Objective To investigate the feasibility of closed reduction assisted with Kirschner wires for irreducible femoral neck fracture.Methods From June 2008 to April 2011,32 patients with irreducible femoral neck fracture were treated.There were 15 males and 17 females,aged from 21 to 59 years (average,46 years).According to Garden classification,there were 6 of Ⅱ,16 of Ⅲ and 10 of Ⅳ.According to displacement direction of the femoral head showed by preoperative X-rays and CT scans,irreducible femoral neck fracture was divided into 3 types:angulation-impaction (11 cases),rotation-separation (15 cases) and abduction-impaction (6 cases).One to three Kirschner wires were penetrated into the femoral head to reduce the displacement in opposite direction of fracture displacement.After reduction was satisfied,guide pins were penetrated,and then the fractures were fixed with cannulated screws.Results Anatomic or nearly anatomic reduction was achieved in 30 patients after closed reduction assisted with Kirschner wires.Two patients underwent open reduction finally due to failure of closed reduction.The operation time ranged from 40 to 80 min,and the blood loss ranged from 20 to 50 ml.According to Garden index,anatomic reduction was achieved in 29 and acceptable reduction in 1.Among 30 patients who had undergone closed reduction,29 patients were followed up for 12 to 20 months.Bone union was achieved in 28 patients,and the fracture healing time ranged from 4 to 10 months.One patient with rotation-separation displacement before closed reduction underwent total hip replacement due to avascular necrosis of femoral head occurred at 15 months after closed reduction.Conclusion Closed reduction assisted with Kirschner wires is an effective method for irreducible femoral neck fracture,which can achieve satisfactory anatomic reduction rate and fracture healing rate.

BACKGROUND: Compound materials have strong osteogenic ability, which reinforce the substitute materials used alone. Compound material will be commonly used to repair bone defects in tissue engineering. OBJECTIVE: To explore the osteogenic capacity of tetracycline loaded bio-derived bone in vivo. DESIGN, TIME AND SETTING: The randomized controlled observation was performed at Tissue Engineering Laboratory (State Key Laboratory) of West China Center of Medical Sciences, Sichuan University from September 2004 to January 2005. MATERIALS: Twenty-four New Zealand white rabbits were randomly divided into 2 groups (n=12). Rabbit models of radial middle segment defect (1.5 cm) were established. Tetracycline collagen bio-derived bone was made of fresh human bone. METHODS: The tetracycline collagen bio-derived bone was implanted into radial defects of experimental group, and collagen bio-derived bone was implanted into control group. All rabbits were executed 6 and 12 weeks after operation. MAIN OUTCOME MEASURES: Osteogenic condition in all specimens was examined by X-ray and histological methods. RESULTS: Twenty-four animals were included in final analysis. ①X-ray results showed that osteotylus was seen in the whole defect area of the experimental group in postoperative 6 weeks, while only in the defect ends of the control group. In 12 weeks after surgery, new bone tissue filled all defect area of the experimental group, which was basically consistent with normal bone, even medullary canal was formed. Osteogenic images were found in the control group. ②Histological results suggested that new osteoid formation was observed in internal pore zone in the experimental group in 6 weeks, while no bone tissue was found in the control group. In 12 weeks, much woven bone was seen in the experimental group, and lamellar bone structure had formed and medullary cavity of bones had transfixed. Osteoid formation was observed in the control group. CONCLUSION: Both tetracycline collagen bio-derived bone and collagen bio-derived bone can promote bone formation, but tetracycline loaded bio-derived materials show superior effect in repairing defects.

