Characteristics of collapsed tibial plateau fracture determines that the joint surface must remain anatomical reduction,line of force in tibial must exist and internal fixation must be strong. However, while renewing articular surface smoothness, surgeons have a lot of problems in dealing with bone defect under the joint surface. Current materials used for bone defect treatment include three categories: autologous bone, allograft bone and bone substitutes. Some scholars think that autologous bone grafts have a number of drawbacks, such as increasing trauma, prolonged operation time, the limited source, bone area bleeding,continuous pain, local infection and anesthesia,but most scholars believe that the autologous cancellous bone graft is still the golden standard. Allograft bone has the ability of bone conduction, but the existence of immune responses, the possibility of a virus infection, and the limited source of the allograft cannot meet the clinical demands. Likewise, bone substitutes have the problem that osteogenesis does not match with degradation in rates. Clinical doctors can meet the demand of the patient's bone graft according to patient's own situation and economic conditions.
Bone Substitutes ; Bone Transplantation ; Humans ; Tibial Fractures ; surgery

OBJECTIVETo study the related risk factors for surgical site infection following Pilon fracture surgery. METH ODS: The data of 561 patients with Pilon fractures treated with open reduction plate osteosynthesis at our institution's trauma centre were collected from January 2006 to December 2012. All the patients were divided into two groups: infection group and non-infection group. In the infection group, there were 23 males and 10 females, ranging in age from 21 to 69 years old, with an average of (45.50±4.40) years old. In the non-infection group, there were 296 males and 232 females, ranging in age from 16 to 76 years old, with an average of (43.50±7.19) years old. The possible risk factors such as age, gender, smoking, diabetes, alcohol abuse, open fractures, compartment syndrome and operative time were studied. The multivariate Logistic regression model was used to analyze the risk, factors.

RESULTSThe infection rate of surgical site after Pilon fracture surgery was 5.88%. There were significant statistical differences between infection group and non-infection group in operative time, open fractures and compartment syndrome. However, multivariate Logistic regression analysis revealed that only operative time was significantly associated with surgical site infection (P=0.005, OR=44.92).

CONCLUSIONOperation time is an independent predictor for post-operative surgical site infection of Pilon fracture treated with open reduction plate osteosynthesis. Though open fracture and compartment syndrome could increase the surgical site infection rate, they could not not be considered as independent predictors.

Adult ; Compartment Syndromes ; complications ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Operative Time ; Risk Factors ; Surgical Wound Infection ; etiology ; Tibial Fractures ; surgery

Equipment Design ; Facial Injuries ; therapy ; First Aid ; instrumentation

Objective To study treatment of Vancouver type-B periprosthetie femoral fractures after total hip arthroplasty.Methods There were 10 cases with Vancouver type-B periprosthetic femo- ral fractures after total hip arthroplasty being treatment,including three cases with type-B1 undergone open reduction and allografi strut to fix the fracture,two with type-B2 undergone open reduction and revi- sion with a long stem and five with type-B3 undergone open reduction,revision with a long stem and al- lograft strut to restore bone.The mean duration of follow-up was 27 months(8-36 months).The Harris Hip Score and radiographs were used to evaluate the outcome.Failure of the procedure.was defined as the need for revision surgery because nonunion of fracture,implant loosening,and infection.Results All cases obtained successful fracture healing,with no stem loosening or infection.Of all,nine cases were a- ble to walk by themselves but one needed aid in walking.The Harris Hip Score was 83 at the time of the final follow-up.Osseous union of the allograft to the host femur occurred in eight hips and mild graft re- sorption in two.The cotex thickness of host femur was increased more than 3-5 mm.Conclusions Stem stability and bone quality are important factors determining the outcome of treatment for periprosthet- ic femoral fracture after hip arthroplasty.Good outcome can be achieved by adopting different treatments according to sub-classification of Vancouver type-B fractures.The allograft strut for the treatment of a Vancouver type-B periprosthetic femoral fracture can not only provide fixation,but also make fracture heal fast and augment bone mass and strength.

OBJECTIVETo summarize clinical outcomes of locking compression plate (LCP) combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) for the treatment of Pilon fracture.

