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.

Objective To discuss the effect of damage control applied for an earthquake pelvic fracture. Methods One case of pelvic fracture in the 5.12 Wenchuan earthquake was treated by damage control in May, 2008. The patient was managed with anti-shock measures and temporal fixation of fracture in the first stage and minimally invasive surgery under fluoro-navigation system in the second stage. Results After two-stage damage control, the patient obtained stable vital signs, satisfactory reduction and internal fixation with no complications. Conclusion Damage control strategy for the earthquake pelvic fractures can improve the survival of patients and decrease their complications.

The criterion of injury severity is an important part of evaluation,which can affect the treatment for closed fracture.The reaction in soft tissue healing process contains microvascular responses and inflammation.Take soft tissue with low immunity as a incision will lead to wound dehiscence and deep infection.Therefore,realization of injury severity lays a foundation for effective treating with closed fracture.Many treatment methods,such as splint fixation,cryotherapy,compression or delayed operation,can prevent soft tissue from a second injury,and promote self-repair ability prior to operation.The newly development surgical tech-nique can improve efficacy of therapy,meantime,decrease the incidence of complications.

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 report the clinical results of treatment of tarsometatarsal joint injuries by close reduction and percutaneous screw fixation. Methods From January 2003 to June 2005, 26 cases of tarsometatarsal joint injuries were treated with close reduction and percutaneous screw fixation. They were 13 cases of middle column injury, seven cases of medial-middle column injury and six cases of three-column injury according to Myerson’ s classification. Results In this series all the wounds healed primarily with a mean operative time of 40 min ( 30 to 70 min) and a mean incision length of 5 mm. A mean follow-up of 11.4 months (ranging from 6 to 17 months) revealed a mean score of 87 according to American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scoring system. All the patients returned to normal daily life after a mean time of 5.3 months (3 to 11 months). Conclusions Tarsometatarsal joint injuries can be treated well by close reduction and percutaneous screw fixation with less operative lesion and lower incidence of soft tissue complications. Reduction of the middle column with screw insertion along the direction of the Lisfranc ligament is the key to reestablishment of the stability of the tarsometatarsal joint complex.

0.05). According to the HSS system, the score was 89.6 (range, 75-98) averagely one year after operation. No any complications occurred, such as necrosis of the incision, deep infection, the loosening and breakage of the internal fixator. Conclusion The technique with modified dual plating for the complex fractures of the tibial plateau provides satisfactory function of the knee, it has many advantages, such as stable and durable fixation, avoiding the replacement and change of the knee mechanics, as well as diminish the problems about the incision and soft tissue.

Objective To compare and analyze the biomechanical strengths of 4 different fixations for the posterolateral shearing tibial plateau fracture. Methods The posterolateral shearing fracture models were created in 40 synthetic tibia (SYNBONE, right) and randomly assigned into 4 groups. Group A was instrumented with 2 lag screws, group B with anteromedial LC-DCP, group C with lateral locking plate,and group D with posterolateral buttress plate. Vertical displacements of the posterolateral fragments and failure loads were measured under axial loads from 500 N to 1500 N. Results The vertical displacements in groups A, B, C and D were respectively(0. 459 ±0. 045) mm, (0. 365 ±0. 035) mm, (0. 264 ±0. 025)mm and (0. 128 ± 0. 018) mm under axial loads of 500 N, (1. 058 ± 0. 091 ) mm, (0. 882 ± 0. 053 ) mm,(0.551±0.053) mm and (0.440±0.068) mm under 1000 N, and (1.559±0.097) mm, (1.466±0. 079) mm, (1. 291 ±0. 077) mm and (0. 832 ±0. 130) mm under 1500 N. The differences between the 4 groups were statistically significant ( P ＜ 0. 05) . The loads to failure in groups A, B, C and D were respectively (1870 ± 156) N, (2520 ± 186) N, (2816 ± 190) N and (3465 ±210) N. The differences between the 4 groups were statistically significant ( P ＜ 0. 05 ). Conclusion The posterolateral buttress plate may be the biomechanically best fixation method for the posterolateral shearing tibial plateau fracture.

