OBJECTIVE:To observe the clinical efficacy and sequela of Salvia miltiorrhiza treatment for severe craniocere-bral injury patients after operation. METHODS:60 severe craniocerebral injury patients were randomly divided into control group and treatment group with 30 cases in each group. Control group was given routine and symptomatic treatment after clearance of hematoma by craniotomy or decompressive craniectomy according to the patient’s condition;treatment group was additionally giv-en intravenous injection of Danshen injection 20 ml/d for 7-10 days 3-5 days after operation without hemorrhagic tendency,on the basis of control group,and then given Compound danshen dropping pills instead (10 pills/time,3 times/d) for one month. GCS score,GOS score,intracranial pressure and brain CT,the levels of ET and CRP were compared between 2 groups after op-eration. The occurrence of sequelae were evaluated 3 months after operation. RESULTS:After the operation,S. miltiorrhiza treat-ment could increase GCS score and GOS score,reduced intracranial pressure and brain edema of craniocerebral injury patients, and the improvement of clinical symptoms in treatment group was significantly faster than in control group,with statistical signifi-cance(P<0.05 or P<0.01). The postoperative S. miltiorrhiza treatment could decrease the levels of ET and CRP in patients with craniocerebral injury in the time-dependent manner,the decreased of treatment group was significantly faster than that of control group,with statistical significance (P<0.05 or P<0.01). The effective of postoperative sequelae improvement was 93.3% in treatment group,which was significantly higher than that of control group(76.7%),with statistical significance(P<0.05). CON-CLUSIONS:Postoperative S. miltiorrhiza treatment can improve the clinical symptoms of severe craniocerebral injury patients,re-duce the incidence of complication and improve the prognosis. The effect may be related to the decrease of plasma ET and CRP levels.

Objective:To compare the clinical outcomes between OTA/AO-C open and closed fractures of the distal humerus treated by open reduction and internal fixation.Methods:The clinical data were retrospectively analyzed of the 70 patients who had been treated at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital for OTA/AO-C fractures of the distal humerus from January 2014 to June 2017. Of them, 22 suffered from open fractures (Gustilo types Ⅰ/Ⅱ) and 48 closed fractures. There were 18 males and 4 females with an age of (42.6±13.0) years in the open group and 21 males and 27 females with an age of (42.2±17.1) years in the closed group. Analyzed were interval from injury to surgery, hospitalization time, injury energy and functional outcomes which included range of motion (ROM) in elbow flexion and extension, ROM in elbow rotation, Mayo elbow performance score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH), complications and rate of secondary surgery.Results:There was no significant difference between the 2 groups in age, injury energy or interval from injury to surgery ( P>0.05), but there were significantly more males in the open group than in the closed group ( P=0.011). The follow-up time for all the patients averaged 34.0 months (from 25 to 54 months). There were no statistically significant differences between the 2 groups in hospitalization time [9.5(6.0, 13.0) d versus 8.5 (6.0, 11.0) d], ROM in flexion and extension [120.0° (100.0°, 137.8°) versus 128.5° (110.0°, 140.0°)], ROM in rotation [155.0° (151.3°, 155.0°) versus 155.0° (155.0°, 155.0°)], MEPS [95.0 (80.0, 100.0) versus 95.0 (80.0, 100.0)] or DASH [2.6 (0.63, 9.2) versus 1.7 (0.0, 8.5)] ( P>0.05). There were no statistically significant differences between the 2 groups either in rate of secondary surgery [36.4% (8/22) versus 33.3% (16/48)], ulnar nerve symptoms [54.5% (12/22) versus 60.4% (29/48)], local irritability in the region of internal fixation [9.1% (2/22) versus 6.3% (3/48)] or elbow stiffness [13.6% (3/22) versus 10.4% (5/48)] ( P>0.05). Conclusion:Open reduction and internal fixation can lead to similar clinical outcomes in the treatment of both open (Gustilo types Ⅰ/Ⅱ) and closed distal humeral fractures of OTA/AO-C, with no significant differences in postoperative ROM, functional scores or complications.

