Objective To investigate the characteristics of the reversed sural neurocutaneou s island flap in clinical application.Methods From June 1997to March 2002,13cases of soft tissue defect in the lower leg,or around the ankle and the heel were repaired with the reversed sural neurocutaneous island flaps.The largest flap size was 15cm ?9cm,while the smallest was 5cm ?6cm.Results11of the flaps survived well and had primary healing,while 2flaps had distal partial necrosis and healed after dressing change.The follow-u p from3months to 4years showed that all fla ps were satisfactory.Conclusion Since the blood supply of the reverse d sural neurocutaneous island flap is reliable,even in patients with insufficient blood supply,and the flap is easy and quick to get without sacrificing the major arteries,it is an ideal method to use this flap to repair the soft tis sue defect in the lower leg and around the malleolus,the heel and the Achilles tendon.[

Objective To systematically summarize and compare results and related advantages of different methods in the management of adult mid-shaft clavicle fractures. Methods The data of adult midshaft clavicle fracture from 1989 to 2009 was retrieved. The database were included Cochrane Database,med & Ovid Medline, OTA, AAOS, High Wire Press, Springer Link, CBM, CNKI, WANFANG DATA and with hand-search journals in related fields. Internalizing randomized controlled trials and retrospective cohort studies which compared the operative and nonoperative treatment for adult mid-shaft clavicle fracture. Evaluating the quality of included studies and using the Rvaman 4.2 for Meta-Analysis. Results 5053 literatures had been reviewed. After screening, there were 8 studies brought into the review that included 519 patients.There were 5 studies which took union rate as observed indicator. The results had statistically significant (P＜0.00001). A total of 4 studies used malunion rate as indicator, the results had statistically significant (P ＜0.0001). A total of 4 researches selected satisfaction of patient as indicator, the results had statistically significant(P＜0.00001). A total of 5 studies selected symptoms of nerve stimulation as indicator, the results had statistically significant (P＜0.0001). A total of 4 studies selected residual pain as indicator, the results had no significant statistically difference (P=0.56). A total of 2 studies selected barriers of joint activities as indicator, the results had no significant statistically difference (P=0.25). A total of 2 researches used refracture as indicator, the results had no significant statistically difference (P＞O.05). Conclusion This study evaluation results shows that operation can be used as the first choice of treatment of adult midshaft clavicle fractures.

Objectve The purpose of the study was to evaluate the surgical treatment method and outcomes of capitellar fractures. Methods From December 2004 to December 2006, sixteen patients with a capitellar fracture were included in the study. There were eight males and eight females. According to Bryan and Morrey classification, there were eight type Ⅰ fractures, one type Ⅲ fracture and seven type Ⅳ fractures. In three of type Ⅳ, a separate trochlear fracture fragment with impaction was seen. Distal lateral column posteroinferior metaphyseal comminutiou and/or impaction was observed in association with three fractures including two type Ⅳ fractures and one type Ⅲ fracture. One Mason type Ⅰ radial head fracture occurred in association with an ipsilateral type Ⅳ capiteilum fracture. The patients ranged from sixteen to sixty-five years old, with an average age of 44.9 years. An extensile lateral exposure and articular fixation with cannu-lated compression screws were performed within five days of injury. Clinical, radiographic, and functional el-bow index rating scale of Broberg-Money were evaluated retrospectively. Results The follow-up time ranged from 24 to 36 months,with the mean of 29 months. All fractures healed at an average of 7.9 (range, 6 to 11) weeks without radiographic evidence of osteonecrosis of the fracture fragment. Average arc of motion was 125.8°±16.8° in flexion-extension and 163.1°±10.62° in pronation-supination. The mean Broberg-Mor-rey was 92.0 points, with eight excellent results, seven good results, and one poor result. There were one pa-tient with a minimum of grade 1 radio-capitellar arthrosis.Fifteen of the sixteen adults were able to continue their former professional activities. The patient had persistent postoperative stiffness with a flexion contrac-ture at the last postoperative visit. Conclusion Prompt treatment with anatomic reduction and internal fixa-tion with lag screws followed by early rehabilitation can lead to functional arc and satisfactory outcome.

Objective To explore the classification and surgical treatment of scapular neck frac-tures. Methods A retrospective analysis was done based on the clinical data of 18 patients (including 12 males and 6 females) who accepted operation in Tianjin Hospital from January 2000 to December 2007. The average age of the patients was 41 years (17-62 years). All patients accepted CT examina-tion. According to Hardegger classification, there were 10 patients with anatomical neck fractures and eight with surgical neck fractures. According to Miller system, there were five patients with type II A fractures, six with type II B fractures, six with type II C fractures and one with type II B + IIC fracture. Of all, 15 patients had associated injury. The operative approach included posterolateral approach in nine patients, modified Judet approach in six and anteroposterior conjoint approach in three. Reconstruction plates and lag screws were applied to fix the fractures. Results All patients were followed up consecu-tively with an average period of 25. 5 months (6-70 months). The mean Constant-Murley score was 73 points (35-95 points, meadian 75.5 points) after treatment. There were two patients with malreduction,one with shoulder instability and three with traumatic arthritis postoperatively. Conclusions The indi-cations for early operation include: (1) angular deformity in horizontal or coronal planes of fractures, ie,glenopolar angle (GPA) <20°(2) fracture displacement =10 mm;(3) associated with floating shoul-der injury or superior suspensory shoulder complex injury. The major factors influencing prognosis are as-sociated injuries, quality of fractures reduction, fixation stability, injury of rotator cuff and postoperative rehabilitation.

