OBJECTIVETo study clinical effects of double plates fixation for the treatment of acromion base fracutres.

METHODSFrom January 2010 to May 2012, 7 patients with acromion base fractures were treated with double plates ORIF surgical treatment. There were 5 males and 2 females, with an average age of 36.3 years old (ranged, 24 to 62 years old). All fractures were acuted and closed injuries. The duration from injury to surgery was 4.6 days (ranged, 2 to 10 days). Hardegger functional criterion, Visual Analogue Scale (VAS) and complications of the patients were documented analysis.

RESULTSAll the patients were followed up,and the duration ranged from 4 to 13 months (averaged 8.9 months). The healing duration of fractures ranged from 8 to 14 weeks without any infection, shoulder instability, subacromial impingement syndrome, nonunion and failure of internal fixation. At the latest follow-up, the VAS ranged from 0 to 5. According to Hardegger criterion, 2 patients got an excellent result, 4 good and 1 poor.

CONCLUSIONDouble plates ORIF plays a positive role in the treatment of acromion base fractures, which reduces complications and maximally restore the function of shoulder.

Acromion ; injuries ; surgery ; Adult ; Bone Plates ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Visual Analog Scale

OBJECTIVETo review and conclude the experience and to prevent a variety of complications of operative treatment for tibial Pilon fractures of type II and III.

METHODSFrom March 2006 to October 2011, consecutive 29 patients were treated in our center. According to Ruedi-Allgower classification, there were 19 patients of type II and 10 patients of type III. There were 23 males and 6 females,ranging in age from 21 to 61 years old. The average age was 35 years old. All the patients were treated by open reduction and internal fixation (ORIF). Cloverleaf plate was applied in 8 cases,anatomical plate in 10 cases, and anatomical locking plate in 11 cases. Results of treatment and complications were thoroughly documented and analyzed.

RESULTSAll the patients were followed up, and the duration ranged from 12 to 42 months, averaging 15 months. Referring to Mazur criterion, 12 patients gained excellent result, 5 good and 2 fair in type II fractures; and 4 excellent, 4 good, 1 fair and 1 poor in type III fractures. All factures healed during 12 to 32 weeks, and the average time was 15 weeks.

CONCLUSIONGood therapeutic effects can be obtained by grasping the timing of surgery and indications strictly, standardising the operative manipulation and gripping the tip of operation.

Adult ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Tibial Fractures ; surgery

OBJECTIVETo introduce the use of single arm external fixation assisted reduction and closed complex intramedullary nail fixation for the treatment of femoral shaft fracture operation method and to study its effects.

METHODSFrom June 2008 to October 2012, 24 patients with femoral shaft fractures were treated with unilateral external fixation assisted by closed reduction, interlocking intramedullary nail fixation. Among the patients, 19 patients were male and 5 patients were female, ranging in aged from 20 to 68 years,with an average of 45.6 years old. The fracture was caused by traffic accidents in 14 cases, by falling in 6 cases, by heavy bruising in 4 cases. Admission diagnosis was femoral shaft fracture. Operation was performed after traction from tibial tubercle for about 1 week.

RESULTSAll the patients were followed up, and the duration ranged from 6 to 24 months, with a mean of 16.2 months. The X-ray showed fracture healing time ranging from 11 to 17 weeks, with an average of 13.8 weeks. All fractures healed without nails broken or close joint dysfunction. According to femoral shaft efficacy evaluation standards, 23 patients got an excellent result, 1 good.

CONCLUSIONUnilateral fixator assisted closed reduction and interlocking intramedullary nail fixation for the treatment of femoral shaft fracture has following advantages: less trauma, simple operation, effective reduction, high rate of fracture healing, and low complication rate.

Adult ; Aged ; External Fixators ; Female ; Femoral Fractures ; surgery ; Fracture Fixation, Intramedullary ; methods ; Fracture Healing ; Fractures, Comminuted ; surgery ; Humans ; Male ; Middle Aged ; Traction

OBJECTIVETo study surgical outcomes of medial plus anterolateral approaches for the treatment of tibial plateau fractures involving three columns.

