Objective To evaluate the clinical outcome of surgical treatment of comminuted and intra articular fractures of the distal radius. Methods Forty two cases of comminuted and intra articular fractures of distal radius encountered from January 1999 to January 2001, were operated upon either with internal fixation with the Titanium screw plate or with external fixator according to the types of fracture. Patiens data: there were 14 male and 28 female patients with age of 21-69 years and an average of 36 years; fractures on the left side in 18 and right side in 24 cases. The fractures were categorized according to the AO classification of distal radial fractures: 3 cases of type B1; 8 cases of type B2(dorsal Barton fracture); 4 cases of type B3(volar Barton fracture); 14 cases of type C1; 8 cases of type C2 and 5 cases of type C3. Types B1, B2, B3 and C1 with unsatisfactory closed manipulation were treated primarily with open reduction and internal fixation with an oblique T shaped pure Titanium plate and screws; types C2 and C3 were primarily treated with external fixators; depending upon the condition of reduction during surgery; Kirshners wires were applied accordingly. Twenty six cases were treated with oblique T shaped pure Titanium plate and screws, 9 with open reduction and external fixator, 7 cases were treated with Kirshners wires and external fixator. According to the types of fracture, the pure Titanium plate and screws, simple internal fixation+external fixator, and only external fixator was used accordingly. Results All 42 patients were followed up regularly. According to AO evaluation of the wrist joint movement, 83.3%(35 cases) of the patients had satisfactory functional outcome, 14.3%(6 cases) had quite satisfactory results and only 2.4%(1 case) had unsatisfactory functional outcome. Conclusion The reduction of the distal radial fractures should include the maintenance of the relative length of the radius and ulna, the smoothness of the articular surface and the palmar and ulnar deviation angles. The shortening of the radius results in the pain with movement and the restriction of function, and hence is considered to be the most important factor affecting the joint function. The ulnar deviation is quite easy to restore, and its mal angulation is rare. The reduced palmar deviation angle results in the restriction of the wrist flexion. For the comminuted and intra articular distal radial fractures, the surgical reduction for the maintenance of the relative length of the radius and ulna, a good reduction of articular surface, reduction of palmar and ulnar deviation angle are the key points for a successful outcome. Early functional exercise is equally important for the best recovery of wrist function.

Objective To explore the surgical treatment of ankle fractures and observe the postoperative rehabilitation. Methods Of 120 cases (68 males and 52 females, age range 18-72 years, average 26.8 years), there were 55 cases with injury on the left ankle and 65 on the right. Eight cases had only medial malleolus fracture, 21 pure lateral malleolus fracture, 58 bimalleolar fracture and 33 trimalleolar fracture.According to Danis-weber's classification, there were eight cases belonging to type A, 78 type B and 34 type C. The lag cancellous screw and tension band were used for medial malleolus and the pure titanic plate and screw for lateral malleolus fractures. The compression screw for 4.5 mm was inserted from anterior part to fixate the posterior malleolus fractures with defects bigger than 1/4 of the joint surface. The criterion was anatomic reduction under naked eyes. Postoperative function exercise was performed with no plaster for external fixation. Results A followed up for 6-12 months showed that 113 cases (94.2%) could walk as normal, 7 (5.8%) felt ache at the culf and uncomfortable at the ankle when walking and 116 satisfied with the results with satisfaction rate of 96.7%. Conclusions Exact reduction,stable internal fixation and active postoperative rehabilitation can help the joint recover to normal function in most cases with ankle fractures.

[Objective]To analyze 29 cases of vertebral fractures treated with percutaneous vertebroplasty(PVP).[Method]Twenty-nine patients(35 vertebral bodies) undergoing percutaneous vertebroplasty from March 2006 to June 2007 and followed-up for 8-24 months(average 16 months) were observed and analyzed.[Result]The ratio of M line(middle height of the vertebral body)of fractured vertebra to P line(post edge height of the vertebral body) of fractured vertebra and the ratios of A line(anterior edge height of the vertebral body) and M line to NM line(M line of the next vertebral body) had statistical differences(P

Objective To discuss the application value of external fixator to treat the fractures of children according to the characteristics of the fracture of chidren. Methods 25 cases of different complicated fractures of children were treated with external fixator from Jan,1999 to Aug.2001, and given function exercises in the earlier periode after operation. Results The mean follow up time was 10 months. All the fractures healed.The recovery of function was excellent in 88%cases.The long effect is to be observed. Conclusions Using of external fixator to treat the complicated unstable fractures of children can make definite reduction,help to observe and manage the limb and skin after operation,and greatly meet the needs of the fractures of children.The external fixator has a great clinical application value in treating different complicated fractures of children.

