Although fractures of distal radius are very common in clinic,new ideas,devices and methods in their treatment are constantly emerging.This review summarizes their classifications and treatment methods,including closed reduction and external fixation,percutaneous internal fixation,external fixation,open reduction and internal fixation,wrist joint arthroscopy and bone grafting.At last,the author puts forwards his opinions about the treatment based on AO classification:Close reduction and cast immobilization should be the first choice for type A fractures.Open reduction and internal plate fixation may be needed for type B and C1 ones when close reduction can not be satisfactory.Internal plate fixation and external fixation may be suitable for C2 and C3 ones.The locking compression plate may be used for old people with osteoporosis.The methods of treatment for distal radial fractures should vary according to the specific type of the fracture.Bone grafting may be considered on the condition of large bone defect or severe osteoporosis.

SUMMARY Peripheral nerve defects are still a major challenge in clinical practice,and the most com-monly used method of treatment for peripheral nerve defects is nerve transplantation,which has certain limitations and shortcomings,so new repair methods and techniques are needed.The peripheral nerve is elongated in limb lengthening surgery without injury,from which we got inspirations and proposed a new method to repair peripheral nerve defects:peripheral nerve elongation.The peripheral nerve could be elongated by a certain percent,but the physiological change and the maximum elongation range were still unknown.This study discussed the endurance,the physiological and pathological change of peripheral nerve elongation in detail,and got a lot of useful data.First,we developed peripheral nerve extender which could match the slow and even extension of peripheral nerve.Then,our animal experiment result confirmed that the peripheral nerve had better endurance for chronic elongation than that of acute elonga-tion and cleared the extensibility of peripheral nerve and the range of repair for peripheral nerve defects. Our result also revealed the histological basis and changed the rule for pathological physiology of peri-pheral nerve elongation:the most important structure foundation of peripheral nerve elongation was Fon-tana band,which was the coiling of nerve fibers under the epineurium,so peripheral nerve could be stretched for 8.5% -10.0% without injury because of the Fontana band.We confirmed that peripheral nerve extending technology could have the same repair effect as traditional nerve transplantation through animal experiments.Finally,we compared the clinical outcomes between nerve elongation and perfor-mance of the conventional method in the repair of short-distance transection injuries in human elbows, and the post-operative follow-up results demonstrated that early neurological function recovery was better in the nerve elongation group than in the conventional group.On the whole,all of these experimental re-sults revealed the physiological phenomenon of peripheral nerve elongation,and described the physiologi-cal change and stretch range in detail.The systematic research results have filled the blank in this field, which is very helpful for clinical limb lengthening surgery,the design of elongation surgery and the evalu-ation of the peripheral nerve stretch injury.Peripheral nerve elongation will become an innovative treat-ment technology in repairing peripheral nerve defects.

Fracture healing is regulated by a complex array of factors,of which calcitonin gene-related peptide(CGRP) has been shown to play an anabolic role in bone metabolism.It has been reported that CGRP-containing sensory nerve fibers increased apparently at bone fracture site.CGRP is an important sensory neuropeptides expressed in bone tissue,although the primary function of this neuropeptides is to induce vasodilatation and blood flow,substantial evidence has shown that targeted expression of CGRP to mouse osteoblasts increased bone density,stimulated cancellous bone formation in vivo,especially the presence of CGRP receptors on rat osteoblast provides further evidence for a direct role for CGRP in modulating the function and growth of bone.CGRP is also proved to be a neuropeptide with proinflammatory activities,it may play a direct role in initiating the local inflammatory cell infiltration in the fracture site.Although it has been recognized that CGRP plays an important role in bone repair and reconstruction,the mechanism of this activation still remains to be elucidated.

