[Objective]To treat the low limb comminuted fracture with biological osteosynthesis as a guide in order to decrease damage of periosteal blood supply and increase the bone healing.[Method]For all types of long bone comminuted fracture in low limbs,the operation was taken for keeping connection of bone fragment with periost,indirect reduction through mechanical line,relative stable fixation and there is no need for anatomical reduction.Eighteen cases of intertrochanteric comminuted fractures and 16 cases of low femoral comminuted fractures were treated with DCS.Twenty-six cases of subtrochanteric comminuted fractures and 24 cases of low femoral fractures were fixed with anatomical steel plate in less screws.Twenty-seven cases of femoral shaft comminuted fractures and 31 cases of tibia and fibula comminuted fractures were fixed with compressive plate in less screws.Twenty-six cases of comminuted fractures of femoral shaft and 22 cases of tibia ones were fixed with LC-DCP in less screws.Twenty-five cases of comminuted fractures of femoral shaft and 18 cases of tibia ones were fixed with locking intermedullary nails.One hundred and three cases of comminuted fractures of tibia and fibula were fixed with extra-fixture.Fifty-six cases of comminuted fractures of tibia and fibula were fixed by unilateral multi-purpose external fixing.Twenty-one cases of comminuted fractures of tibia and fibula were fixed by unilateral multi-purpose external fixing with limited screws and plaster.[Result]A total of 413 cases had been treated and followed up within 6～18 months(average 10.5 months).Four hundred and eight cases had bone union and accounted for 98.46% in all cases.One case had nounion and two cases had malunion in femoral fracture.Two cases had delayed union and four cases had nounion in tibia fractures.[Conclusion]It is useful for the bone blood supplying and healing with biological osteosynthesis of reducing bone fracture indirectly and fixing one relatively,especially for comminuted fracture of long bone shaft.

Objective To investigate the therapeutic effect of vascular pedicle bone graft and compound bone matrical gelatin (Co BMG) in treatment of nonunion of femoral neck fracture . Methods 28 cases of femoral neck fracture who had been treated with operation and traction and observed for 6 to 9 months suffered from nonunion. The 28 cases of nonunion were treated by vascular pedicle bone graft and compound bone matrical gelatin. The progress of bone healing, complications such as necrosis of femoral head, and joint function were followed up after operation. Results All the 28 cases healed. The function of joint was evaluated according to Jacobs criteria. It was excellent in 19 cases, fine in 7 cases, and poor in 2 cases. Conclusion The vascular pedicle bone graft combined with BMG is the effective choice for treatment of nonunion of femoral neck fracture in adolescents and adults, because it has the double effects of bone grafting and bone induction.

Objective To compare patellar ring,Kirschner wire tension band and patellar ring plus Kirschner wire in fixation for treatment of patella fractures.Methods A retrospective analysis was conducted on the 285 patients with patellar fracture who had been treated between September 2009 and January 2016.They were 155 men and 130 women,with an average age of 45.5 years (from 18 to 70 years).Their fractures included 176 transverse,28 longitudinal split and 81 comminuted ones.They were divided into 3 groups according to their different internal fixation methods:patellar ring fixation (98 cases),Kirschner wire tension band (92 cases),patellar ring plus Kirschner wire fixation (95 cases).The 3 groups were compared in terms of operative time,intraoperative bleeding,fracture healing time,knee function by B(o)stman score at the last follow-up and postoperative complications.Results The operative time in the patellar ring group(58.9 ±6.4 min) was significantly shorter than in the Kirschner wire group (71.8 ± 7.8 min) and in the patellar ring plus Kirschner wire group (74.4 ± 8.0 min) (P ＜ 0.05).There were no statistical significant differences between the 3 groups in fracture healing time and intraoperative bleeding (P ＞ 0.05).The good to excellent rate of knee function at the last follow-up in the Kirschner wire tension band group was 100.0％ (92/92),significantly higher than in the patellar ring group (90.8％,89/98) and in the patellar ring plus Kirschner wire group (91.6％,87/95) (P ＜ 0.017).There was no significant difference in postoperative complication rate between the patellar ring fixation group (2.0％,2/98),Kirschner wire tension band fixation group (1.1％,1/92) and the patellar ring plus Kirschner wire group (2.1％,2/95) (P ＞ 0.05).Conclusion Internal fixation with Kirschner wire tension band has definite curative effect on patellar fractures,showing the advantages of less operative invasion,fewer postoperative complications,better functional recovery of the affected knee joint,and lower price over the other 2 internal fixation methods.