BACKGROUND: Each matrix material alone possesses the limited ability of osteogenesis, so it is a future direction of tissue engineering that apply composite materials on the repair of bone defect by enhancing osteogenesis. OBJECTIVE: To study the osteogenesis ability of collagen loaded bio-derived bone implanted in animals. DESIGN, TIME AND SETTING: A random controlled animal experiment was completed in Tissue Engineering Laboratory of West China Center of Medical Sciences, Sichuan University between January and April in 2004. MATERIALS: Sixteen New Zealand white rabbits were adopted to prepare 1.5-cm segmental defect model at the middle part of radius. Human bone was extirpated from donators, and collagen Ⅰ was the product of Sigma Company. METHODS: Rabbit models were divided into 2 groups by randomization, experimental group and control group, with 8 rabbits in each group. The extirpated bone was made into pure bio-derived bone by means of defatting, decellularization and deproteinization. Collagen loaded bio-derived bone was established by the vacuum absorption of collagen on pure bio-derived bone. Collagen loaded bio-derived bone was implanted into the defects of experimental group, while pure bio-derived bone for the control group. MAIN OUTCOME MEASURES: At 6 and 12 weeks after operation, all specimens were examined by X-ray and histological methods. RESULTS: The result analysis included all of 16 rabbit models. X-ray results showed that, osteotylus was seen in the whole defect area of experimental group at 12 weeks postoperatively, at this time osteogenesis was more obvious compared with 6 weeks, the bridge grafting of defect area was obviously visible. In the control group, osteotylus was only observed on two ends of the defects, no osteogenesis was found in the central part of defect area. Histological results showed that, new osteoid formation could be seen in internal porous zone of the experimental group at 6 weeks postoperatively, while in control group fibrous connective tissue filled internal porous zone and no new bone formed; at 12 weeks, much more woven bone-like tissues were visible and trabecular-like structure had formed in the experimental group, while osteoid tissue could be seen in bone defect area of control group. CONCLUSION: Both pure bio-derived bone and collagen bio-derived bone can enhance osteanagenesis, but collagen loaded bio-derived bone scaffold material is more effective.

Objective To explore clinical effect of surgical treatment of displaced intra-articular calcaneal fractures via modified lateral L-shaped incision.Methods From January 2005 to October 2011,133patients (143 feet) with displaced intra-articular calcaneal fractures,including 125 males and 8 females,aged from 19 years to 65 years (average,43.2 years),underwent open reduction and internal fixation via modified lateral L-shaped incision.There were 56 cases of left calcaneal fractures,67 cases of right calcaneal fractures,and 10 cases of bilateral calcaneal fractures,and all of them were closed fracture.According to Sanders classification,15 feet were classified as type Ⅱ,107 type Ⅲ,and 21 type Ⅳ.The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale were used to access outcomes.Results One hundred and twenty five patients (135 feet) were followed up for 12 to 28 months (average,18.5months).All fractures healed after an average of 13 weeks (range,8-16 weeks).There were on nerve injury or osteomyelitis.Incision dehiscence occurred in 4 feet,which healed after removing the plate.Subtalar joint traumatic arthritis occurred in 17 feet,with walking pain.Collapse of articular surface occurred in 5 feet after weight-bearing.According to AOFAS ankle-hindfoot scale,excellent result was got in 94 cases,good in 29 cases,fair in 14 cases,poor in 6 cases; and the excellent and good rate was 92.9％.Conclusion Open reduction and internal fixation via modified lateral L-shaped incision for treating displaced intra-articular calcaneal fractures can obtain satisfactory results,but the skilled surgical techniques are needed.

Objective To estimate the effect of open reduction and internal fixation for treating the trimalleolar fracture in the elderly.Methods 57 aged patients suffered from the trimalleolar fracture and were treated with internal fixation from January 2009 to June 2012.25 males and 32 females with an average age of 71.5 years ranged from 65 to 81 years were involved in this study.The supination-external rotation type were in 41 cases and pronation-external rotation type in 16 cases according to Lauge-hansen's classification.The posterior and lateral approach was taken for surgical procedure of lateral malleolar frature.The routine or locking plates were used to fix the fratures.The posterior malleolar fractures were usually fixed through the posterolateral approach as well.The screws or tension band fixation was selected for fixing the medial malleolar fragments.The parallel screwing fixation could be helpful for fixing the tibiofibular syndesmosis.Results The ankle function was evaluated by the criteria system of the American Orthopaedic Foot and Ankle Society (AOFAS).The efficacy was excellent in 23 patients,good in 24 patients,fair in 7 patients.The skin problems such as super facial infection and delayed union of incision were in 7 cases.Conclusions If choosing reasonable operation method and suitable internal plant,the open reduction and internal fixation has better effect in treating the trimalleolar fracture in the elderly,with fewer complications.

