It is a clinically tough problem to repair compound tissue d efects of limbs. Application of microsurgical technique with autologous pedicel or free tissue grafts has saved numerous invalid limbs with tissue defects, and is still an essential method to restore compound tissue defects of limbs and res love effectively many difficult problems, such as larger solf tissue defects,seg mental bone defects, bone-skin compound defect, and etc. Microsurgical repair i n emergency has special value in treating compound tissue defects of hand. Altho ugh the resource of autologous tissue graft as donator is limited, tissue engine ering and gene technology hold the promise of revolutionary advances in repairin g compound tissue defects of limbs. Because of the achievements made in the fiel ds of trauma repair and tissue regeneration, both structure and function will be hopefully restored.

Objective To investigate the functional changes of osteoblasts in female SD rats in vivo at different phases following ovariectomy and to analyze their mechanism. Methods 40 female SD rats aged 6 months were randomly divided into 2 groups: the sham operated group and the ovariectomized (OVX) group. During the 4-month experiment, 10 rats from each group were sacrificed to have the serum and the 4th lumbar vertebrae specimens at the end of the 2nd week and the 16th week respectively. Serum bone gla protein (BGP), serum bone specific alkaline phosphatase (BALP) were measured. The excretive function and morphologic changes of the osteoblasts were observed under TEM (Transmission Electronic Microscope). Results In the OVX group, the levels of BGP and BALP all increased at the end of the 2nd week, but showed no significant difference from those in the control group at the end of the 16th week. TEM indicated osteoblasts were activated at the end of the 2nd week, but tended to be inactivated in the ovariectomized group at the end of the 16th week. Conclusions When estrogen decreases in ovariectomized rats, osteoblasts experience a short activated period, but their capacity of bone formation decreases in the end. Abnormal function of osteoblasts may play an important role in pathogenesis of osteoporosis.

Proximal tibial fractures, especially high energy ones, can incur unique challenges in clinical treatment. Soft tissue is injured from both fracture and surgical dissection; the fracture often brings with it neurovascular problems; it is difficult to reduce and stabilize proximal fragments. Treatment strategies of dealing with associated injuries, accurate diagnosis, and selection of individualized method for reduction and fixation are emphasized. Soft tissue protection should always be kept in mind during operation.

Complex Pilon fracture is always a challenge to orthopaedic surgeons. Careful assessment of the injury, especially the soft tissue condition, is essential for a proper treatment planning. Classification of the fracture is also important for evaluation of the prognosis. Treatment planning includes: timing of the surgery, selection of the fixation method and postoperative protocols. In this article, on the basis of literature review and personal experience, the author suggests criteria for injury assessment and postoperative treatment. A brief comparison of different kinds of fixation is made and the principle of implant selection is discussed in the text.

Objective To evaluate effects of minimal invasive plating for treatment of mid-distal humeral shaft fractures.Methods From May 2004 to December 2007, 20 patients with isolated unilat-eral mid-distal third humeral shaft fractures were surgically treated with close reduction and internal fixation using a 4.5 mm dynamic compression plate which was anteriorly inserted through 2 small incisions on the anterior aspects of proximal and distal parts of the arm, away from the fracture site.The postoperative function of the radial nerve and the musculocutaneous nerve, the postoperative alignment of the main fragments on the anteroposterior radiographs, the bone healing time and muscle strength of biceps muscles were measured and recorded, Results Four patients complained of numbness at the area innervated by the lateral ante-braehial cutaneous nerve in the affected forearm after the surgery.No signs of iatrogenic radial nerve palsies occurred after the surgery.A completely normal alignment was achieved in 7 patients, but varus of 11° was found in 2 cases and varus of 2°, 3°, 4°, 5°, 6°, 7° and 10° in one each.Valgus deformity was noticed in 4 cases, and valgus of 3°, 4°, 6° and 7° in one each.The mean follow-up of 10.4 months for 19 patients re-vealed bony union of all the fractures.The average bone healing time was 13.4 weeks.At the latest follow-up, the biceps muscle strength of all the patients was 5 degrees.Hardwires were removed in 5 patients without any complications.Conclusions Minimally invasive anterior plating is a safe alternative osteosynthesis for mid-distal third humeral shaft fractures.However, this technique may interfere with the function of the lateral antebrachial cutaneous nerve.

