Objective To probe the effects of interlocking intramedullary nail fixation in treatment of long bone fractures, evaluate the application of intramedullary nail fixation treatment of long bone fractures, and explore the complications and their management. Methods Retrospective study of 2126 cases with long bone fracture treated with interlocking intramedullary nail from January 1996 to January 2004 was carried out. Of them, 1089 cases were followed up, and the average follow-up duration was 4 years (1 to 8 years). The locations of fracture were tibial and fibular in 603 cases, which were left in 237 cases and right in 331 cases and bilateral in 35 cases, close fracture in 511 cases of type C 240 cases, type A of 134 cases and type B 137 cases, open fracture 92 cases of Gustilo Ⅰ type 63 cases and Gustilo Ⅱ type 29 cases; femoral fractures in 360 cases, which were left 136 cases, right 205 cases and bilateral 19 cases, close fracture 319 cases of type C 191 cases, type A 103 cases, type B 25 cases; Open fracture 41 cases; Humeral fractures in 126 cases, which were left 49 cases, right 71 cases and bilateral 6 cases, close fracture 113 cases of type C 24 cases, type A 64 cases and type B 25 cases; Open fracture 13 cases. Results Fracture healing rate was 93% in interlocking intramedullary nail fixation treatment of long bone fracture. Complication included fracture nonunion rate 7%, infection rate 3%, fat embolism syndrome 2%, nail and locking bolts broke 2%, iatrogenic fracture 1.3%, knee pain in patients with tibia shaft fracture after interlocking intramedullary nail treatment 35%. Conclusion Interlocking intramedullary nail is more suitable for long bone fracture because it can result in more reliable fixation, less operative trauma. It can be used as the first alternative to treat long bone fractures.

[Objective]To explore a new therapy for postoperative non-union distal humeral frature.[Method]From January 2000 to January 2005,27 cases of non-union after internal fixation operations of distal humeral fractures were treated with retrograde intramedullary nailing combined with bone graft.[Result]All cases were followed up form 6 months to 32 months,with an average of 16 months.All the non-union were healed and joint function resumed to normal.No infection,no nail and locking bolts broken and no humeral distal fracture were found.[Conclusion]Retrograde intramedullary nailing combined with bone graft is an effective therapy for postoperative non-union of distal humeral fracture.

[Objective]To present a validated two-functional spinal unit C4~7 finite element model with simulated placement of a disc prosthesis treatment to predict stresses and strains within adjacent vertebal bodies. [Methods]Two finite element models of C4~7 were generated using the CT scans taken from a male patient following placement of a disc prosthesis treatment,which were included with adjacent bodies,intervertebral discs. Simulations were conducted imposing a compression preload combined to a flexion/extension moment,a pure lateral bending moment and a pure torsion moment,and to quantify the stress levels in intervertebral discs,endplate,cancellous bone,cortical bone and adjacent bodies following placement of a disc prosthesis under clinically relevant loading conditions.[Results]The BryanTM disc prosthesis allows to correctly reproduce a physiological motion at the implanted level,and the changes in stresses and strains in levels adjacent to a placement of a disc prosthesis treatment level were minimal.[Conclusion]The artificial cervical disc prosthesis well restores the biomechanical behavior of the intact spine. Moreover,the selection of surgical indications and proper manipulations shoule bve paid more attehtion to.

Objective To explore a new surgical procedure of open reduction and internal fixation for intraarticular fractures of calcaneus and its clinic outcome. Methods Between August 2004 and August 2005, 54 feet in 44 patients with calcaneal fracture were treated in our department. Based on the results of X-ray and coronal CT scan before and after treatment, small incision (2-3 cm) at lateral sides of calcaneus, self-made calcaneal anatomical plate and stud bolt were used. According to Sanders classification system, there were 12 cases of type Ⅱ, 32 cases of type Ⅲand 10 cases of type Ⅳ. Results The internal fixation with the calcaneal anatomical plate almost restored the height, length, width, Blher's and Gissane's angles of the calcaneus for the 44 patients. No infection of incision happened. The results were evaluated using Maryland Foot Score. 54 fractures were followed up for 2 to 12 months (averaging 8.3 months) after treatment. Excellent results were noted in 26 fractures,good in 24,fair in 4, and the excellent and good rates were 92.6%. Conclusion The open-reduction and internal fixation with self-made calcaneal anatomical plate and stud bolt is one of the best ways for treatment of fracture of calcaneus.