Objective To study the effect on bone formation by intermittent administration of simvastatin. Methods Seventy three month old virgin female rats, weighted (200?10) g each had been divided into two groups ovariectomized (50 rats) and pseudo ovarectomized (20 rats). Ten rats each of Group A and Group B were sacrified at the 30 th day for the confirmation of successful establishment models of the osteoporosis. Then the remaining animals were re divided into 5 groups: Group A, pseudo ovarectomized control, 10 rats; Group B, ovarectomized control, 10 rats; Group C, given Nylestriol 0.1 mg/(kg?d), 10 rats; Group D, 10 rats, given calcium 10 mg and vitamin D3 2 IU/(kg?d); Group E, 10 rats given simvastatin 5 mg/(kg?d) for 14 days; and the drug was suspended for 28 days, then simvastatin was given for another 14 days. All of the animals were given the agents through gastric tube 30 days after surgery. At 120 th day all the rats were sacrified for the measurements of bone mineral content and bone mineral density by the dual energy X ray absorptiometry for bone mophometrical study. Results The average of bone mineral content was (46?11.34) mg (P

Objective To describe the method of treating so ft tissue defects of the lower 1/3of l egs with the reversed saphenous neurocu taneous island flaps.Methods From June 1998to December 2000,eight cases of soft tissue defects or unstable scars of the lower one third of the legs,or around the ankle and th e heels were treated with reversed sap henous neurocutaneous island flaps.The size of the flaps were from 6cm ?5cm to 15cm ?9cm,averaging 9cm ?6.3c m.In 3cases in order to avoid the inju ry of the blood vessels of the flap pedicle when it passed thr ough the subcutaneous tunnel,a skin fascial bridge was designed in width of 1.5cm as the pedicle of the island f lap and to form the roof of an open tunnel.Results Seven cases had the flaps survived,one case had partially necrosis of the flap.After 6mo nths to 2years follow-up,all of the8cases were evaluated as satisfacto ry.Conclusion The blood supply of the reversed saph enous neurocuta-neous island flap is reliable,even i n patients with insufficienct arterial supply of the distal one third of t he lower limb.The flap does not sacrifice the major arteries and is easy to be perfomed.[

Objective To evaluate the clinical results of femoral, tibial and humeral fractures treated with locked intramedullary nailing. Methods 546 fractures of femur, tibia, and humerus in 526 patients treated with locked intramedullary nailing from April 1994 to September 2004 were retrospectively reviewed. There were 430 fractures in 412 males, 116 fractures in 114 females, with an average age of 36.4 years. 432 were close fractures, 76 old fractures, and 38 open fractures. With image intensifier, 196 fractures were reduced closely, while 350 fractures failed to be reduced by close manipulation and required open reduction. Bone grafting were undertaken in 161 fractures of the latter group. 485 fractures were reamed, and 61 unreamed. 539 fractures were stabilized statically, and 7 dynamically. The nails were inserted antegradely in 519 fractures, and retrogradely in 27. Dynamization was undertaken in 10 statically locked fractures due to delayed union. The early postoperative weight-bearing was directed. The patients were followed up with an average of 31.6 months (9~123 months). Results Among the 546 fractures, 543 fractures(99.5%) were eventurally healed, with an average union time of 4.4 months. 530 fractures(97.1%)primarily healed, and 13 fractures(2.4%) healed after secondary operation. The complications were 11 delayed unions(2.0%), 4 nonunions(0.7%), 3 malunions(0.5%), 5 bone infections(0.9%), 2 traumatic fractures(0.4%), 9 hip heterotopic ossifications(1.6%), 6 implant failures(1.0%), with 3 nail breakages(0.5%), 3 interlocking screw breakages or back-outs, 1 radial nerve palsy, and 1 fatal pulmonary embolism. The ROM of the hips and the knees were excellent in patients with femoral or tibial fractures. Flexion restriction(90?~125?) of the knee were found in 10 patients. There were 5 and 10 anterior knee pains in femoral and tibial fracture patients respectively. The ratio of excellent and good function of the shoulder was high in the humeral shaft fracture patients, with the abduction less than 90? in 2 patients, extension loss of 15? in 2 elbows, and shoulder pain in 6 patients. Conclusion Interlocking intramedullary nailing is one of the good alternatives in treating long bone fractures, with a higher union rate and a lower complication rate. Close reduction for fresh fracture, open reduction for old fracture, static locking, reaming or unreaming in regard to the site and severity of the fracture, and individualized rehabilitation protocols all contribute to the excellence of the results.

