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.

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.

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.

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.

10.3969/j.issn.2095-4344.2013.26.016

Objective To discuss clinical outcomes of extraperitoneal pelvic packing (EPP) plus external fixation for hemodynamically unstable pelvic fractures. Methods We used EPP plus external fixation to control 15 cases of hemodynamically unstable pelvic fractures from further damage. They were 6 males and 9 females. Their average age was (44. 0 ± 1.2) (38 to 56) years old. Their injury was caused by a traffic accident (13 patients) and falling from a great height (2 patients). According to the Tile classification,there were 3 cases of type B1, 2 cases of type B2-2, 5 cases of type C1, 3 cases of type C2, and 2 cases of type C3. All the 15 patients were hemodynamically unstable and had a hypovolemic shock. Results There was a statistically significant increase in systolic blood pressure, hematocrit and hemoglobin measured immediately after EPP( P < 0. 05) . However, the units of RBC transfusion significantly decreased( P <0.05) and there were no significant difference in pulse rate( P > 0. 05) . The average operation time was (32.0 ± 2.6) min(30 to 40 min). Five patients died (72. 0 ± 4.2) h after operation ( 1 to 7 d). There was no significant difference between the survivors and the non-survivors in systolic blood pressure, pulse rate,hemoglobin, ISS score, hematocrit and blood transfusion( P > 0. 05). But there was significant difference in age and time between injury and EPP ( P < 0. 05). Conclusions In emergency treatment of patients with the hemodynamically unstable pelvic fracture, especially those combined with hypovolemic shock, EPP plus external fixation can effectively control the massive venous (presacral venous plexus) and bone hemorrhage.The blood pressure and pulse rate can be restored by fluid replacement and blood transfusion. Consequently,this method may significantly improve the hemodynamical parameters and decrease the mortality.

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 evaluate the indications and clinical results of less invasive stabilizing system (LISS) in the treatment of complex fractures around the knee. Methods Screws in this system can be inserted through the aiming handle and can be locked into the plate-holes. Between Dec. 2003 and Jun. 2004, 41 cases(29 males, 12 females) of complex fractures around knee were treated with LISS. The mean age of the patients was 40.6 years (range 24 to 67 years). The proximal tibia was involved in 28 cases and distal femur in 13. In all 41 cases, there are 22 (53.7%) polytrauma, 6 (14.6%) delayed fractures and 1 revision surgery. All fresh fractures were operated in a minimal invasive way (only articualr surfaces need open reduction), fractures in metaphyseal area and tibial shaft were reduced indirectly and stabilized with minimal invasive percutaneous plate osteosynthesis(MIPPO). The delayed and revisional fractures were reduced with limited approach and stabilized with MIPPO. Results The mean operation time was 87.2 min. The follow-up averaged 16 months(range 13 to 21 months). 3 patients with bone deficit in distal femur underwent a bone graft which unioned eventually, the other patients had a mean healing time of 15.1 weeks(11 to 23 weeks) and a mean weight bearing time of 16.8 weeks (12 to 25 weeks). One pulling device broken and one screw lost in the tibial medullary cavity occured intraoperatively. Postoperatively, one loss of reduction occurred, no deep infection, loosening, breakage or failure of implants was noted. According to Rasmussen criteria of fracture reduction, excellent in 31 (75.6%) cases, good in 10 (24.4%). One year postoperatively, the mean ROM of the knees was 2.4? to 95.6?, the mean HSS knee score was 88.4 points(58 to 98 points)with 27 excellent, 10 good, 3 fair and 1 poor according to HSS scoring system. Conclusion LISS, with a novel operating concept and technique different to traditional methods, is an effective and alternative way for complex juxtaarticular fractures around the knee, especially for those difficult to deal with in traditional way. As a novel product further clinical studies are required to verify its effectiveness.

[Objective]Tibial plateau fracture may be combined with soft tissue injuries including menisci injuries, but what tibial plateau fractures influence on meniscus healing has never been reported. This study is to observe the influence on menisci healing caused by knee variation when tibial fracture occurred by making animal models.[Method]Lateral tibial plateau fracture models and non-full-thickness laceratin and perforation defect of menisci models were made in 12 New Zealand rabbits, along with control group without fractures. The differences of menisci healing between two groups were observed with morphological and light microscopic observation after 12 weeks.[Result]No menisci repair in avascular portion could be found in both groups, menisci laceration within vascular portion had repaired the fissures in both groups, and hardly been distinguished from normal tissue. Perforation defect in one third of lateral side coulc be partially filled with protein clot in tibial plateau fractures group.[Conclusion]No evidence revealed that fracture could prevent menisci healing when tibial plateau fractures combined with menisci injury, however, defects of menisci may get advantage of filling tissue from fracture. It still need further research whether it is good for menisci healing or not.