Objective To report the clinical results of the treatment of proximal humeral fractures with a locking proximal humeral plate (LPHP) through a small skin incision on the anterolateral shoulder. Methods In the period from May 2004 to June 2005, 17 cases of proximal humeral fractures were treated in our department. There were 3 Neer two-part fractures, 10 Neer 3-part ones and 4 Neer 4-part ones. Starting from 1.5cm anterior to the acromion, the skin was incised for 6 cm in length and the deltoid muscle was separated along the muscle fibers to expose the fracture fragments. Under direct vision the indirect reduction of the fracture was performed and the fragments were temporarily fixed with K-wires. The LPHP was inserted distally beneath the deltoid muscle and the position between the distal plate and the humeral shaft was adjusted through another small skin incision on the lateral upper arm. 4 locking screws were inserted to the proximal plate to fix the fracture fragments while screws were percutaneously inserted to the distal plate to fix it to the humeral shaft. Results This series experienced a primary wound healing, a mean operation time of (128?35) min, a mean intraoperative blood loss of 65?19 mL, and an average hospitalization of 4 days. A follow-up of mean 6.1 months, ranging from 3 months to 14 months, was performed in 12 cases of the 17 and revealed fracture union in all, with a mean healing time of 15.7 (ranging from 12 to 24) weeks. The final follow-up demonstrated a normal sensation on the lateral arms and a motion range in shoulder abduction of 80?to 150?and flexion of 80?to 160?. Conclusion The treatment of proximal humeral fractures by open reduction and internal fixation with LPHP through a small skin incision on the anterolateral shoulder has the advantages of simplifying operative maneuver, reducing tissue damage, decreasing blood loss, shortening bone healing time and improving functional recovery.

BACKGROUND:Repeated injections or nasal spray of large doses of calcitonin can effectively prevent postmenopausal osteoporosis. Calcitonin should be taken for a long time.But the use of calcitonin is limited by the need for repeated protein administration, costly production methods and antigenicity. Gene therapy can provide effective economic therapeutic regimen for osteoporosis,and reduce side effect of drugs.OBJECTIVE:To describe the expression of human calcitonin produced in myoblasts and determine the effects of the recombinant protein on murine osteoblast cells.DESIGN:A gene-based controlled observational experiment.SETTING:Institute of Radiation Medicine,Fudan University.MATERIALS: The experiment was carried out at the Institute of Radiation Medicine, Fudan University from December 2005 to June 2006. Ten healthy SD fetal rats were selected from Institute of Radiation Medicine, Fudan University,Human Calcitoninsas monoclonal antibody was purchased from American Santa Cruz Biotechnology Company. L6 myoblast line was provided by Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences,Chinese Academy of Sciences. METHODS:The pcDNA3.0.-hCT liposome transfection mixture (transfection group) and empty vector pcDNA3.0 liposome mixture (control group) were added in the L6 myoblast medium, respectively.The expression and secretion of human calcitonin by myoblast cells were confirmed by enzyme-linked immunosorbent assay (ELISA),Western blot analysis and immunohistochemical analysis.1×10-14,1×10-13,1×10-12 mol/L recombinant human calcitonin and MEM were respectively added in myoblast medium. MAIN OUTCOME MEASURES:The proliferation and differentiation of rat myoblasts were observed by MTT and alkaline phosphatase (ALP).RESULTS: Human calcitonin was found by ELISA in the supematant of cell culture. Western blot and immunohistochemical analysis verified that human calcitonin could be expressed stably in myoblasts after transfection. Osteoblast proliferation and ALP activity were higher when recombinant human calcitonin was 1×10-14 and 1×10-13 mol/L than the control group (P＞0.05).It was significantly higher when the concentration was 1×10-12 mol/L than the control group (P＜0.05).CONCLUSION:The stable synthesis and secretion of biologically active human calcitonin can be achieved in myoblasts by gene transfection.Recombinant human calcitonin can enhance proliferation and differentiation of osteoblasts.

