Objective To explore the clinic effect of earlier AO solid bone nail fixation for treating tibia and fibula fractures in patients with multiple injuries.Methods Twenty-four patients with multiple injuries combined tibia and fibula fractures were selected between January 2004 and June 2007,including 13 close fractures and 11 open fractures,8 cases of Gustilo gradeⅠ,2 casesof Gustilo grade Ⅱ,1 case of Gustilo grade Ⅲa..All patients underwent closed reduction fixation with AO solid bone nail.Of all the patients,19 had emergency operation,5 had selective operation.Results During 8～29 months following up Among 24 patients,1 case was found with deep infection,1 case complained knee pain,another cases gained excellent clinic results.Conclusion Earlier Intramedullary Nailing fixation for tibia and fibula fractures in patients with multiple injuries can not only easy for early functional exercise,but also easy for nursing care.

Objective To compare the biomechanical differences between injectable calcium sulfate hemihydrate to fill the bone graft fixed and a simple fixed tibial plateau fractures.Methods Create a rabbit osteoporosis tibial plateau collapse fracture model,filled with calcium sulfate bone graft and Kirschner wire fixation on a regular basis based on general observation,the general X-ray,bone mineral density ( BMD ) analysis,non-decalcified biopsy,mechanical loading experiment.Results Ordinary X-ray observations suggested that the fracture zone filled with calcium sulfate gradually degraded and absorbed by new bone tissue replacement.The 1,2,3,4,6,8,12 weeks after the filling of the bone cement treatment group rabbit calcium sulfate bone cement sample of the BMD of the fracture,the axial load carrying capacity was significantly higher than the blank control group,the difference was statistically significant ( P ＜ 0.01 ).Conclusion Osteoporosis rabbit tibial plateau fracture filling calcium sulfate bone cement early can increase bone density,improve the axial load carrying capacity.

Objective To investigate the methods of X-ray diagnosis of various displacement of unstable pelvic fracture in three-dimensional space and its instructive significance in closed reduction.Methods A normal adult pelvic specimen was selected and fixed in a wood-frame at supine position after soft tissue rejection and ligament preservation.With the breakage at the unilateral anterior-posterior ring,models of hemipelvic rotation in the transverse and sagittal planes and hemipelvic vertically upward displacement were induced.Anteroposterior radiographs of the pelvic specimen were made and picture archiving and communication system (PACS) was used to measure width of iliac wing,suprainferior diameter of hemipelvis,vertical displacement of iliac crest,acetabulum roof,pubic tubercle and sciatic tuber and area of obturator foramen.Methods of X-ray diagnosis of various displacements of hemipelvis were concluded and applied in treatment of 43 patients with unstable pelvic fractures.Operation time and intraoperative blood loss were recorded.Postoperative images were evaluated by Matta standard.Results Hemipelvic rotation in transverse plane included eversion and inversion.Width of iliac crest was enlarged and area of obturator foramen was shrunk while extroversion ; on the contrary,an opposite result was observed while inversion.Sagittal rotation included pronation and supination.Pubic tubercle had obvious downward shift,iliac crest presented no change or slight upward shift,suprainferior diameter of hemipelvis was lengthened,iliac roof and sciatic tuber remained their position unchanged and area of obturator foramen was shrunk while pronation; on the contrary,pubic tubercle had obvious upward shift,iliac crest presented no change or slight downward shift,suprainferior diameter of hemipelvis was shortened,iliac roof and sciatic tuber remained their position unchanged and area of obturator foramen was enlarged while supination; iliac crest,acetabular roof,pubic tubercle and sciatic tuber presented equidistant upward shift while the hemipelvis displaced upward vertically.Average operation time was 55 minutes (range,15-85 minutes) and intraoperative blood loss was 26 ml (range,10-50 ml).According to Matta standard,pelvic radiography evaluation at postoperative 3 days was excellent in 31 cases and good in 12 cases,with excellent and good rate of 100％.Conclusion Pelvis X-ray films are able to diagnose various three-dimensional displacement of unstable pelvic fractures and guide closed reduction timely and rapidly to achieve satisfactory result.