Objective To report and evaluate the treatment results of unstable distal radial fractures with volar locking compression plate (LCP). Methods 46 cases of unstable fractures of distal radius were treated with open reduction and LCP fixation through volar approach from April 2002 to May 2004. 14 of which underwent bone graft and 12 postoperative immobilization with plaster sprint. Results A follow-up of 6 to 30 (mean 21) months revealed bone union in all cases with a mean volar deviation angle of 9.7?and a mean ulna deviation of 21.3?of the distal radius. The wrist functions were evaluated by the modified Gartland and Werley system only to find 32 excellent cases, 11 good ones, 2 fair ones, and 1 poor one. Conclusions The unstable distal radial fractures can effectively be treated with open reduction and LCP fixation through volar approach. The subsidence of the radial articular surface can well be prevented and bone healing accelerated with supplementary bone graft.

Objective To report the preliminary results of Less Invasive Stabilization System (LISS) applied in treatment of proximal tibial fractures. Methods 22 patients with acute fractures of proximal tibia were treated with LISS plates from November, 2003 to June, 2004. There were 6 females and 16 males, with a mean age of 41.8 years (ranging from 22 to 69 years). According to AO classification, 7 cases were type 41- A, and 15 cases were type 41- C (9 combined with other fractures). 5 of these were open fractures (3 cases of Gustilo- Anderson type Ⅲ A and 2 cases of type Ⅲ B). Results All fractures were eventually healed. There were 2 cases of superficial infection. No deep infection, failure of fixation or malalignment was found in this group. However, 1 case showed displacement of articular surface 6 months postoperatively. The range of motion was from 2? to 98.6? . The mean time of radiographic healing was 14.5 weeks (ranging from 11 to 17 weeks) and the mean time of full weight bearing was 15.2 weeks (ranging from 12 to 18 weeks). By Johner - Wruhs' evaluation, 13 cases were rated as excellent, 7 as good, 2 as fair 1 year postoperatively. Conclusions LISS is a safe and effective fixation device for proximal tibial fractures, especially for those caused by high- energy injuries. The benefits of this system include less intervention of blood supply, less soft tissue complications and a high union ratio of fractures.

Objective To evaluate minimally invasive plate osteosynthesis (MIPO) technique in the treatment of humeral shaft fractures using locking compression plate (LCP). Methods Between February 2004 and January 2005, 17 consecutive patients with 17 humeral shaft fractures were treated with LCP by MIPO technique. There were 12 men and 5 women with a mean age of 48 years (range, 18 to 75). According to AO classification, three fractures were type12-A, 10 type 12-B, and four type 12-C. Results The mean duration of follow-up was 19. 1 months (range 14 to 25) . Union occurred in all patients with a mean healing time of 11. 3 weeks (range 9 to 14) . With regard to ROM of the shoulder, the mean flexion was 174 degrees (range, 135 to 180 ), the mean extension was 38 degrees (range, 20 to 40), and the mean abduction was 87 degree (range, 70 to 90). For the elbow, the mean flexion was 133 degree (range, 115 to 135), the mean extension was -1 degree(range, - 10 to 0). Using the patient-rated functional questionnaire, the mean DASH (disabilities of the arm, shoulder and hand) score of 11 points (range, 6 to 44) at the latest follow-up indicated a mild to moderate impairment. There were three postoperative complications. One superficial infection occurred in a Custilo type MB open fracture and was uneventfully healed with conservative managements. One patient experienced transient radial nerve palsy which showed complete remission within 3 months. The third one demonstrated a dysfunction of shoulder and elbow. There were no cases of secondary malalignment or late hardware failure in this cohort. Conclusions Internal fixation using LCP in MIPO can attain a stable fixation, a high union rate as well as a low complication rate. The neurovascular structures may be at less risk of iatrogenic injuries through the anterior approach. It may be considered a reliable and efficient method for humeral shaft fractures, especially for comminuted ones and those with poor bone quality.