METHODSFrom January 2009 to December 2012, Pilon fracture patients treated by LCP with MIPPO were retrospectively analyzed. All open fractures, pathologic fractures and those who had limb vascular disease or nerve injury were excluded. Thirty-eight patients were enrolled, including 29 males and 9 females aged from 21 to 78 years old with an average of 48 years old. According to AO classification, 20 cases were type B, 18 cases were type C. Operative time, blood loss, reduction quality, time of fracture healing complications and postoperative ankle joint function were applied for evaluating clinical outcomes, AOFAS scoring were used for assessing postoperative clinical effects.

RESULTSAll patients were followed up from 13 to 24 months (averaged 18 months). All patients obtained bone union without any plate failures or loss of fixation/reduction. One patient occurred superficial wound infection, and resolved with antibiotics and local wound care. Postoperative average AOFAS score was 81 (ranged 65 to 97).

CONCLUSIONLCP with MIPPO for Pilon fratcure has advantages of less invasion, fewer complications and satisfactory ankle function.

Adult ; Aged ; Bone Plates ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Retrospective Studies ; Tibial Fractures ; surgery

Objective To investigate the clinical characteristics, diagnosis and treatment of acute mesenteric venous thrombosis(MVT) in the elderly. Methods The clinical features, diagnosis, treatments and prognosis of 10 aged cases with acute MVT were retrospectively analyzed. Results The chief complaints of the 10 cases were different degrees of abdominal pain, which not paralleled with abdominal signs. The accompanying symptoms were nausea, vomiting and bloody stools and so on. All of these patients were misdiagnosised as pancreatitis, appendicitis or intestinal obstruction and so on. diagnosis of two cases was confirmed by ultrasound, 8 by CT. At the same time, 2 cases underwent angiography examination. Of the 8 cases who underwent operation, 5 cases were cured, 3 cases died (1 died of toxic shock and 2 died of multiple organ failure ). Two cases underwent conservative intervention thrombolysis. Conclusions It is essential to improve the knowledge of acute MVT,especially its intricate clinical characteristics, high rates of misdiagnosis and mortality. Early proper diagnosis is crucial. The main treatment is operation and conservative intervention thrombolysis can be performed in the patients whose bowel has not necrosed yet.

OBJECTIVETo comparatively analyze the medical records of patients with limb fractures as well as rescue strategy in Wenchuan and Yushu earthquakes so as to provide references for post-earthquake rescue.

METHODSWe retrospectively investigated 944 patients sustaining limb fractures, including 891 in Wenchuan earthquake and 53 in Yushu earthquake, who were admitted to West China Hospital (WCH) of Sichuan University.

RESULTSIn Wenchuan earthquake, WCH met its three peaks of limb fracture patients influx, on post-earthquake day (PED) 2, 8 and 14 respectively. Between PED 3-14, 585 patients were transferred from WCH to other hospitals outside the Sichuan Province. In Yushu earthquake, the maximum influx of limb fracture patients happened on PED 3, and no one was shifted to other hospitals. Both in Wenchuan and Yushu earthquakes, most limb fractures were caused by blunt strike and crush/burying. In Wenchuan earthquake, there were 396 (396/942, 42.0%) open limb fractures, including 28 Gustilo I, 201 Gustilo II and 167 Gustilo III injuries. But in Yushu earthquake, the incidence of open limb fracture was much lower (6/61, 9.8%). The percent of patients with acute complications in Wenchuan earthquake (167/891, 18.7%) was much higher than that in Yushu earthquake (5/53, 3.8%). In Wenchuan earthquake rescue, 1 018 surgeries were done, composed of debridement in 376, internal fixation in 283, external fixation in 119, and vacuum sealing drainage in 117, etc. While among the 64 surgeries in Yushu earthquake rescue, the internal fixation for limb fracture was mostly adopted. All patients received proper treatment and survived except one who died due to multiple organs failure in Wenchuan earthquake.

