Objective To study the repairation of the appearance and reconstruction of the function to the destructive palm Method Two methods were adopted according to the destructive extent of palm and finger The destructive severed palm can be ectopicaly replanted by four kinds of ways:(1) 2 severed fingers and partial palm were ectopicaly replanted to the end of the forearm (2) 2 or 3 severed fingers and partial palm were replanted to the wrist (3) 5 fingers and partial plam were replanted to the end of the forearm (4)The partial palm was reconstructed and the severed fingers were ectopicaly replanted For the cases suffered from complete or partial destructive palm injury,the corresponding tissues from the foot such as toe,first web,metatarsal bones or dorsal flap were transplanted according to the needs of hand reconstruction Since the blood supply and return system mainly depends on dorsal artery of foot and great saphenous vein,the entire resection and transplantation can be done at one stage in all cases Result All the cases gained success except one finger with partial necrosis Good recovery of appearance and function of hand were obtained Conclusion The destructive palm can be reconstructed by ectopic replantation and tissue transplantation The function and appearance of hand can be improved

Objective:To establish a 3 dimensional finite element model of calcaneus and talus for analysing their stress distribution during different gait phases. Methods: CT scanning and computer image processing system were used to establish the model to simulate the situation of calcaneus and talus for 3 phases (heel strike, midstance, push off) during the gait. A finite element solver was used to calculate stress. Results: A three dimensional finite element model of calcaneus and talus was established. And the stress distribution within the bone was obtained and regions with elevated stress at 3 phases were located. The stress distributions of 3 phases were significantly different. The stress increased gradually from heel strike to push off. Conclusion:The model can be used to study biomechanics of calcaneus and talus. The regions of elevated stress of calcaneus and talus are important, which provide an insight into the factors contributing to the fractures and arthritis.

BACKGROUND:A selection of treatment for thoracolumbar fracture is very important.OBJECTIVE:To develop and validate three-dimensional finite element models of human thoracolumbar fracture using varying fixation methods,and to compare biomechanical characteristics of fixation method.DESIGN TIME AND SETTING:A contrast observation was performed at the Mechanical Experiment Center of Tongji University from August to October 2008.MATERIALS:64-slice spiral CT (Siemens,Germany) was used to scan T_(11)-L_1 segments of an adult male,and the slice thickness was 0.6 mm.based on Boolean operation,the lower half of T_(12) segment was resected,and the structure of posterior part was reserved to establish finite element model of thoracolumbar fracture.METHODS:There were five groups in this study,including 4 pedicle screws+2 rods (group 1),5 pedicle screws+2 rods at one side (group 2),6 pedicle screws+2 rods at both sides (group 3),anterior fixation (group 4),and anterior plus posterior fixation (group 5).Forces of axial compressive,anterior bending,posterior extension,left bending,and right rotation were loaded to compare the biochemical characteristics.MAIN OUTCOM MEASURES:vonMises stress and displacement at different directions.RESULTS:The stresses of all the fixation screws increased from the anterior part to posterior part in all movement tests,and the strongest stress was measured in the joint position.The stress of proximal screw was stronger than that of the distal screw.Additionally,the stress in group 1 was significantly stronger than in groups 2,3,and 5 (P<0.01).The group 5 was the most stable,but the group 1 was the poorest.CONCLUSION:T_(12) bursting fracture models were established using varying fixation methods,and the results verified that short segment plus fracture vertebral segmental fixation has more superior biomechanics.

Objective Investigate the methods of reconstituting the first web of hand Try to find some ways to make the the lst web more beautiful Method To design a flap including two flap (instep island flap and medial plantar island flap) to reconstitute the lst web of hand the instep flap reconstituted the back of the lst web of hand,the medial plantar flap reconstitute the volaris part of the lst web of hand Result All 9 cases were applied successfully with the transplanted tissue survived The function of hand recovered satisfactorily and the exterior look like original web of hand Conclusion Use combined flap on the medial foot to reconstitute the lst web of hand can recovered either function or original exterior of the lst web of hand

From May 1981 to September 1983. experimental study of the effect of buried nerve endings into muscles on the recovery of its motor functions was carried out in our hospital with 40 robust rabbits of both-sexes divided into two groups. In group A. left common peroneal nerve was cut off at the relatively deep site of myoneural junction and divided into three bundles, which were separately buried into long extensor muscle of digits, anterior tibial muscle and long peroneal muscle. For group B. a piece of 1.2cm cut from left common peroneal nerve and another piece of 1.4cm cut from right common per-oneal nerve were freely transplanted to the left-side muscles in the same way as in group A. Experimental results showed that the motor function of the muscles transplanted with nerve ending started to recover in two months after operation, and that the muscle power reached more than the 4th grading and electric irritation could induce muscle contraction at the 6th month after operation. Electromyogra-phic examination showed mixed disturbing potential. The new motor end-plates could be found on his-tological examination. In one clinical case follow-up for 6 months was made post-operatively and the recovering muscle power was fairly satisfactory.

Post-traumatic osteomyelitis is painful and challenging disease.High success rate of antimicrobial therapy in most cases has not been achieved in skeleton due to its physiological and anatomical characteristics.The key to successful management is early diagnosis and treatment.Different types of post-traumatic osteomyelitis require different medication and different surgical therapeutic strategies.Post-traumatic osteomyelitis is associated with avascular necrosis of bone and formation of sequestrum(dead bone).Surgical debridement is necessary in addition to antibiotic therapy.Generally,multidisciplinary techniques are required,including orthopaedic surgery,plastic surgery,as well as vascular surgery,especially for complex cases with soft-tissue defect.