Objective To investigate the treatment of radi us head fracture through internal fi xation.Methods 42cases of radius head fracture trea ted with internal fixation were foll owed up.Mason classification and Broberg and Morrey criteria were use d to analyze the correlation between the results and the factors of fractu re type and method of fixation.Results42cases were followed up for a mean time of 25months.Evaluation was done according to Broberg and Morrey score systems.The function recovered we ll in 76%of the cases.The results of minor plate group were better than th ose of the screw(P=0.01)or K wire group(P=0.04).The results of Mason typeⅡwere better than those of the typeⅣ(P=0.03).Conclusion Treatment of radius head fracture with internal fixation will improve the elbow function and has better result for Mason typeⅡ.Fixation with minor plate is better than with screw or K wi re.[

Chronic elbow dislocation has a low incidence, but high disability rate, often leads to complications such as stiffness and instability, whose management is still a huge challenge in orthopedics traumatology. The mainstream strategy now is to reduce the elbow after extensive soft tissue release, repair or reconstruct collateral ligaments, stabilize the elbow with a hinged external fixator, and start rehabilitation as soon as possible. However, as evidence supporting treatment approaches comes mostly from small case series and case reports, controversies still remain in some intraoperative issues, such as the choice of surgical approach, the indications and methods of triceps lengthening and the reconstruction of ligaments. Combining relevant literature and clinical experience, the authors discussed the research progress in diagnosis and treatment of chronic elbow dislocation, suggesting that clinical doctors should focus on prevention rather than treatment of this disease, and advocated further reducing the incidence and disability rate of chronic elbow dislocation.

Objective To investigate the situation of concomitant anxiety in posttraumatic elbow stiffness and analyze the risk factors for posttraumatic elbow stiffness.Methods Participants for this investigation were the outpatients who had sought special medical attention for elbow injury from September to October, 2017 and from May to June, 2018 at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. Their demographic and injury-related data ( gender, age, education, injury time, injury type, treatment and rehabilitation ) were collected through questionnaires. Self-rating Anxiety Scale ( SAS ) was used to evaluate their anxiety. The range of motion ( ROM ) of the elbow was measured by the same qualified orthopedist. The relationship between posttraumatic elbow stiffness and anxiety and risk factors for stiffness were analyzed sta-tistically. Results The proportion of concomitant anxiety ( 39.2%) in the patients with posttraumatic elbow stiffness was significantly higher than that in those without posttraumatic elbow stiffness ( 10.5%, P＝0.021 ) . The SAS score for the patients with posttraumatic elbow stiffness ( 47.6 ± 11.6 ) was significantly higher than that ( 38.9 ± 8.2 ) for those without posttraumatic elbow stiffness ( P＝0.004 ). Passive rehabil-itation was a risk factor for flexion-extension stiffness. Complex intra-articular fracture, high-energy injury and passive rehabilitation were risk factors for limited forearm rotation. Conclusions Our study suggests the comorbidity of posttraumatic elbow stiffness and anxiety. Complex intra-articular fracture, high-energy injury and passive rehabilitation are risk factors for forearm rotational stiffness after elbow trauma. Passive rehabil-itation is also a predictor of less range of flexion-extension of the elbow.

