Objective To explore the effect of anterior decompression plus posterior intradural release in treatment of old thoracolumbar fractures with paraparesis. Methods A total of 22 patients with old thoracolumbar fractures with paraparesis were admitted to our hospital since January 2004 to Jan-uary 2008. Before admission, all patients were treated with decompression and internal fixation with pos-terior pedicle system, with bony compression to the spinal cord found through CT scanning and intact spi-nal cord found by MRI but without obvious neurofunction recovery. Of all, 20 patients were kept with the original posterior fixation except for two patients that were fixed with Z-plate after removal of posterior hardware. Autologous bone grafts from iliac were utilized in all patients. Intradural release was done 3-6 months after anterior decompression. Results Of all, 19 patients were followed up for 17-49 months (average 28 months). Twenty patients obtained varied recovery of neurofunction after anterior decompres-sion, with ASIA motor scores increasing from average 59.4 points before decompression to 71.3 after de-compression. The followed-up patients won further recovery after secondary posterior intradural release, with ASIA motor scores further increasing to average 80.6 points. Conclusion For patients with old thoracolumbar fractures combined with paraparesis, the release of intradural sear and fibrocompression is also important besides anterior decompression.

BACKGROUND:For the treatment of distal tibial fractures, open reduction and plate fixation, minimal y invasive percutaneous plate fixation and intramedul ary nail fixation are effective, but each has advantages and disadvantages. OBJECTIVE:To compare the effects of intramedul ary nail combined with blocking screws versus minimal y invasive percutaneous plate fixation in treating distal tibial fractures. METHODS:Fifty-one cases of distal tibial fractures were divided into two groups. The blocking screw group (23 cases) was treated with closed reduction and internal fixation with interlocking nail combined with blocking screws. The plate fixation group (28 cases) was treated with minimal y invasive percutaneous plate fixation. Fracture healing time, recovery of tibial function and complication occurrence were observed during fol ow-up. RESULTS AND CONCLUSION:Al patients were fol owed up for 8 to 32 months. (1) Except one patient in the plate fixation group, the other patients had bony union. The healing time was (4.6±1.7) months in the blocking screw group and (6.9±2.3) months in the plate fixation group. Significant differences in healing time were detected between the two groups (P<0.05). (2) The excel ent and good rate of tibial function recovery was significantly higher in the blocking screw group (100%) than in the plate fixation group (82%) (P<0.05). (3) No significant difference in the incidence of adverse events was determined between the blocking screw group (13%) and plate fixation group (18%) (P>0.05). (4) Results suggested that interlocking intramedul ary nail combined with blocking screw fixation in the treatment of distal tibial fractures can promote fracture healing and joint function recovery.

Objective To explore the incidence of tibial plateau fracture with ligament injuries and the early diagnosis and management of the condition. Methods Fifty seven cases of tibial plateau fractures which had been treated operatively from Jan. 2001 to Jun.2003 and had satisfactory reduction of the articular surface were reviewed. The stability of their knee joints was analyzed. Results The follow up lasted 6 to 30 months with an average of 15 months. The incidence of knee unstability was low. The four potential reasons for the postoperative knee stability were found to be: 1) the low prevalence of ligament injury with displaced fractures of tibial plateau; 2) incomplete ligament disruption or mild ligament injury; 3) anatomic reduction and rigid internal fixation; 4) fine and detailed plan for immobilization and functional exercise. Conclusion The prevalence of complete ligament disruption is low, and nonoperative management can result in satisfactory outcomes for tibial plateau fracture with incomplete ligament injury.

Objective To compare intramedullary nailing assisted by minimally invasive cerclage with simple intramedullary nailing in the treatment of femoral long oblique subtrochanteric fractures.Methods From April 2010 to September 2015,our department treated 39 patients with femoral long oblique subtrochanteric fracture.Of them,16 were treated by cephalomedullary nailing combined with minimally invasive cerclage (observation group of 11 males and 5 females with an average age of 42.8 ± 13.2 years) and 23 by simple cephalomedullary nailing (control group of 17 males and 6 females with an average age of 46.2 ± 10.1 years).Their operation time,intraoperative blood loss,radiologic results (union time and alignment) and functional results [Visual Analog Scale (VAS) and Harris hip score] were compared between the 2 groups.Results The 39 patients were followed up from 12 to 30 months (average,15 months).For the observation group,the varus angle (2.2°± 1.4°) was significantly smaller than for the control group(4.1°±2.2°),the VAS scores at 1 and 3 months postoperatively (3.43 ± 1.54,1.13 ± 1.20) were significantly lower than for the control group (5.61 ± 1.41,3.34 ± 1.82),and the clinical union ratio at 3 months postoperatively(87.5％,14/16) significantly higher than for the control group (47.8％,11/23) (P ＜ 0.05).There were no significant differences between the 2 groups in terms of operation time,intraoperative blood loss,Harris hip score at one year postoperatively,VAS score at 6 months postoperatively,or clinical union ratio at 6 or 12 months postoperatively(P ＞ 0.05).Conclusions Cephalomedullary nailing is effective for the treatment of femoral long oblique subtrochanteric fractures no matter it is assisted by minimally invasive cerclage or not.However,since minimally invasive cerclage has the advantage of improving reduction and mechanical stability,combination of minimally invasive cerclage and cephalomedullary nailing may be more advantageous in early pain-relieving and functional recovery.

Objective To analyze the causes of postoperative step off of the tibial plateau fracture and to suggest strategies to cope with them. Methods 57 cases of tibial plateau fracture who had been treated operatively in our department from January 2001 to June 2003 with satisfactory reduction of the articular surface were reviewed. Their radiograms were analyzed. Results The follow ups lasted 6 to 30 months (average 15 months). Postoperative step off rate was 28.1%in all the cases according to radiological step off criteria. (A depression of the articular surface more than 3 millimeters or malalignment of the extremity more than 5 degrees is considered as step off.). Six causes of loss of reduction were: 1) more than sixty years of age, 2) severe osteoporosis, 3) preoperative displacement and fracture fragmentation, 4) poor anti shearing strength of screw and plate, 5) loose bonegraft, and 6) premature weight bearing. Conclusions The key points to enhance the outcome include precise judgment of the type of fracture, sufficient amount of bonegraft, rigid internal fixation after anatomic reduction and an appropriate plan for performing early, loadless, functional exercise. The traumatic osteoarthritis may be avoided or deferred if the above mentioned six causes can be taken into full consideration or preventive measures can be taken.