ObjectiveTo study the technique and therapeutic effect of percutaneous cannulate screw fixation to treat the traumatic diastasis of the pubic symphysis.MethodsFrom February 2003 to December 2010,46 patients (27 men and 19 women,mean age of 34.6 years) with unstable pelvic fractures and diastasis of the pubic symphysis were admitted.All the patients were treated by closed reduction and percutaneous cannulate screw fixation of the symphysis pubis.Then to complete the fixation of posterior ring,by percutaneous screw inserted through the sacroiliac joint or posterior iliac wing.According to Tile's classification,the patients were classified into type B1.1 in 4 cases,B1.2 in 7,B2 in 2,B3 in 2,C1.1 in 7,C1.2 in 7,C1.3 in 10,C2 in 5 and C3 in 2.All patients were performed posterior ring fixation except 4 cases of type B1.1.Anteroposterior,inlet and outlet X-ray radiographs and CT scans of the pelvis were taken preoperatively to evaluate the stability and deformities,and after surgery the plain radiographs and CT scans were taken to evaluate the reduction and the location of screws.ResultsThe average operative time was 45 min (range,15-65 min),and the average intraoperative blood loss was 25 ml (range,15-50 ml).Each patient was inserted one screw in the symphysis pubis.Thirty-five patients underwent postoperative pelvic CT scan and 3screws of them penetrated the wall of symphysis pubis.The average follow-up period was 23.5 months (range,5-48 months).In the follow-up period,no infection and displacement were found.The last follow-up result:according to Matta and Tornetta's standard,the result was excellent in 43 cases and good in 3.Among all patients,31 cases (67.39％) had returned to their original works,6 were to give up their original works as complicating injuries; 28 cases had no pain,13 cases had slight pain of the symphysis pubis while to make an effort,5 cases had pain of sacroiliac joint.There were no iatrogenic injury of nerve.ConclusionClosed reduction and percutaneous cannulate screw fixation of the traumatic diastasis of the pubic symphysis is a safe,feasible and easy manipulated method.The operative injuries is small and the clinical outcome is satisfactory.

ObjectiveTo investigate the relationship between the imaging manifestations and postoperative efficacy scores through measuring postoperative ankle mortise morphometry of Rüedi-Allg(o)wer Ⅲ pilon fracture.MethodsForty-seven cases of Rüedi-Allg(o)wer Ⅲ pilon fracture patients,including 20 males and 27 females with a mean of 43 years (range,21-65 years) were treated and followed up.Indexes including the width,height,depth,coronal angle and sagittal angle of ankle mortise were measured at the last follow-up.According to the Mazur score at the last follow-up,operated ankle functions were evaluated and divide into three groups (excellent group,good group and poor group.By comparing the five indexes of 47 cases and 3 groups between injury ankle and healthy ankle,we analyzed the correlation of the ankle mortise change and the ankle function.ResultsAll patients were followed up 18-24 months(mean,21 months).The results showed there were significant differences about all the measuring indexes except the height of ankle mortise between the injury ankle and healthy ankle of 47 follow-up cases.About the difference between both sides in 3 groups,the results showed there was a negative correlation between all indexes except the height of ankle mortise and the Mazur score.No correlation was found between the height of ankle mortise and the Mazur score.Recovering the ankle mortise's width,depth,coronal angle as well as sagittal anglein the surgery of severe pilon fractures has a significant effect on ankle function.ConclusionRecovery of the ankle mortise's width,depth,coronal angle as welld as sagittal angle during the surgery of severe pilon fractures has a significant effect on ankle function,so the anatomy of the ankle mortise should be recovered as much as possible.

Objective To compare the effect of novomix30 and metformin in treatment of diabetes mellitus combined with osteoporosis.Methods 117 patients diagnosed as type 2 diabetes mellitus (T2DM) combined with osteoporosis were collected from Sep.2013 to Apr.2017 in our hospital.They were divided into two groups:metformin group (n=53),and novomix group (n=64) according to different therapies.General information of the two groups were comparable.The patients of metformin group reveived calcium,alendronate and metformin.The patients of novomix group received calcium,alendronate and novomix.The lumbar bone mineral density (BMD),greater trochanter BMD,femoral neck BMD,Ward triangle BMD,the serum levels of BGP,alkaline phosphatase (ALP),β-cross-linked C-telopeptide of type Ⅰ collagen(β-CTX),1,25-(OH)2D3,the levels of fasting plasma glucose (FPG),2h plasma glucose (2h PG),HBA1c and adverse reactions were recorded during the treatment.Results The lumbar BMD,greater trochanter BMD,femoral neck BMD,Ward triangle BMD of novomix group were higher than those of metformin group after treatment (P＜0.05).The serum β-CTX levels of novomix group were lower than those of metformin group after treatment (P＜0.05),while the serum BGP,ALP,1,25-(OH)2D3 levels of novomix group were higher than those of metformin group after treatment (P＜0.05).The levels of FPG,2hPG,HBA1c had no significant difference between the two groups after treatment (P＞0.05).The adverse reactions rate of metformin group and novomix group was 28.30％ and 25.00％ respectively,and there was no significant difference between the two groups (P＞0.05).Conclusion Novomix30 can significantly improve bone metabolism level for patients combined with T2DM and osteoporosis,maintain bone remodeling balance,reduce bone loss,and improve BMD,which is worthy to be promoted.