Objective To explore regional characteristics of road traffic injury in urban Beijing through analysis of the investigation by a single hospital. Methods Using Emergent Road Traffic Injury Questionnaire we designed, we performed a survey for 2 weeks on all the patients with road traffic injury who had sought medical care in the emergency department of our hospital. A comparison was made between them and other patients at the emergency department at the same period. Results From 8:00 on 25 April 2006 to 8:00 on 8 May 2006, 18 emergent cases of road traffic injury were treated. They accounted for 0.54% of all the emergency patients and 4.5% of all the trauma patients. They were 7 males and 11 females, with an average age of 48.3±14. 3 years. The average time to hospital was (26.8±14.4) rain. Seventeen cases of injury happened in the street, 1 in the highway;15 in Xicheng District, 1 in Haidian District, and 2 in the suburbs. They included 8 pedestrians, 9 riders, and 1 passenger. They were injured by 12 light vehicles, 2 heavy vehicles, 2 special vehicles, and 2 bicycles. Twelve patients had injury at extremity, 3 at spine, and 3 at multiple sites, They received treatment only in Emergency Department. No one was dead or hospitalized. Conclusions Contrary to common belief, road traffic injury patients seem to account for a small part of trauma patients and the injury tends to be moderate. Females and extremities may be more likely to get injured.

Objective To understand the mechanism of extracts of Hedysarum ploybotrys hand Ma22 on Schwann cell,we studied the effects of the extracts on protein tyrosine kinase (PTKs) in vitro Methods Getting sciatic nerve by operation from SD rats and cultured them in PRMI 1640 medium with 15% embryo bovine serum and with Hedysarum Ploybotrys Hand Ma22 at rate of 1∶1 600,1∶3 200,1∶6 400,1∶12 800 or with nerve growth factor (NGF) NGF as positive control and normal medium as negative one After 48,72 and 96 hours cultures,the sciatic nerve been captured separately and used to examine the activity of PTKs by [? 32 P] ATP incorporation test using protein tyrosine kinase assay system Result In normal culture condition,there are no active PTKs Cultured with NGF and Hedysarum Ploybotrys Hand Ma22,the activity of PTKs increases notable The peak of NGF group appears at 48th hours and 96th hours were 0 0636 and 0 1548 respectively. Hedysarum Ploybotrys Hand Ma22 at 48th hours were 0 4460,0 3326 and 0 4169 at concintration of 1∶1 600,1∶3 200,1∶6 400, and decrease after it. Rank sum test show the correlations to time were negative ( P

Objective To analyze epidemiologie and injury characteristics of traffic injuries in Shenzhen through emergency department. Methods A questionnaire was pre-designed to collect data of patients admitted to six general emergency departments of six district in Shenzhen from January 2007 to December 2007 for clinical analysis. Results There were 1 328 patients with road traffic injuries, at age range of 2-84 years (average 31 years). According to occupation, most patients were local workers and migrant workers (57.8%). The accidental vehicles were mostly cars (48.5%). Most accidents (78.6%) occurred in urban streets. As for time distribution of traffic injuries, most injuries happened on Friday and Saturday (accounting for 17.8% and 18.7% respectively), especially on Friday (r = 0.166 0, P <0.01). There was central tendency around 15:35 p.m. in one day (r = 0.285 6, P < 0.01). The age of male was (32.36±8.70) years and that of female (29.96±4.32) years, with statis-tical differences (P < 0.05). Of patients followed up, 84.4% patients could work on their original jobs, 8.5% needed ehange of their jobs and 7.1% lost the ability of work. Conclusions It is neeessary to strengthen road safety education among local workers and migrant workers to improve their awareness of road safety. Traffic administrators and road safety marks should be added in the chief period and districts where road traffic injuries happen most frequently. Controlling the number of small cars may be effective to reduce traffic accidents.

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 Study the biologic compatibility of the membrane of biologic conduit made of chitin and Schwann cells in vitro Methods Cultured Schwann cells with the membrane,then observed their attachment,spread and growth Results Around the membrane,the shape,amounts and growth of Schwann cells in the experimental groups were same with the control group.Schwann cells can lived on the membrane,and their amounts were larger on the membrane precoated with collagen (rat tail) than on the simple membrane Conclusion The membrane of biologic conduit made of chitin have good biologic compatibility with Schwann cells and have better nerve cell affinity after being precoated with collagen.

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 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.