Objective To discuss the clinical effect of hallux valgus deformity treated with minimally invasive the first metatarsal distal osteotomy. Methods The data of 375 cases (626 feet) treated with minimally invasive the first metatarsal distal osteotomy was retrospectively analyzed. Hallux valgus angle was21°-65°(mean37.61°±9.25°), intermetatarsal (IM) anglewas7° -21° (mean 13.03°± 3.73°). The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was (46.5 ± 9.4) pints. Results The patients were followed up 12-30 months [mean (18.5 ± 6.8) months]postoperation, hallux valgus angle was 7.18°±4.55°,intennetatarsal angle was 5.07°± 1.70°,with a mean angle decreasing 30.54° and 12.33°.The AOFAS score was (84.8±7.6) points (P <0.01). Conclusion According to the hallux valgus angle,intermetatarsal angle and the length of the first metatarsal,decide the place and method of osteotomy, the hallux valgus can be corrected in three-dimensional and get an excellent effect.

BACKGROUND: Vascular endothelial growth factor (VEGF) is able to effectively treat the ischemic heart disease, but in vivo VEGF cannot be maintained effective concentration. OBJECTIVE: To detect the expression of VEGF mRNA and protein in human bone marrow mensenchymal stem cells transferred by VEGF-165 gene. DESIGN, TIME AND SETTING: The empirical study was conducted from March 2006 to April 2007 at Shanghai Chest Hospital. MATERIALS: Human bone marrow mesenchymal stem cell line and VEGF were offered by Basic Laboratory, Thoracic Tumor Institute, Shanghai Chest Hospital. METHODS: hVEGF165 gene was reconstructed in pcPGK-vector and transferred into human bone marrow mensenchymal stem cells (BMSCs) by liposome-mediated method, clone screening by G418. MAIN OUTCOME MEASURES: The mRNA and protein of VEGF gene in transferred cells was detected by reverse transcription-polymerase chain reaction (RT-PCR), Real time PCR, Western Blot, enzyme linked immunosorbent assay (ELISA) in 3 stem cells of pcPGK-VEGF165-IRES-GFP and pcPGK- IRES-GFP, respectively. RESULTS: pcPGK-hVEGF165 vector was reconstructed and transferred into hMSCs successfully. The expression of hVEGF165 in the transfected hMSCs was demonstrated with RT-PCR and Real time PCR. Western Blot and ELISA demonstrated that the expression of hVEGF165 in the transfected hMSCs and VEGF protein in supernatant were significantly more than untransfected hMSCs. CONCLUSION: hVEGF165 can be successfully transfected into BMSCs by using liposome mediated gene transfer. Stably expressed VEGF165 cell line can be obtained..

Objective To measure the normal sagittal and coronal diameters of thumb and great toe distal phalanx bottom by ultrasonography. Methods One hundred and twenty volunteers' sagittal and coronal diameters of thumb and great toe distal phalanx bottom were measured by ultrasonography. The measurements was analysed by the statistical method. Results The thumb and great toe distal phalanx bottom showed hyperechoic zone,clear boundary with the adjacent fascia and tendon tissue showed low echo area at cross section by high frequency ultrasound. The sagittal diameters of thumb distal phalanx bottom was (8. 07 ± 0. 67)mm in men, while that of great toe distal phalanx bottom was (8. 34 ± 1. 02) mm( t = 1.73, P =0.86).The coronal diameters of thumb distal phalanx bottom was (11.61 ±0.89)mm in men, while that of great toe distal phalanx bottom was (14. 25 ± 0. 84)mm( t = 16. 77, P = 0. 00). The sagittal diameters of thumb distal phalanx bottom was (7. 52 ± 0. 62) mm in women, while that of great toe distal phalanx bottom was (7. 72 ± 0. 67) mm( t = 1. 72, P =0. 14). The coronal diameters of thumb distal phalanx bottom was (10.94 ± 0.97) mm in women, while that of great toe distal phalanx bottom was (13. 51 ±0. 75) mm( t =16.21, P = 0.00). Conclusions The normal sagittal and coronal diameters of thumb and great toe distal phalanx bottom measured by the ultrasonography can guide the operation of wrap-around flap of a great toe with phalanx ungual for thumb II degree defect reconstruction.