Objective To investigate the effects of artificial semi-shoulder joint replacement for humerus proximal fractures in the aged patients. Methods From January 2004 to February 2007, 42 elderly patients who had been diagnosed as three or four-part fractures of proximal humerus received humeral head replacement. The rotor cuffs were repaired during operation, and the lesser tuberosity and greater tuberosity were reconstructed. Early functional exercise was carried out according to the Neer rehabilitation principles. Results All the patients were followed up for 10 to 28 (mean, 12.7) months postopera-tively. Their shoulder functions were assessed by the ASES (American Shoulder and Elbow Surgeon) score. Obvious pain relief was observed. Eleven cases were excellent, 24 good, 4 fair and 3 poor. The good-to-excellent rate was 83.3%. No prosthetic loosening was noted in this group, but upward shift of the shoulder prosthesis occurred in 3 cases, slight limitation of upward movement in 1 case and absorption of lesser or greater tuberosity in 4 cases. Conclusion Artificial semi-shoulder replacement can be applied for three or four-part fractures of proximal humerus in the aged patients.

Proximal femur consists of femoral head, femoral neck and trochanter. The neck and trochanteric parts of femur are easy to get fractured under conbolution forces. As the conservative treatment tends to cause high rates of complication and mortality, more and more surgeons vote for early internal fixation in recent years. The best treatment for femoral neck fracture is now internal fixation with cannulate screws, especially for the patients with good bone density, fundus and intertrochanteric fractures as well as the type I, type Ⅱand part of type Ⅲfractures in Gardon's classification. Although intertrochanteric fractures are relatively stable, but internal fixation is necessary for good results and prevention of complications. DHS(dynamic hip screw)are advisable for A1, part of A2 and A3 intertrochanteric fractures in AO classification, especially for A1 cases. PFN (proximal femoral nail) is designed for intertrochanteric fractures, inversion and elevation intertrochanteric fractures. In order to get better prognosis in patients older than 70 years and with serious osteoporosis and A2 3, A3 3 fractures, we designed a special kind of prosthesis for them and therefore get satisfactory results.

Objective To evaluate the immunomodulatory effect of Haishen-Xiyangshen-Gouqizi Koufuye(HXGK),an oral liquid of healthy food product,on the immunocompromised mouse model. Methods The cytotoxicity was assayed by the MTT method using murine monocyte macrophagse Raw264.7 cells. The in vitro phagocytic activity of RAW264.7 cells was assayed by the colorimet-ric neutral red phagocytosis test. In the in vivo mouse test,animals were randomized into six groups,each with ten mice:the normal control,model control,positive control groups and three HXGK(5,10,and 20 ml/kg)test groups. The immunocompromised mouse model was created by the intraperitoneal injection of 40 mg/kg dexamethasone once every other day for a total of five times. After first time injection of dexamethasone,the normal control(without the dexamethasone injection)and model control groups were adminis-tered orally once a day with saline,the positive control group with 25 mg/kg levamisole,and the three test groups with 5,10 and 20 ml/kg HXGK,respectively,for a total of 21 days. Then the carbon particle clearance index,the spleen and thymus indices,and the leukocytes,lymphocytes,IgG and IgA in peripheral blood were measured respectively. Results Compared with the normal control, HXGK significantly enhanced the phagocytic index of RAW264.7 cells from 1.00 to 1.12(P<0.01)and 1.32(P<0.01)at the 100-and 20-fold diluted dosages,respectively,in the in vitro neutral red phagocytosis test. In the in vivo mouse test,compared with the model control group,HXGK at the doses of 5,10 and 20 ml/kg obviously increased the carbon particle clearance index about 1.8(P<0.01),1.5(P<0.05)and 1.7-fold(P<0.05)and improved the spleen index from 1.60 to 2.96(P<0.01),2.56(P<0.01)and 2.32(P<0.05),the thymus index from 1.31 to 1.46,1.59(P<0.05)and 1.71(P<0.05),respectively. Meanwhile,HXGH at the 5,10 and 20 ml/kg dosages also increased the leukocytes about 1.32,1.75(P<0.05)and 1.46 folds(P<0.05),the lymphocytes about 16 (P<0.01),20(P<0.01)and 19 folds(P<0.01),the IgG level about 19%,57%(P<0.01)and 64%(P<0.05),and the IgA lev-el about 65%(P<0.01),47%(P<0.05)and 44%(P<0.01),all in the peripheral blood respectively. Conclusion HXGH could significantly enhance the immune function of the immunocompromised mice.