Objective To explore the clinical characteristics and operative methods of the ankle fracture combined with Tillaux-Chaput and Volkmann fractures.Methods The data of 15 patients who were suffered the ankle fracture combined with the simultaneous fractures of Tillaux-Chaput and Volkmann between Septenber 2005 and January 2012 were analyzed.There were 8 males and 7 females with an average age of 27.3 years (range,16-57 years).All had medial malleolar and fibular fracture with Tillaux-Chaput and Volkmann tubercle avulsed fracture.X-ray film shows that there were 8 cases in which the patients had Tillaux-Chaput fracture,among whom 7 were diagnosed by CT scan.Classified by Lauge-Hansen system,ankle fracture could be divided into pronation-exterual rotation type in 4 cases,and pronation-abduction type in 11 cases.The fracture of fibula and the Volkmann tubercle were treated through the posterolateral approach.The fibular fracture was fixed with plate.The medial malleolar fracture was explored from medial curve approach.Tillaux-Chaput fracture was treated by the mierotubule cut.All patients were assessed with the ankle hindfoot clinical rating system of the American Orthopaedic Foot and Ankle Society (AOFAS).Results All patients were followed up for 8-20 months (average,12.5 months).The fracture healed 12-36 weeks later in all the 15 patients,with an average of 23.5 weeks.Twelve patients walked normally and 3 with mild claudication in the last follow-up.The AOFAS score was average 85.4 points,9 were excellent,4 were good,2were fair,with the good-excellent rate being 86.7％ (13/15).The movement of ankle joint limited in 3 patients,tenderness occurred when weight bearing in 3 patients.Conclusion The ankle fracture include the simultaneous fractures of Tillaux-Chaput and Volkmann were more seen in the type of pronation-abduction.It is often misdiagnosis by the photograph; CT scan should be helpful to find the fracture fragments.The exact reduction and stable fixation were needed in the treatment of the ankle fracture combined with Tillaux-Chaput and Volkmann fractures.Inferior tibia fibular screw was not routinely used in this fracture.

Objective To assess the clinical value of hybrid external fixator combined with limited internal fixation for distal tibial fracture.Methods 22 patients with distal tibial fracture were treated with hybrid external fixator and limited internal fixation from March 2002 to January 2005.In those cases,17 patients were male and 5 patients were female,their age was from 20 to 48 years old,with an averge of 33 years old,all fracture sites were not beyond the ankle joint for 5 cm.Among those cases,18 patients were intraarticular fracture and between them 4 patients belong to Ruedi typeⅡ,14 patients belong to Ruedi type Ⅲ.4 patients were extraarticular fracture.18 patients were close injury and of them 16 patients belong to modified Tscherne typeⅡ,2 patients belong to modified Tscherne typeⅢ.4 patients were open fracture,2 patients belong to GustiloⅡand 2 patients belong to Gustilo Ⅲ.Displaced articular fragments were fixed with cannulated lag screws or Kischner wires,the reduction of extraarticular fracture by adjusting external fixator to acquire.Results All patients were followed-up from 8 to 28 months,mean 18 months and average heal time was 3.2 months.Using Tornetta criteria,excellent 10,good 5,fair 3,with 83% excellent and good rate for intraarticular fracture.Excellent 3,good 1,for extraarticular fracture.There were 20 patients with wound primary healing,2 patients delayed healing and they all were open fracture.Complications included 10? anterior angled malunion in 1 case,and pin tract infection in 2 cases.Conclusion Using this metheod treated distal tibial fracture can reduce soft tissue injury,can obviously reduce the wound infectious rate and admit early motion of ankle joint,so it is beneficial to early restore the ankle joint's function.

