Objective To study the clinical effect of cohesive elastic bandage (CEB) after operative treatment of ankle fractures. Methods After surgery, 60 patients with ankle fracture were randomly as-signed to 2 even groups: CEB dressing group and common dressing group. Functional exercise started the next day after operation. Comparison was made between the 2 groups in drainage, displacement and swelling. Results In CEB dressing group, the volume of drainage was (34.6±18.1) mL, the rate of displacement 6.7%, and the swelling was slight in 21 patients, moderate in 5 and severe in 4. In common dressing group, the volume of drainage was (85.1±17.1) mL, the rate of displacement was 63.3%, and the swelling was slight in 7 patients, moderate in 12 and severe in 11. The differences were significance(P<0.05) . Conclusion Use of CEB after surgery for ankle fractures may alleviate swelling, reduce bleeding effectively, and benefit early functional exercise.

Objective To introduce the method of treating chronic mallet finger using Micro Arc bone Anchor, and investigate the feasibility of this method with the clinical effects.MethodFourteen chronic mallet fingers were treated with Micro Arc bone Anchors. During the operation, a "?" skin incision over the dorsum of the DIP joint was made to expose the extensor tendon and resect the scar tissue between the disrupted ends. Then the DIP joint was made at extending position was immobilized with a 1mm Kirschner wire and the ends of extensor tendon was sutured with horizontal mattress suture method. After that,the Micro Arc bone Anchor was sutured into the dorsal base of the distal phalanx,the suture thread attached the end of anchor was tied to the proximal end of the extensor tendon to reinforce the former suture. External fixation on the anterior face of forearm was applied to immobilize the wrist at 30?of extention and the metacarpophalangeal and interphalangeal joints and extending position for 3 w, and Kirschner wire fixation was taken out 6 w postoperatively. Functional exercises were performed after the Kirschner wires were removed.ResultAll the cases were followed up for 6 months to 1 year, and excellent results were obtained in 10 cases, good in 2, fair in 2 and poor in 1 according to Dargan's functional assessment system, with dysfunction of flexion in DIP joint in 1 case, and recurrence of abnormity in 1 case.The total rate of excellent and good results was 85.7%.ConclusionMicro Arc bone Anchor is a convenient and effective alternative for the treatment of chronic mallet finger deformity with many advantages such as the high suturing intensity,low recurrence rate of abnormity, convenient for operation and reliable effect.

Progress in the metacarpophalangealgeal joint implantation has drawn increasing attention to its role in treatment of chronic arthritis of the hand. This paper summarizes the biomechanic research and devolvement of the prosthesis, preoperative evaluation and plan for metacarpophalangealgeal joint implantation and the clinical results of different designs of the MCP prosthetic joint in the past decade. With improvement of prosthesis designs and operative technology, the MCP implantation will play a better role in clinical treatment of chronic arthritis of the hand, such as relief of pain, rectification of abnormality and functional recovery of the hand.

Objective To study the histologic changes of arteries dilation under different hydraulic pressure. Methods Right carotid arteries were dilated by using hydraulic method with different pressures (40, 80, 120 kPa) normal saline. The endothelial cells, internal elastic membrane (IEM), smooth muscle (SM) and adventitia of the arteries were studied under microscope. The arterial calibre, thickness of tunica intima and smooth muscle were measured under TJTY-300 automatic medical photograph analyser. Results 1) The calibre of the dilated arteries increased. 2) When the pressure was 40 kPa, there were mild injuries of endothelial cells, internal elastic membrane and smooth muscle; all the injuries recovered to normal 1 week later. 3) The degree of injury of the individual layers of the arteries gradually aggravated as the pressure raised up to over 80 kPa. The repair also required long periods of time and was found imperfect. The proliferation of fibres of connective tissues took place one week later. Conclusion 1) Blood flow could be increased after hydraulic dilation of the artery, and the strength of washing away the small thrombosis over the site of anastomosis could be increased. 2) For safety, the hydraulic pressure of arterial dilation should be better kept within 40 kPa.

Objective To observe the patency and the rate of arterial spasm in different time periods following segmental hydrolic dilation during the course of tissue transplantation; also the influence of arterial dilation to arterial structure was studied with histological examinations. Methods Fifty seven patients with thumb or finger defects were treated with thumb reconstruction using thumb nail flap free transplantation in 41 cases, thumb reconstruction using free transplantation of the second toe in 6 cases and 10 cases had finger reconstruction using the second and third toe free transplantation. Following complete tissue isolation, and prior to vascular anastomosis, heparin+normal saline was injected into the dorsal pedal artery, the first metatarsal artery and the digital artery of the big toe or the second for segmental dilation with the pressure of 300 mmHg. The dorsal pedis arteries were taken for histologic studies after hydrolic dilation. Results 1)The temperature of transplanted tissues were 0.16 ℃ higher than the health side. 2)The immediate arterial patency rate was 100% after anastomosis and the rate of spasm was 0. Vascular crisis took place in one case 24 hours after the operation, and was relieved after removal of the hematoma. There was one failure due to the extensive thrombosis formation in the capillaries. 3)Histologic study showed: there were 15% of the arterial endothelium exfoliated following hydraulic dilatation, resulting in looseing of the internal elastic membrane, a basically normal muscular layer of different thickness; without hydraulic dilatation, 7% of the arterial endothelial cells exfoliated, with homogeneous thickness of the internal elastic membrane and intact muscular layer. Conclusion 1)Segmental hydrolic dilation is one of the effective methods to prevent and treat vascular spasm and it is a safe and effective method to increase the successful rate of free tissue transplantation. 2)Hydrolic dilation within a certain range(300 mmHg) had no obvious effect on arterial structure.