Objective:To compare the outcomes between hook thin plate compression technique and conventional screw-plate fixation in the treatment of adolescent tibial tubercle avulsion fractures.Methods:A retrospective analysis was performed of the 43 adolescent patients with tibial tubercle avulsion fracture who had been treated at Department of Orthopedics and Traumatology, Beijing Jishuitan Hospital from January 2018 to October 2020. There were 42 males and one female, aged from 13 to 17 years. According to their treatment methods, they were divided into an observation group (9 cases) treated with hook thin plate compression technique and a control group (34 cases) treated with fixation with cannulated screws alone or in addition with a 1/3 tube plate. The maximum range of knee flexion, B?stman score, and cases returning to school at one month after operation, as well as fracture union time, B?stman score and cases with complications at the last follow-up were compared between the 2 groups.Results:There were no significant differences in the preoperative general data between the 2 groups, showing comparability ( P>0.05). By the postoperative one month, the maximum range of knee flexion [90.0° (85.0°, 102.5°)], B?stman score [21.0 (18.5, 21.0)] and cases returning to school (7) in the observation group were significantly better than those in the control group [22.5° (15.0°, 30.0°), 11.0 (10.0, 13.0), and 0] ( P<0.001). The last follow-up revealed no significant differences between the 2 groups in frature union time [(2.7±0.5) months versus (2.8±0.5) months], B?stman score [30.0 (30.0, 30.0) versus 30.0 (30.0, 30.0), 30.0)] or cases with complications (1 versus 2) ( P>0.05). Conclusion:In the treatment of adolescent tibial tubercle avulsion fractures, compared with conventional fixation with cannulated screws alone or in addition with a 1/3 tube plate, hook thin plate compression technique may lead to better outcomes, because it allows early rehabilitation to shorten the postoperative immobilization time and promote early functional recovery.

Total elbow arthroplasty (TEA) is an effective surgical method for treatment of end-stage elbow arthritis. However, compared with hip and knee arthroplasties, the implant survival rate of TEA remains low, with a high postoperative complications rate and a high revision rate. The main reasons for revision include aseptic loosening, periprosthetic infection, periprosthetic fracture, component failure, and postoperative instability, of which the most common cause is aseptic loosening. Unlike the initial TEA, revision surgery usually needs to deal with complicated conditions such as infection, scars, bone defects, prosthetic stem extraction and cement removal, making the operation more difficult. There are few clinical studies related to TEA revision in China. Therefore, the authors review the reasons for postoperative revision, the management of key intraoperative issues, and the outcomes of treatment to provide the basis for future clinical application and academic research of TEA revision surgery in China.

Objective To compare the function outcome and complication of emergency operation and staged operation with enhanced recovery after surgery (ERAS) for Gustilo type Ⅰ &Ⅱ open distal humeral fractures.Methods Retrospective analysis of 22 patients with Gustilo type Ⅰ & Ⅱ open distal humeral fractures who were treated in Department of Orthopeaedic Trauma,Beijing Jishuitan Hospital from July 2013 to June 2017 was conducted.There were 18 males and 4 females,aged (42.5± 13.0) years,with an age range of 14-65 years.According to different treatment methods,all patients were divided into two groups:emergency operation group (n =6),direct internal fixation after emergency debridement;staged operation group (n =16),emergency debridement and suture,performed the second period of fixed treatment after the soft tissue condition to improve.Patient's waiting time from emergency to surgery,fasting time,surgery time,intra-op blood loss,hospital stay time,elbow range of motion,Mayo elbow performance score (MEPS),secondary surgery rate and complication at the last outpatient visit at 1,3,6,12 and June 2018,post-operatively were recorded.The measurement data of normal distribution and homogeneity of variance were expressed as mean ± standard deviation (Mean ± SD),and the independent sample t test was used for comparison between the two groups;the measurement data not conforming to the normal distribution were expressed as [M(P25,P75)].The rank sum test was used for comparison between the two groups.Comparison of count data between the two groups was performed by x2 test or Fisher exact probability method.Results The time from emergency to surgery of emergency group and staged group was [5.1(4.5,7.3) h],[160.0(102.9,221.2) h],respectively,P ＜0.001.Fasting time was [5.1(4.5,7.3) h],[12.1(9.7,13.2)h],P＜0.001.Hospital stay time was [5.5(5.0,6.5) d],[11.5(9.0,13.0) d],P=0.001.These differences were significant.Surgery time was [3.0 (2.0,3.6) h,2.6 (2.0,3.4) h].Intra-op blood loss was [75.0(25.0,225.0)ml,100.0(100.0,200.0)ml].Elbow range of motion was [155.0(141.3,155.0)°,155.0 (143.8,155.0) °].MEPS was [95.0 (83.8,100.0) scores,90.0 (80.0,100.0) scores].Secondary surgery rate was(33.3％ vs.31.2％).Complication rate was (83.3％ vs.68.7％).These differences were not significant (P ＞0.05).Conclusions ERAS's quick emergency surgery for Gustilo type Ⅰ&Ⅱ open distal humeral fractures significantly reduces the waiting time from emergency to surgery,fasting time and hospital stay time.Function outcome is comparable to the staged group.Therefore,emergency surgical procedures are recommended for patients with Gustilo typeⅠ&Ⅱ open distal humeral fractures.