Objective To assess the clinical value of limited internal fixation combined with hinged super-articular external fixator for the treatment of elbow fracture. Methods 10 patents with elbow fracture were treated with hinged external fixator from March 2001 to November 2002. It involved 8 males and 2 females, aged from 22 to 46 years. There were 4 humeral intercondylar fractures of Riseborough type Ⅳ, the fractures were fixed with few cancellous or interfacial screws through the postero-medial approach, the olecranon and the attached triceps were reflected proximally after the olecranon osteotomy. Among the other 6 severe fracture-dislocations of the elbow, 2 complicated with fracture of the coronoid process; 1 fracture of the Regan type Ⅲ, whose fragments were over 50% of the coronoid process, was fixed with screws; another 1 fracture of the Regan type Ⅱ, whose comminution was less than 50%, was sutured with the joint capsule from proximal to distal part; 2 combined with radial head fracture of Mason type Ⅳ, both selected the lateral elbow approach, 1 with resection because of comminution, the other was fixed nearly the 2/3 of its whole dimension; and 2 with olecranon fracture were fixed with tension-band wire. Results All 10 patients were available at final follow up, the mean duration was 12 months (range, 6-18 months). According to the Morry scoring system, there were 6 excellent, 3 good, 1 fair, and the effective rate was 90%. 8 cases united in the first-stage, the other 2 achieved delayed union because of open fracture. Conclusion The technique of hinged external fixator for the fractures around elbow not only can help to stabilize the fractures but also allows early rehabilitation. In comparison with other methods, it can better improve the function of elbow, so it is an effective treatment for this kind of injury.

Objective To evaluate the causes of complications of patients with femoral Intertrochanteric fractures after gamma3 nail fixation.Methods A retrospective analysis was conducted to summarize the treatment of intertrochanteric fractures in 186 cases with Gamma3 nail from May 2006 to July 2011.Complications occurred in 24 cases during the operations.19 were males,5 females,with the age from 42 to 81,the average age of 69.00±3.27 years.According to AO/OTA classification,8 cases were type A1,1 case were type A2.1,15 cases were type A3.All patients included were acute fractures,while pathological fractures were excluded.Supine position were selected during operation,close reduction were performed in traction bed.Gamma3 nail made by Stryker Company was used to fix fractures through small incisions.Operational times were from 45 to 160 minutes,averaged by 80 min.Blood lose were 300-800 ml in average.No patient need blood transfusion.The procedure from hospitalized to operation is from 3 to 12 days,6 days in average,discharged from 3 to 16 days after operation.According to the intraoperative and postoperative follow-up evaluation of the X-ray and Harris evaluation criteria,Gamma3 nail complications were summarized in the application.Results Time of surgery in 24 cases were 45-160 min,average 80 min.Blood loss were 300-800 ml,average 600 ml,walking time 35-106 d.Harris evaluation were 75-91 point,average 81 point.The anti-spiral nail dropped into inner thigh muscles occurred in 1 case,causing defects of femoral lateral wall in 3 cases.Splitting fractures occurred in the proximal femoral shaft during the operations in 5 cases,poor fracture reduction during closed reduction in 6 cases.Fracture site were shifted lately postoperative in 5 cases,lag screw cut-out in 3cases and refracture in the site of distal femoral interlocking nail in 1 case.Conclusion Higher incidence of complications were occurred in some special types of AO classification when using close reduction and short Gamma3 nail.The reduction method,wrong indication selection and unreasonable application of equipment may result in the occurence of complications.We,therefore,should use long or short Gamma nail according to their respective induction method and scope of its application,aiming to avoid complications.

In the elderly, patient who suffered from hip fracture need to stay in bed for a long time and has a higher prevalence of complications and mortality. Considering the factors of patients in the intraoperative death and postoperative re?habilitation, we take appropriate treatment measures during preoperative, intraoperative and postoperative period respective?ly based on the concept of Enhanced Recovery. Patient will benefit from rapid rehabilitation and reduction of incidence of complications and mortality. ERAS includes preoperative fasting, preventive anagelsia, intraoperative temperature control, anesthesia and surgical approach, postoperative intravenous restriction, nutritional support and painless early motion. This ar?ticle intends to review the security , reliability and clinic efficacy of ERAS.