METHODSFrom March 2010 to March 2012,20 patients with tibial plateau fractures involving three columns were treated with internal fixation by using T-shape, L-shape plate, or distal radius T-plate through medial plus anterolateral approaches. Among the patients, 13 patietns were male and 7 patients were female,ranging in age from 29 to 52 years old with an average of 39.4 years old. The intervals between injury and operation ranged from 8 to 12 days, with a mean of 9 days. At the latest follow-up,the American Hospital for Special Surgery score (HSS) was used to evaluate clinical effect,and the average loateau angle,posterior slope angle and femorotibial angle of tibia were measured on the X-ray films.

RESULTSThe average operation time was 2.11 hours; average intraoperative blood loss was 452 ml and average hospital stay was 22.3 days. All the patients were followed up,and the duration ranged from 12 to 20 months,averaged 14.6 months. The fracture healing time ranged from 3 to 8 months, with a mean of 6.1 months. The average loateau angle, posterior slope angle and femorotibial angle of tibia at 3 days after operation were (86.1 +/- 2.7) degrees, (10.7 +/- 1.6) degrees and (168.0 +/- 4.7) degrees respectively; and (84.1 +/- 3.2) degrees, (13.7 +/- 1.9) degrees, (170.0 +/- 5.8) degrees respectively at 1 year after operation (P > 0.05). According to HSS, 11 patietns got an excellent result, 6 good, 2 poor and 1 bad. There were no postoperaive neural and vascular injuries, no plate lossening or broken. One patient had local infection. One patient had skin flap partial necrosis and was cured by conservative treatment. Four patients had postoperative numbness below the inside leg.

CONCLUSIONMedial plus anterolateral approaches for the treatment of fractures involving three columns are effective to get good anatomic reduction and stable fixation without changing body position, which is helpful to early functional rehabilition of knee joint.

Adult ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Tibial Fractures ; surgery

OBJECTIVEThrough establishing the rat model of CIA to evaluate the effect and mechanism of Rhizoma Drynariae Flavone on bone destruction of CIA rat.

METHODSSubcutaneous injection of bovine type II collagen was used to induce Wistar rats to fall ill, and then established the rat model of CIA. The rats whose inflammation scores reached to two points or above were randomly divided into four groups, and were treated accordingly. The effect of Rhizoma Drynariae Flavone on bone destruction was evaluated.

RESULTSAt 12 weeks after treatment, bone trabecular area percentage and bone trabecular number in Rhizoma Drynariae Flavone group, Rhizoma Drynariae Flavone-1/2 Etanercept group, Etanercept group was obviously higher than that of sterilization water group (P < 0.05); and the trabecular resolving power of these groups was obviously less than that of sterilization water group (P < 0.05).

CONCLUSIONRhizoma Drynariae Flavone can obviously inhibit inflammation of joint bone destruction of CIA rats,the effect may be related with bone trabecular number reduction and trabecular resolving power increasing.

Animals ; Arthritis, Experimental ; drug therapy ; pathology ; Bone and Bones ; pathology ; Female ; Flavones ; therapeutic use ; Polypodiaceae ; chemistry ; Rats ; Rats, Wistar

OBJECTIVETo construct one lentiviral vector containing mouse SRY-related silencing group--box gene 9 (SOX9) and to transfect murine bone mesenehymal stem cells (mBMSCs) in vitro and observe the expression of target gene.

METHODSRNA inteference target sequence was designed in connectin with mice SOX9 gene sequence. The double strands DNAoligo containing interference sequence were synthesized and cloned into lentivirus vector. The siRNA lentiviral vector with SOX9 gene silencing was constructed and identified, which was transfected into rat bone mesenehymal stem cells. The expression of target gene was detected by immunofluorescence, RT-PCR and Western blot.

RESULTSLenti-SOX9-siRNA-EGFP was recombined successfully and transduced efficiently into mBMSCs. The expression of SOX9 gene silencing was confirmed by RT-PCR and Western blot.

CONCLUSIONMouse SOX9 gene silencing by RNA interference and Lentiviral vector can transfected successfully into mBMSCs. Meanwhile,SOX9 gene may be silenced in SOX9 transduced mBMSCs. This will provide target cells for the following study about SOX9 gene respairing cartilage injury.

Animals ; Female ; Gene Expression ; Gene Silencing ; Genetic Therapy ; Genetic Vectors ; Lentivirus ; genetics ; Male ; Mesenchymal Stromal Cells ; metabolism ; Mice ; SOX9 Transcription Factor ; genetics ; Transduction, Genetic

OBJECTIVETo measure anatomical data of the femoral tunnel anatomy reconstruction of anterior cruciate ligament (ACL), so provide anatomical basis for clinical anatomy reconstruction of ACL.