CONCLUSIONProvision of suitable and sufficient medical care in a catastrophe can only be achieved by construction of sophisticated national disaster medical system, prediction of the injury types and number of injuries, and confirmation of participating hospitals?exact role. Based on the valuable rescue experiences after Wenchuan earthquake, the rescue was faster, more orderly and effective in Yushu earthquake. Nevertheless, there is still a long way to go in the development of a stronger emergent response to the disasters.

Adult ; Aged ; China ; epidemiology ; Earthquakes ; Extremities ; injuries ; Female ; Fractures, Bone ; epidemiology ; therapy ; Hospitals, Teaching ; Humans ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVETo retrospectively analyze the medical treatment of 332 patients with lower leg fracture in Wenchuan earthquake admitted in West China Hospital.

METHODSFrom May 12, 2008 to June 15, 2008, 332 patients with lower leg fracture injured in Wenchuan earthquake were treated in our hospital. The data on trauma condition and clinical treatment were collected and analyzed.

RESULTSAmong the 332 cases of lower leg fracture, there were 179 cases of open fracture, accounting for 53.9%, in which 91% belonged to Gustilo II or III injury with serious pollution. Many patients had posttraumatic complications, vascular and nerve injury, wound infection or osteofascial compartment syndrome. After medical treatment, blood vessels were reconnected, wound surface was repaired and wound infection was under control.

CONCLUSIONFor the patients with lower leg fracture in earthquake, we followed the principle of "complete debridement - restoring the continuity of bone bracket-timely recovering blood supply of limbs and repairing nerve damage - repair the wound surface at stage I or II " so as to reduce the incidence of amputation and infection.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; China ; Compartment Syndromes ; etiology ; Earthquakes ; Female ; Fracture Healing ; Fractures, Bone ; surgery ; Humans ; Leg ; blood supply ; innervation ; Leg Injuries ; surgery ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVETo summarize experience of using screws and cement to rebuild tibial bone defect in primary total knee arthroplasty (TKA) and to discuss the relationship between the number of required screws and the severity of tibial bone defects.

METHODSFrom July 2009 to May 2015, 34 patients (40 knees) with varus knees underwent TKA, and the screw and cement technique was used to rebuild medial tibia plateau during operation. There were 8 males (8 knees) and 26 females (32 knees), and the average age was (65.00 +/- 7.25) years old (ranged,55 to 82 years old). One to 6 screws were used in each case. Extension stems were used in 2 cases (4 and 5 screws was used respectively). The area percentages of the bone defects measured as defect area/tibia plateau area, depth of each defect, the number of screws needed in each case, were all used to determine the relationship between the number of screws and the area percentage in certain depth of bone defect by statistic methods, as well as the relationship between screw number and defect depth.

RESULTSAll the patients were followed up and the average duration was 24 months (ranged, 1 to 72 months). The average preoperative HSS score was 43.33 +/- 6.11 (ranged, 32 to 51 scores). Whereas the average postoperative HSS score was 92.15 +/- 4.64 (ranged,83 to 96 scores). The preoperative individual scores including pain, function, activity, nuscle strength, flexion deformity and stability were all improved compared with preoperation,and the differences were statistically significant. All the patients received normal alignment postoperatively, femoraltibial angle was improved from (167.00 +/- 6.39) degrees preoperatively to (175.00 +/- 2.69) degrees postoperatively, the tibial angle was improved from (78.09 +/- 4.51) degrees preoperatively to (88.75 +/- 1.24) degrees postoperatively. Both area percentage and depth of bone defect in a fitting Ologistic model had a significant statistical relationship with the screw number, and a rectangular coordinate system could be formed according to the relationship.

CONCLUSIONScrews and cement technique is a simple, safe and convenient method to rebuild tibial bone defects in primary TKA and its short-term and midterm effect are both reliable. During opera- tion, according to the rectangular coordinate system, the screw number needed in the operation can be inferred form th area and depth of tibia defect, which could have a guiding function in surgery.

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee ; instrumentation ; methods ; Bone Screws ; utilization ; Female ; Fracture Fixation, Internal ; Humans ; Knee Injuries ; surgery ; Knee Joint ; surgery ; Male ; Middle Aged ; Tibia ; surgery