanteric fractures, inversion and elevation intertrochanteric fractures. In order to get better prognosis in patients older than 70 years and with serious osteoporosis and A2 3, A3 3 fractures, we designed a special kind of prosthesis for them and therefore get satisfactory results.

Objective To investigate the effect of calcitonin gene-related peptide(CGRP) on early-stage bone fracture healing and on the expression of bone morphogenetic protein-2(BMP-2) in bone tissue of rats.Methods Totally 30 SD rats with tibial fracture were randomly and equally divided into 3 group and received normal saline(control group),CGRP or CGRP receptor antagonist injection intraperitoneally.In 1,2 and 4 weeks later,the fracture sites from the 3 groups were subjected to X-ray scanning,callus measurement and HE staining.The expression of the BMP-2 was detected by immunohistochemical method.Results There was no obvious difference on callus amounts among the 3 groups,but at 2 weeks after treatment,there were significantly more callus in CGRP group with enlargement in the fracture site than in the other 2 groups;The enlargement of CGRP group became minimized with fused cortex and almost normal morphology and size.So were the other 2 groups.Immunohistochemical results showed that exogenous CGRP significantly increased BMP-2 expression,but the expression was decreased significantly after administration of CGRP receptor antagonist.Conclusion Our results suggest that CGRP may participate in the regulation of bone fracture healing,and induce BMP-2 production,implying that BMP-2 may be related functionally with CGRP in the mechanism of bone metabolism.

Objective:To analyze the causes and risk factors for failure of internal fixation with proximal femoral nail antirotation (PFNA) in the treatment of femoral intertrochanteric fractures.Methods:A retrospective analysis was conducted of the 568 patients with femoral intertrochanteric fracture who had been treated with PFNA fixation at Department of Orthopaedic Surgery, The Fifth Central Hospital of Tianjin from March 2013 to March 2018. They were 348 males and 220 females, aged from 44 to 93 years (average, 74.6 years). According to the fracture stability classification, the patients were divided into a stable group of 424 cases and an unstable group of 144 cases. According to the AO classification, the stable group had type 31-A1 and type 31-A2.1 while the unstable group type 31-A2.2, type 31-A2.3 and type 31-A3. The 2 groups were compared in terms of reduction quality, rate of internal fixation failure, and function of the affected hip. Single factor and multi-factor binary logistic regression analyses were conducted to determine the risk factors responsible for failure of PFNA fixation of femoral intertrochanteric fracture.Results:There were no significant differences in the preoperative general data between the 2 groups, showing comparability between groups ( P> 0.05). Internal fixation failure occurred in 19 cases, which was caused by spiral blade withdrawal in 13 cases, femoral neck shortening in 17 cases, hip varus in 14 cases, and spiral blade cut-out in 14 cases. The failure rate for the stable group was 1.2% (5/424), significantly lower than that for the unstable group [9.7%,(14/144)] ( P<0.05). The Harris hip score at the last follow-up for the stable group [98(95,100)] was significantly higher than that for the unstable group [84 (82, 87)] ( P<0.05). There was no significant difference in reduction quality between the 2 groups ( P>0.05). The multivariate analysis showed that osteoporosis ( OR=7.283, 95% CI: 1.626 to 32.623, P=0.009) and unstable fracture ( OR=11.607, 95% CI: 4.039 to 33.355, P<0.001) were risk factors responsible for the failure of PFNA fixation of femoral intertrochanteric fracture. Conclusions:PFNA fixation for unstable intertrochanteric fracture can lead to a high failure rate. It forms a lever like structure so that the main stress is shifted to the internal fixation. Its lever fulcrum is located at the angle of intramedullary fixation so that a long arm forms at the load-bearing side, leading to a high failure rate. The weight-free time should be longer for patients with osteoporosis and unstable fracture after operation.