METHODSThere were 30 adults' cadaveric knee specimens. The ACL femoral tunnel was reconstructed through anterior medial approach (AMP) in genuflex position of 120 degree, and was marked by Kirschner. The soft tissue of the specimen was removed and the femoral condyle was split at the middle side. The index including length of the femoral tunnel, the distance from internal opening of tunnel to cortical edge of femoral condyle and vertical distance to the top of femoral intercondylar notch were measured. Then the time position of internal opening of tunnel in the intercondylar notch was recorded, and the location of outside opening of tunnel to the femoral condyle was detected.

RESULTSThe mean length of the femoral tunnel was (36.35 +/- 3.14) mm (ranged, 30.65 to 42.35 mm). The distance from internal opening of tunnel to cortical edge of femoral condyle was (17.84 +/- 3.35) mm (ranged, 14.02 to 23.49 mm), vertical distance to the top of femoral intercondylar notch was (14.05 +/- 2.32) mm (ranged, 9.17 to 20.08 mm). According to the way of circular dial,internal opening of tunnel located at 02:30 +/- 00:10 (ranged, 01:50 to 02:50) in the left knee,and 09:30 +/- 0:15 (ranged, 08:30 to 10:40) in the right knee. The outside opening of femoral tunnel located at (3.16 +/- 2.51) mm (ranged, 1.61 to 6.30 mm) to the proximal end of external epicondyle of femur, and (4.25 +/- 2.16) mm (ranged, 1.73 to 8.52 mm) to the posterior of external epicondyle of femur.

CONCLUSIONThe anatomical features of femoral tunnel for reconstruction of ACL is revealed,which will provide anatomical basis for clinical practice.

Adult ; Aged ; Anterior Cruciate Ligament ; anatomy & histology ; surgery ; Female ; Femur ; anatomy & histology ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures

OBJECTIVETo study clinical characteristics and resistance of wound surface infections, so as to guide clinical diagnosis and rational administration.

METHODSThe clinical setting and laboratory results were collected by analyzing 20 strains of Bacillus cereus isolated from clinical samples in patients from our hospital from October 2011 to June 2012, including 18 males and 2 females,ranging in age from 22 to 67 years old, averaged (47.30 +/- 11.16) years old. The courses of disease ranged from 5 to 20 days. All the patients were treated with nutrition support therapy, debridement and the corresponding antibiotic therapy. The patients had anemia, low protein hyperlipidemia and wound contamination history while Bacillus cereus infected. Thirty people were selected as normal group, including 23 males and 7 females,with an average age of (45.20 +/- 15.05) years old. Infection control condition was assessed by comparing culture for pathogens and patients wound redness or exudation cases before and after treatment. Antimicrobial susceptibility test was conducted by K-B method.

RESULTSA total of 20 stains of Bacillus cereus were isolated from wound surface infections in department of orthopedics of our hospital. Among them,the infections were correlated with the wound contamination (16/20), malnutrition (20/20), and open-fracture (20/20), operation time (15 cases > 3 h). The laboratory blood test showed that the levels of TP [(49.94 +/- 8.24) g/L], ALB [(29.54 +/- 5.45 ) g/L] and Hb [(103.20 +/- 11.79) g/L] in the infection group was lower than those of control group; in the contrast, the levels of WBC [(8.35 +/- 2.31) x 10(9)/L], NEUT [(6.98 +/- 1.99) x 10(9)/L], hs-CRP [(73.60 +/- 55.14) mg/L] and CK [(900.10 +/- 1 259.12) IU/L] were higher in the infection group than those of control group, and the differences were statistically significant (P < 0.01). The diameter of inhibition zone in penicillin, cefazolin, cefuroxime, ceftazidime, cefepime, cotrimoxazole, erythromycin were less than 15 mm, and suggested that Bacillus cereus resisted to these antibiotics. However, the diameter of inhibition zone in clindamycin, vancomycin, gentamicin, ciprofloxacin, imipenem were larger than 20 mm and this data indicated that the bacteria were highly sensitive to these antibiotics.

CONCLUSIONOrthopedic patients who immunocompromised, hypoproteinemia and accompanied by open wounds and contaminated wound susceptible to infect Bacillus cereus; sensitive antimicrobial drugs should be selected on the basis of supplement albumin, symptomatic and supportive treatment.

