Objective To investigate the classification and its application in one-stage repair of massive posttraumatic bone defects which are infection-induced and refractory in lower extremities. Methods From March 2002 to December 2008, we treated 42 patients with massive posttraumatic refractory infection-induced bone defects in lower extremities. We classified the defects into 3 types: simple massive infection-induced bone defects (type Ⅰ), massive infection-induced bone and soft-tissue defects (type Ⅱ) and massive infection-induced bone defects plus limb shortening (type Ⅲ). After thorough debridement, various types of vascularized fibular grafts were used to repair the 3 kinds of defects accordingly. Simple fibular grafts were used in 6 cases, transplantation with fibular and skin flaps was used in 31 cases, fibular grafts combined with anterior lateral thigh flap in 4 cases, and one-stage limb lengthening and fibular graft in one. Results The follow-ups of 6 to 41 (average, 26. 3) months revealed that the refractory bone defects were repaired successfully in 38 cases, amputation due to necrosis of fibular grafts in 2 cases and uncontrolled infection in 2 cases. In the 38 cases, infections were controlled effectively, circulation of the traumatic limbs was good,contour and function were restored satisfactorily, and no obvious complication was found in donor limbs. By Johner-Wruhs evaluation, 17 cases were excellent, 18 cases good, 3 cases fair and 4 cases poor, with a total excellent and good rate of 83.33%. Conclusions Refractory and massive posttraumatic infection-induced bone defects in lower extremities can be classified into 3 types. They can be repaired using various types of vascularized fibular grafts according to the defect types at one-stage.

Objective To analyze causes for postoperative coxa vara and anti-rotation nail cutting-out after treatment of brittle femoral intertrochanteric fractures with proximal femoral nails ( PFN ).Methods An retrospective study was done on 227 patients with intertrochanteric fracture treated with PFN from June 2006 to February 2009. The causes for postoperative coxa vara and anti-rotation nail cutting-out were analyzed. Harris score was used to evaluate the functional recovery of the hip joint. Results Of all, 221 patients were followed up for 12-48 months (mean 23 months) and six patients were died from serious internal disease within one year. According to Harris evaluation system, the results were excellent and good in 183 patients, fair in 30 and poor in 14. Postoperative coxa vara and anti-rotation nail cuttingout occurred in 16 patients, eight of whom received reoperation to remove internal fixation and skeletal traction at abducent position and the other eight received prosthetic replacement. Conclusions Treatment of proximal femoral fracture with PFN requires a high precision of reduction and operation. Many factors including lateral cortical bone conditions of tuberosity, postoperative patient's cognitive condition,use of improved Jensen-Evans classification and Singh's classification may affect operation outcome.

BACKGROUND:Vascularuzed fibular graft is one of the effective methods for repair of large segmental bone defects in the extremities OBJECTIVE:To explore the clinical effects of vascularized fibular graft for repairing large segmental bone defects in the extremities. METHODS:Twenty-eight non-malignant patients who received vascularized fibular graft for repairing large segmental bone defects in the extremities and were folowed up for more than 20 months were enroled. After lesion removal, vascularized fibula bone graft was used to repair the bone defects. If cases combined with soft tissue defects, fibula flap or anterolateral thigh flap was adopted. RESULTS AND CONCLUSION: Al patients were folowed up for 20 months to 6 years. The grafted bones were healed with the surrounding bone at 3-8 months after fibula bone grafting. The grafted bone was enlarged near to the diameter of recipient bone at 10-22 months after grafting. Based on the Enneking system, the average score of large segmental tibia bone defects was 24.2 points with 81% limb function recovered and 94.1% patient satisfaction; the average score of large segmental femur bone defects was 26.3 points with 87.7% limb function recovered and 100% patient satisfaction; the average score of large segmental bone defects of the distal radius and ulna was 21.75 points with 72.5% limb function recovered and 100% patient satisfaction. These findings reveal that vascularized fibular graft for repairing large segmental bone defects in extremities can effectively promote bone healing and reduce disability, infection, amputation rate; moreover, patients are satisfied with the postoperative recovery of limb function.