Objective To investigate surgical outcomes of anterolateral plus posteromedial approaches for treatment of complex tibial plateau fractures.Methods We reviewed 68 patients with tibial plateau fractures of Schatzker types Ⅴ and Ⅵ who had been treated from January 2008 to December 2011 and fully followed up in our department.They were 42 men and 26 women,22 to 64 years of age (average,42.3 years).Fractures occurred at the left side in 24 cases and at the right side in 44 cases.Intervals between injury and operation ranged from 3 to 15 days,7.4 days on average.All of them were operated on through anterolateral plus posteromedial approaches.T-or L-shaped steel plates were used laterally while reconstruction plates or T-shaped plates for distal radius were used medially.Results In this cohort the operation time averaged 3.13 hours,intraoperative blood loss 562.7 mL and hospital stay 20.4 days.All cases were followed up for an average of 18.8 months (range,12 to 38 months).Fractures healed from 4 to 8 months,6.7 months on average.The average tibial plateau angle,posterior slope angle and femorotibial angle immediately postoperation were respectively 87.3°± 1.5°,12.0°± 2.5° and 170.0°± 2.5°,not significantly different from those at one year postoperation (86.8° ± 1.2°,13.0° ± 1.8° and 171.0° ± 1.7°) (P ＞ 0.05).According to The Hospital for Special Surgery Score,the outcomes were excellent in 36 cases,good in 24 cases,fair in 6 cases and poor in 2 cases,with a good to excellent rate of 88.2％.No neural or vascular injury,deep infection,or implant failure was found in this group.Conclusion Anterolateral plus posteromedial approaches are effective for complex tibial plateau fractures,leading to anatomic reduction,stable fixation and early functional rehabilitation.

Objective To evaluate the outcome of posterolateral approach to the fibula for trimalleolar fractures,especially the fracture in posterior malleolus.Methods Thirty-two patients with trimalleolar fractures treated via posterolateral transmalleolar approach from July 2006 to July 2011 were analyzed retrospectively.All underwent open reduction and internal fixation,including 22 Lauge-Hansen grade Ⅳ supination-external rotation ankle fractures and 10 Lauge-Hansen grade Ⅳ pronation-extemal rotation ankle fractures.Results All fractures had bone union after the follow-up of average 15.5 months (range,12-18 months).Average American Orthopedic Foot & Ankle Society (AOFAS) score was 90.75points,suggesting an excellent result.Kellgren grading system for posttraumatic arthritis severity was grade 0 in eight patients,grade Ⅰ in 18,grade Ⅱ in five,and grade Ⅲ in one,which turned out to be satisfactory.Conclusions Posterolateral approach to the fibula for trimalleolar fractures allows direct reduction and fixation of posterior malleolus fragment in treatment of trimalleolar factures and the clinical outcome is satisfactory.Moreover,the approach deserves clinical practice.

Objective To evaluate the causes of complications of patients with femoral Intertrochanteric fractures after gamma3 nail fixation.Methods A retrospective analysis was conducted to summarize the treatment of intertrochanteric fractures in 186 cases with Gamma3 nail from May 2006 to July 2011.Complications occurred in 24 cases during the operations.19 were males,5 females,with the age from 42 to 81,the average age of 69.00±3.27 years.According to AO/OTA classification,8 cases were type A1,1 case were type A2.1,15 cases were type A3.All patients included were acute fractures,while pathological fractures were excluded.Supine position were selected during operation,close reduction were performed in traction bed.Gamma3 nail made by Stryker Company was used to fix fractures through small incisions.Operational times were from 45 to 160 minutes,averaged by 80 min.Blood lose were 300-800 ml in average.No patient need blood transfusion.The procedure from hospitalized to operation is from 3 to 12 days,6 days in average,discharged from 3 to 16 days after operation.According to the intraoperative and postoperative follow-up evaluation of the X-ray and Harris evaluation criteria,Gamma3 nail complications were summarized in the application.Results Time of surgery in 24 cases were 45-160 min,average 80 min.Blood loss were 300-800 ml,average 600 ml,walking time 35-106 d.Harris evaluation were 75-91 point,average 81 point.The anti-spiral nail dropped into inner thigh muscles occurred in 1 case,causing defects of femoral lateral wall in 3 cases.Splitting fractures occurred in the proximal femoral shaft during the operations in 5 cases,poor fracture reduction during closed reduction in 6 cases.Fracture site were shifted lately postoperative in 5 cases,lag screw cut-out in 3cases and refracture in the site of distal femoral interlocking nail in 1 case.Conclusion Higher incidence of complications were occurred in some special types of AO classification when using close reduction and short Gamma3 nail.The reduction method,wrong indication selection and unreasonable application of equipment may result in the occurence of complications.We,therefore,should use long or short Gamma nail according to their respective induction method and scope of its application,aiming to avoid complications.