Objective: To explore the risk factors for elbow stiffness after open reduction and internal fixation (ORIF) for intercondylar fractures of the distal humerus. Methods: From January 2013 to May 2017, 159 patients underwent ORIF for intercondylar fractures of the distal humerus with dual plating. They were 83 males and 76 females with a mean age of 42.6 years (from 14 to 79 years). They were divided into 2 groups according to their range of motion at the latest follow-up and the secondary elbow arthrolysis they had undergone or not. The stiffness group had extension-flexion and/or pronation-supination <100° and secondary elbow arthrolysis while the non-stiffness group had extension-flexion and pronation-supination ≥100° and no secondary elbow arthrolysis. Age, gender, fracture side, mechanism of injury, AO fracture classification, open/close fracture, additional fracture, preoperative nerve injury, time from injury to surgery, surgical approach, configuration of plating, medication for anti-heterotopic ossification and implant removal were analyzed as risk factors for elbow stiffness using Logistic regression analysis. Results: The mean follow-up period for this cohort was 32.0 months (from 10 to 63 months). The latest follow-up showed fracture union in all the patients. The stiffness group had 38 patients and the non-stiffness group 121. Multivariate regression analysis showed that high energy trauma (OR=3.141, 95%CI 1.396~7.070, P=0.006) and time from injury to surgery >one week (OR=2.596, 95%CI 1.123~6.000, P=0.026) were independent risk factors for elbow stiffness after ORIF for intercondylar fractures of the distal humerus. Conclusion The patients with high energy trauma and time from injury to surgery >one week should be treated with caution and special care in clinical practice because the 2 factors are closely related to posttraumatic elbow stiffness after ORIF for intercondylar fracture of the distal humerus.

Objective: To compare the clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by open reduction and internal fixation (ORIF) with either parallel or orthogonal double-plate. Methods: From January 2013 to December 2017, 54 patients with humeral intercondylar fracture were treated at Department of Orthopedic Trauma, Jishuitan Hospital by ORIF with anatomical locking compression plate (LCP) (either parallel or orthogonal double-plate configuration). According to their age, the patients were divided into a young group (from 18 to 30 years old) of 29 cases with an age of 25.5±3.6 years and an elderly group (≥60 years old) of 25 cases with an age of 67.1±5.8 years. The 2 groups were compared in terms of perioperative data, ranges of motion (flextion, extension and rotation), numeric rating scale for pain (NRS), Mayo Elbow Performance Score (MEPS) and quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) at the last follow-up, complications and secondary surgery. Results: The 2 groups were comparable because there were no significant differences in the preoperative general data except in injury energy, combined injury and gender between them (P>0.05). The young group had significantly more cases of high-energy injury and combined injuries than the elderly group(P<0.05). All patients were followed up for 33.6±15.0 months (from 12 to 63 months). The total blood loss in the elderly group (643.9±298.7 mL) was significantly less than that in the young group (953.9±554.6 mL) (P<0.05). At the last follow-up, there were no significant differences between the 2 groups in ranges of motion, NRS or MEPS (P>0.05), but the elderly group had significantly higher Quick-DASH scores (13.9±14.4 points) than the young group (5.7±8.9 points) (P<0.05). There was no significant difference in postoperative elbow stiffness or postoperative ulnar nerve symptoms betwee the 2 groups (P>0.05), but the rate of secondary surgery in the young group (37.9%, 11/29) was significantly higher than that in the elderly group (4.0%, 1/25) (P<0.05). Conclusions In the treatment of humeral intercondylar fractures, ORIF with LCP (either parallel or orthogonal double-plate configuration) can lead to similarly safe and effective clinical outcomes for both young and elderly patients.