The purpose of this study was to compare the biomechanical stability obtained by using our technique featured an anatomical plate and compression bolts versus that of the conventional anatomic plate and cancellous screws in the fixation of intraarticular calcaneal fractures. Eighteen fresh frozen lower limbs of cadavers were used to create a reproductive Sanders type-III calcaneal fracture model by using osteotomy. The calcaneus fractures were randomly selected to be fixed either using our anatomical plate and compression bolts or conventional anatomic plate and cancellous screws. Reduction of fracture was evaluated through X radiographs. Each calcaneus was successively loaded at a frequency of 1 Hz for 1000 cycles through the talus using an increasing axial force 20 N to 200 N and 20 N to 700 N, representing the partial weight bearing and full weight bearing, respectively, and then the specimens were loaded to failure. Data extracted from the mechanical testing machine were recorded and used to test for difference in the results with the Wilcoxon signed rank test. No significant difference was found between our fixation technique and conventional technique in displacement during 20-200 N cyclic loading (P=0.06), while the anatomical plate and compression bolts showed a great lower irreversible deformation during 20-700 N cyclic loading (P=0.008). The load achieved at loss of fixation of the constructs for the two groups had significant difference: anatomic plate and compression bolts at 3839.6±152.4 N and anatomic plate and cancellous screws at 3087.3±58.9 N (P=0.008). There was no significant difference between the ultimate displacements. Our technique featured anatomical plate and compression bolts for calcaneus fracture fixation was demonstrated to provide biomechanical stability as good as or better than the conventional anatomic plate and cancellous screws under the axial loading. The study supports the mechanical viability of using our plate and compression bolts for the fixation of calcaneal fracture.

Objective To analyze the diagnostic value of MSCT and MRI in detecting the distal third of tibia shaft fracture complicated with occult posterior malleolar fracture.Methods One hundred and fifty-one patients with the distal third of tibia shaft spiral fracture underwent X-ray examination.For patients without posterior malleolar fracture on X-ray,MSCT and MR imaging were further performed.A binomial test was used to evaluate the significance of the differences between MSCT and MRI in the detection of posterior malleolar fractures and cortical involvement.Results A total of 126 (83.4％) in 151tibia shaft fracture were found to be associated with posterior malleolar fracture.Twenty-seven ( 21.4％ ) cases with posterior malleolar fracture were detected on X-ray.MSCT and MR examination were performed in 124 cases.Ninety-nine posterior malleolar occult fractures were detected on MRI,which included 81cases showed on MSCT.The sensitivity,specificity and accuracy of posterior malleolar occult fracture on MRI were 100％ (99/99),100％ (25/25) and 100％ ( 124/124),while they were 81.8％ (81/99),100％ (25/25)and 85.5％ (106/124) for MSCT respectively.The accuracy of posterior malleolar occult fracture on MRI was significant higher than MSCT ( Z =2.56,P =0.01).Seventy-eight cortical fractures were found on MSCT among 99 posterior malleolar occult fractures,while 51fractures were found on MRI.The sensitivity,specificity and accuracy of cortical fracture involvement were 100％ (78/78),100％ (21/21) and 100％ ( 99/99) for MSCT,while they were 65.4％ (51/78),100％ (21/21) and 72.7％ (72/99) for MRI respectively.The accuracy of cortical fracture involvement on MSCT was significant higher than MRI ( Z =4.02,P =0.00).Conclusions MRI has a higher accuracy than MSCT in detecting the distal third of tibia shaft fracture complicated with occult posterior malleolar fracture,while MSCT has a higher accuracy than MRI in detecting cortical fracture involvement.

ObjectiveTo analyze the treatment of pediatric unstable pelvic fractures retrospectively and sum up the experiences and lessons.MethodsFrom October 1998 to March 2011,30 patients of unstable pelvic fractures with an average age of 7.9 years were admitted.All these cases were Torode-Zieg type Ⅳ.Hemorrhagic shock was determined in 14 patients,and associated with other fractures in 11,urogenital system injuries in 14,sacral plexus injuries in 3,iliac vascular injuries in 2,and diaphragm rupture in one patient.Blood transfusion was done as a component of damage control in 13 cases.The pelvic fractures were treated conservatively in 15 patients,with external fixation in 9,with internal fixation in 4,and with combined external and internal fixation in 1 patients.Hemipelvectomy was performed in the remaining one case.Results One patient died during the emergent surgery due to severe hemorrhage.Thirteen patients werelost follow-up.Sixteen patients were followed up for 3 months to 11 years.According to Cole's grading scale,functional outcome was excellent in 12,good in 1,fair in 2,and poor in 1.Residual vertical displacement after skeletal traction caused inclination of pelvis and leg length discrepancy in one patient.Hip subluxation caused by sciatic nerve injury was found in one patient who severely limped in the last follow-up,and slight gait abnormality due to associated lumbosacral plexus injury was determined in one patient.Conclusion Treatment of pediatric unstable pelvic fractures is different with that of adult cases.Damage control is more significant for children than for adults.Skeletal traction remains one of the main resorts of managing pediatric unstable pelvic fracture,often predicting good functional outcomes.Surgical fixation should be adopted if residual vertical displacement cannot be corrected by skeletal traction,and should be minimal invasive as soon as possible.In addition,associated nerve injury is closely related to the functional prognosis and should be detected carefully and followed up closely.