BACKGROUND:Recently,open reduction and internal fixation has become an important therapy for pelvic and acetabular fracture. However,screw penetration sometimes occurs,which damage vessels or nerves in the pelvic cavity. OBJECTIVE:To measure the best entry points,direction and length of screw in acetabular anterior column fracture lag screw internal fixation technique. DESIGN,TIME AND SETTING:Measurement experiment was performed at the Department of Anatomy,Medical School of Shandong University from June to October 2008. MATERIALS:A total of 20 semi-pelvic specimens of adult male cadavers were used to make serial cross-sections of the acetabular anterior column. METHODS:In single screw technique,the horizontal distance OP and vertical distance PQ from entry point O to apex of greater sciatic notch Q were measured,and screw length was measured. In double screw technique,the horizontal distance O1P1,O2P2 and vertical distance P1Q,P2Q from entry point O1 of the inner screw and entry point O2 of the outer screw,respectively to apex of greater sciatic notch Q were measured. The length of inner screw and outer screw were measured respectively. Angle ? on sagittal plane and the angle ? on coronal plane of the screw were determined. All data were put into software SPSS 10.0 for statistical analysis. MAIN OUTCOME MEASURES:The entry points,direction and length of screw in acetabular anterior column fracture lag screw internal fixation technique RESULTS:Single screw technique:the length of OP and PQ was (23.5?2.2) mm and (16.8?1.6) mm respectively; the length of lag screw was (84.9?4.7) mm. Double screw technique:the length of O1P1 and P1Q was (26.3?2.3) mm and (13.6?1.4) mm,respectively,and the length of medial lag screw was (69.8?4.1) mm; the length of O2P2 and P2Q was (20.7?2.1) mm and (20.1?1.8) mm,and the length of lateral lag screw was (61.2?3.7) mm. Angle ? was (123.4 ? 4.1)? and angle ? (62.2 ? 5.8)?. CONCLUSION:The entry point of single screw technique lies in the summit of greater sciatic notch 17 mm outward,vertical to the medial margin of the posterior column,24 mm upward,parallel to the medial margin of the posterior column; the length of the screw is 85 mm. The entry point of medial screw in double screw technique lies in 14 mm outward,vertical to the medial margin of the posterior column,and 26 mm upward,parallel to the medial margin of the posterior column; the length of the screw is 70 mm. The entry point of lateral screw in double screw technique lies in 20 mm outward,vertical to the medial margin of the posterior column,and 21 mm upward,parallel to the medial margin of the posterior column; the length of the screw is 61 mm. The angle of lag screw with respect to the parallel line of the medial margin of the posterior column is 123?,and the angle lag screw with respect to the vertical line of the medial margin of the posterior column is 62?. The position of the lag screw must be confined by intraoperative fluoroscopy in multiple projections.

Objective To analyze the stress distribution of calcaneus and talus with posterior facet after compression fracture during gait by finite element method. Methods A wedge was resected to simulate the malunion calcaneus with compression fracture of posterior facet. The Bo?hler’s angle was reduced from 35? to 10?. The calcaneus and talus malunion were used to simulate for three phases of the stance during the gait (heel strike, midstance, push off). A finite element solver to calculate. The results were compared with normal condition. Results The stress distribution within the bone in condition of malunion was obtained, and sites of enhanced stresses for three phases were located. The results were significantly different from that of normal condition. Conclusion The results revealed the importance of reconstruction of calcaneal structure and helped us understand the cause of sequela of calcaneal fractures

Objective To introduce our experience of treating Pilon fractures with an articulated and spanning external fixator. Methods From February 2002 to June 2004, 19 patients with high energy Pilon fractures (21 sides) were treated with a T- shaped unilateral articulated and spanning external fixator in our department. The fixators were placed medial1y across the ankle joint, and the fixation of fracture was enhanced by a combined use of limited internal fixation. The main causes of injury were traffic accidents and high altitude falling. The distal 2 pins were inserted into the talus and the tuberosity of calcaneus so that the subtalar joint was treated as an axis during ankle movement. At approximately postoperative 2 or 3 weeks, the articular hinge was released and the patient began ankle exercises. The clinical outcomes and complications were investigated and the postoperative X- ray examinations of the ankle were also evaluated. Results 19 patients were followed up for a mean period of 13 months. No infection of wound or pin site, no neurovascular complication or no nonunion was found. According to Baird & Jackson ankle joint scoring system, their functional evaluation of the ankle scored from 72 to 98 (averaging 92). Clinical results were excellent in 4, good in 12, fair in 3 and poor in 2. Reduction of the articular surface was anatomic in 16, fair in 3 and poor in 2 according to Burwell & Charnley classification. Conclusions External fixation with an articulated and spanning fixator combined with limited internal fixation is a satisfying technique to treat Pilon fractures. This technique can restore anatomical articular surface, allow early ankle joint motion, effectively decrease complications of both wound and bone healing, and prevent ankle joint stiffness after fixation.

Objective To investigate the methods for emergency treatment of open tibial fractures of type ⅢB. Methods From February 1999 to February 2002, 16 cases of open tibial fractures of type ⅢB (age range: 19 47 years; average age: 27 years; the skin defect area: 4.5cm ?3cm-14cm ?6cm) were treated with administration of antibiotics, debridement, stabilization by unreamed locking intramedullary nails, and finally transfer or transplantation of cutaneous or musculo cutaneous flaps. Autografting from the iliac crest was done for 4 cases with bone defects. Results The follow ups averaged 9 months (ranging from 6 months to 14 months). The survival rate of flaps was 100%and all were free of deep infection. All fractures healed within 6 months in 14 patients and within 10 months in 2 patients. According to the Johner Wruchs method, the functions of ankle and knee were excellent in 14 cases, and good in 2 cases. Conclusion Emergency management of open tibial fractures of type ⅢB with unreamed locking intramedullary nails and skin flap grafting results in good outcome.