Adult ; Aged ; Anti-Bacterial Agents ; pharmacology ; Bacillus cereus ; drug effects ; isolation & purification ; Female ; Humans ; Male ; Middle Aged ; Orthopedics ; Wound Infection ; microbiology

OBJECTIVETo study the results of closing-wedge high tibial osteotomy and arthroscopy for the treatment of medial compartment osteoarthritis of the knee.

METHODSFrom October 2005 to June 2007, 25 patients met with our inclusion criteria. All the patients with medial compartment knee osteoarthritis were treated with arthroscopy and closing-wedge high tibial osteotomy. There were 11 males and 14 females,with a mean age of 53 years old. The pre-operative HSS knee score was 67.6 +/- 2.8, FTA was (185.54 +/- 1.11) degrees, and aLPTA was (96.54 +/- 0.52) degrees in average. The patients were followed up and evaluated according to HSS knee score. The efficacy of the osteotomy was evaluated by FTA and aLPTA.

RESULTSAll surgeries were successful without serious complication. All the patients were followed up, and the duration ranged from 5 to 7 years. The HSS was 85.5 +/- 3.7 at the 1st year and 80.3 +/- 5.4 at the latest follow-up. There was significant difference between every two scores of before operation and the two after operation (t = -33.135, P = 0.000; t = -13.215, P = 0.000). The FTA was (173.65 +/- 0.92) degrees at the 1st year and (174.34 +/- 0.53) degrees at the latest follow-up. There was significant difference between every two angles of before operation and after operation (t = 28.739, P = 0.000; t = 2.331, P = 0.048). The aLPTA was (87.32 +/- 0.33) degrees at the 1st year and (87.67 +/- 2.82) degrees at the latest follow-up. There was significant difference between every two angles of before operation and after operation (t = 37.264, P = 0.000; t = 2.469, P = 0.039).

CONCLUSIONIndication is important and good surgical technique is critical for good clinical outcome. A detailed plan before operation is essential for the operation. Arthroscopy is helpful for treating the intra-articular pathology. The osteoarthritis is still in progress but in a slow mode. The combined method of arthroscopy and closing-wedge high tibial osteotomy is a reliable way for medial compartment osteoarthritis of the knee.

Arthroscopy ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Osteoarthritis, Knee ; surgery ; Osteotomy ; methods ; Tibia ; surgery ; Time Factors

OBJECTIVETo compare the clinical efficacy of trapezoid pad coordinate with small splint fixation treatment with plaster slab fixation treatment for comminuted Colles fracture.

METHODSFrom October 2010 to March 2012,80 outpatients with comminuted Colles fracture were divided into two groups. There were 40 patients in trapezoid pad splint fixation treatment group and 40 patients in pipe type plaster control group. There were 13 males and 27 females in trapezoid pad splint fixation treatment group,with an average age of (62.1 +/- 19.2) years old. And there were 15 males and 25 females in pipe type plaster control group,with an average age of (60.2 +/- 19.5) years old. After treated with manipulative reduction,the fractures were fixed with pipe plaster in the control group, and were fixed with trapezoid pad joint by small splint in the treatment group. The patients in both groups were regularly taken X-ray recheck and changed dressings to obtain the clinical healing. Patients were guided to do functional exercise after splints were taken off. The therapeutic effects were evaluated according to Gartland-Werlley wrist score when splints taken off and after 2 months.

RESULTSAccording to wrist score, the average scores in the treatment group were (8.1 +/- 2.8) when splints taken off and (5.3 +/- 4.5) after 2 months. And the average scores in the control group were (10.3 +/- 2.6) when splints taken off and (8.4 +/- 5.8) after 2 months. The score in the treatment group was higher than that of control group. The average shortened lengths of radius were (4.8 + 1.7) mm in the treatment group and (8.2 +/- 2.1) mm in the control group. The shortened length of control group was larger than that of treatment group.

CONCLUSIONTrapezoid pad coordinated with small splint fixation is better than traditional pipe type plaster for treating comminuted Colles fracture.

Adult ; Aged ; Case-Control Studies ; Casts, Surgical ; Colles' Fracture ; surgery ; Female ; Fractures, Comminuted ; surgery ; Humans ; Male ; Middle Aged ; Splints