Objective To investigate biomechanical characteristics of flexor profundus tendon repaired by modified Kessler or Tsuge technique in the early of postoperative period, and to discuss the feasibility of using two techniques in flexor tendon repair in order to proceed early active or passive mobilization protocols. Methods 42 Sanhuang cocks were randomly divided into two groups. The second and fourth flexor digitorium profoundus tendons of cocks were severed at the middle phalanx transversely and repaired by modified Kessler or Tsuge technique respectively, postoperative plaster cast immobilization was maintained for 3 weeks. The repaired tendons were harvested at 7 time intervals-immediately after repair, 1, 4, 7, 10, 14, 21 days after operation and stored at  20 ℃ in a refrigerator until biomechanical test. A tensile strength-elongation curve was obtained for each tendon sample. Biomechanical parameters including tensile strength of rupture and elongation ratio of rupture were calculated from the curve automatically by testing machine. SPSS software was used for statistical analysis. Independent-samples t test for inter-group comparison; One way ANOVA and SNK q test for inter-group comparison. Results The tensile strength of rupture dropped to the lowest level between 10th and 14th day and resumed its original level immediately after repair at 21st day in modified Kessler group; while in Tsuge group, it decreased at 10th day, then slowly rised up at 14th day but still didnt reach the original level at 21st day. There was no significant difference between two repair methods after 4th day after operation. The elongation ratio of rupture was lowered significantly since 7th day in modified Kessler method, but 4th day in Tsuge method and decreased consistently until 3 weeks postoperatively. There was no significant difference between the two suture methods at any time-intervals. Conclusion The rather high biomechanical characteristics of Tsuge method loses quickly in the early period of tendon healing and resumes slowly; Modified Kessler method maintains its biomechanical properties at all time-intervals except 10th day.

Objective To evaluate the treatment method and clinical outcome of the aged distal radius fractures. Methods 171 cases with fractures of distal radius from January 1999 to March 2004 were analysed. There were 31 males and 140 females(mean age, 67.3 years; range, 60-76 years). The fractures were classified according to the AO classification of distal radial fracture: 7 B1, 12 B2, 8 B3, 27 C1, 22 C2 and 19 C3. The operation group included 95 patients, 19 males and 76 females(mean age, 69.1 years; range, 60-76 years). 45 were on the left side and 50 on the right side. The non-operation group included 76 patients, 12 males and 64 females(mean age, 65.1 years; range, 60-69 years). 34 were on the left side and 42 on the right side. The fractures type were the following: 35 A2, 24 A3, 5 B1, 4 B2, 3 B3, 2 C1, 1 C2 and 2 C3. For the type A fractures, the priority of treatment was the close reduction and plaster immobilization; for the type B and C1 fractures, it was the open reduction and "T" titanium plate fixation when the close manipulation failed; for the type C2 and C3 fractures, the "T" titanium plate fixation would take the precedence of other methods; and when the fractures were closed to the joints, the external fixator would take the place of plate. Furthermore, the locking compression plate could be selected for the severe osteoporosis. Results Only 22 cases of patients were followed-up in the non-operation group(mean 7 months; range, 4-22 months); but all of 95 operated patients were followed-up(mean 6.5 months; range, 3-20 months). The fractures all healed on X-ray. According to Aro's evaluation of the distal radial fracture, in the non-operation group, there were 11 excellent, 9 good, 1 fair and 2 poor, the good-excellent rate was 86.9%; while in the operation group there were 46 excellent, 40 good, 7 fair and 2 poor, the good-excellent rate was 90.6%. Conclusion The different methods of treatment should be used for distal radial fracture according to the patient types. In case of the fracture and deformity in the articular surface or severe comminuted fracture in the metaphysis of the distal radius, the operation is indicated; and the manipulation can be used in simple metaphysis fractures with a good bone quality.

Objective To investigate the prognostic outcome of open reduction and internal fixation(ORIF)with radial head resection in treatment of comminuted radial head fractures so as to discuss the corresponding operation options.Methods A series of 23 patients with Mason type Ⅲ or Ⅳ radial head fractures were enrolled in the study including 11 males and 12 females.Eight patients(three with Mason type Ⅲ and five with Mason type Ⅳ)underwent radial head resection and 15(seven with Mason type Ⅲ and eight with Mason type Ⅳ)received open reduction and internal fixation including nail and plate fixation in eight and screw and K-wire fixation in seven.The outcomes were assessed in regard of range of motion,radiographic findings,visual analogous scale(VAS)of pain,patient satisfaction degree,disabilities of the arm,shoulder and hand score system(DASH)and the Broberg & Morrey elbow performance score system.Results The follow-up period ranged from 12 to 65 months(mean 35 months),which showed fracture healing in all patients,with no traumatic arthritis happened.The mean range of flexion and extension arc at the elbow of ORIF group and resection group was 132°and 79.4°(P＜0.01)and the patient satisfaction was 9.1 and 8.0(P ＜0.05)respectively.According to the Broberg & Money elbow performance score system,the score was average 93.9 in the ORIF group,with excellent result in nine patients,good in five and fair in one,while the score was average 80.6 in the resection group,with excellent result in two patients,good in two and fair in four.There was statistical difference between two groups(P ＜0.01).The DASH score of the ORIF and resection group was 2.9 and 18.1 respectively(P＜0.05).Conclusions ORIF has better elbow motion,elbow function,daily living and satisfactory outcomes than radial head resection and is recommended for treatment of Mason type Ⅲ or Ⅳ radial head fractures for repair of the radial head as far as possible.