Objective To investigate treatment method for existing and impending benign pathological femoral neck and trochanteric lesions.Methods A retrospective study wad done on 25 patients with benign proximal femur lesions treated between 2002 and 2004.All patients were treated with lesion curettage,cauterization,autografting and/or allografting.Then,dynamic condylar screw (DCS) or hip joint-span external fixator were selected according to the involved area of the lesion of the proximal femur.The duration of follow-up was mean 2.3 years (2-4 years).Results Sound bony union was seen on the radiographs of all patients by 3-6 months after surgery.There found no local recurrence or avascular necrosis of the femoral head,or complications like necrosis,infections or fractures.Function of the patients in the current series was graded excellent,assessed by the validated outcome measures MSTS-87,MSTS-93 and TESS lower extremity.Conclusion DCS or hip joint-span external fixator may be better alternative treatment of benign pathological femoral neck and trochanteric lesions,compared with conventional surgical methods such as simple bone grafting,traction and hip spica cast.

Objective To analyze the effect of meniscus tear on prognosis of tibial plateau fracture and the effect of fracture on meniscus healing by comparing the outcomes of simple tibial plateau fractures and the fractures combined with meniscus injury. Methods A retrospective analysis was conducted in 57 cases of tibial plateau fractures treated with internal fixation in our hospital from January 2004 to June 2006. Twenty-three of them were complicated with meniscus tear and received repairing. Knee joint functions were evaluated by the HSS (The Hospital for Special Surgery) score. The menisci were examined by Joint-line tenderness, McMurray, Apley and Thessaly tests. The femorotibial angle (FTA), tibial plateau angle (TPA) and posterior slop angle (PA) were measured on X-ray images. Results Fifty cases were followed up for an average Of 15 (6 to 24) months. The HSS scores for the simple tibial plateau fracture and the tibial plateau fracture combined with meniscus tear were 87.9 and 87.1, respectively. There were no statistical signifi-cances in HSS score(t=0.351, P=0.727), FTA, TPA and PA results between the 2 groups. No more positive physical signs of meniscus tear were found in the group of tibial plateau fracture combined with meniscus tear than in the other group. Conclusions Meniscus tear may not affect the postoperative re-habilitation of the knee joint with tibial plateau fracture; neither is there evidence that tibial plateau fracture may hinder meniscus healing.

Objective To analyze the validity and safety of using a novel posteromedial approach whose L-shaped incision is reversed in treatment of posterior fractures of the tibial plateau. Methotis Anatomical research was performed on 4 fresh-frozen cadaveric specimens with 8 normal knees. All specimens were dissected by the posteromedial reversed L-shaped approach. Parameters of the important structures were measured. Results two important structures were involved in the novel approach. Including medial saral artery and vein and inferior medial genicular artery. The average distance between the eruptive site of medial sural artery and articular surface was 45.29 mm, and the average length ofmedial sural artery was 36.28 mm. The average distance between the eruptive site of inferior medial genicular artery and articular surface was 10.12 mm. The main posterior structures of the proximal tibia were all surveyed by the single approach, including the posterior bi-condyles and the tibial insertion of the posterior crueiate ligament. Conclusion The posteromedial reversed L-shaped approach is an effective approach for treating posterior fractures of the tibial plateau or posterior injuries of the proximal tibia, because it is less invasive, highly safe, simple in anatomy, direct and sufficient in exposure.