Objective To report the preliminary clinical results of treatment of severely comminuted radial head fractures by replacement with floating cup radial head prosthesis. Methods In the period from August 2002 to June 2005, replacement with floating cup radial head prosthesis was performed to treat 10 cases of Mason Ⅲ , Ⅳ radial head fractures, of whom 9 were acute fractures and 1 old. Results All the patients were followed up for 6 to 40 months (mean 14.9 months). The mean flexion/extension of the elbow was 133.5? /9.0? , while the mean pronation/supination of the forearm was 78.5? /84.0? . There were 3 cases of mild pain, 1 case of mild valgus instability in the elbow and 3 cases of mild weakness. The Broberg and Morrey elbow scores averaged 93. The result was excellent in 6 cases, good in 3 and fair in 1, the excellent and good rates were 90% . Conclusion The replacement with floating cup prosthesis shows satisfying preliminary clinical outcome in the treatment of radial head fractures unable to be reduced, while its long- term result needs further follow- up

Objective To reports to anatomy and clinical application of the medialis pedis perforator flap. Methods The origin, course, distribution and out diameter of medial plantar perforators, which were located at the septums between the abductor hallucis muscle and the flexor digitorum brevis, and between the abductor hallucis muscle and the skeleton, were observed on 10 sides adult feet specimens perfused with red latex. 11 free medialis pedis perforator flaps were transferred for soft-tissue defect in hand. The areas of tissue defect ranged from 2 cm x 2 cm - 9 cmx 4 cm. Results The medial plantar artery sends 2 perforators with regular anatomy through the septum between the abductor hallucis muscle and the flexor digitomm bre-vis, and 2 perforators with regular anatomy through the septum between the abductor hallucis muscle and nav-icluar bone and the medial cuneiform bone. These perforators supply the medial plantar flap and medialis pedis flap respectively. All of the 11 cases of free medialis pedis perforator flap survived uneventfully. The flap areas ranged from 2 cm × 3 cm - 11 cm× 5 cm. The appearance and functional results were satisfactory with following up for 6 to 24 months. Conclusion The free medialis pedis perforator flap is a good method in repairing soft-tissue defect in hand.

BACKGROUND: The articular surface of interphalangeal joint and metacarpophalangeal joint is destroyed or defected, that would remain serious sequela in many patients and affect patient's routine work and living. Therefore, therapeutic efficacy of finger joint damage determines the functional recovery of hands. Tissue engineering provides a novel pathway for finger joint damage. OBJECTIVE: To summarize the research progress on the repair and reconstruction of finger joint damage. RETRIEVAL STRATEGY: The researcher of this article used the computer to retrieve literatures of Pubmed database with docuterms of "Interphalangeal joints fractures, Metacarpophalangeal joints fractures, Finger osteoarticular, Reconstruct", and the language was defined to English. Meanwhile China Academic Journals Full-Text Database from 2000 to 2007 was also retrieved with docuterms of "Interphalangeal joints, Metacarpophalangeal joints, Fractures, Repair and reconstruct", and the language was defined to Chinese. Totally 106 correlated articles were screened out and the data were firstly checked. Inclusion standard: ①closely correlated to the repair and reconstruction of finger joint damage; ②those published in the near future or authorized journal in the same field were preferred. Exclusion standard: repetitive investigation. LITERATURE EVALUATION: The resource of literatures was the clinic empirical studies of the repair and reconstruction of finger joint damage. Among 32 included articles, 3 of them were reviews and the others were clinic or empirical studies. DATA SYNTHESIS: The homogeneity variant bone-joint transplantation has got some successes in clinic, but how to prolong the survival time of transplanting joints would be a new research topic. Autoallergic joint transplantation is a good method to treat the defects of finger joints, but how to make handling conveniently, diminish secondary damage and search new donor site, all deserve to research. The ideal therapeutic efficacy of the finger joint damage is anatomical reset of the joint profile, that can reduce traumatic arthritis and anchylosis at the minimal level. But it is still a tough problem in the fingers joint's repairs, because of the multiple structure of bone-joint in hands and trauma factors. Open reduction and internal fixation, skeletal traction, arthroplasty, fusion of joint, prosthetic replacement of joint, articular transplantation and bone-joint tissue engineering have all obtained success, but none can fully succeed or be generally adopted. CONCLUSION: There are many treatments of the finger joint damage, but their results are not very well. With the research of homogeneity variant bone-joint transplantation, autoallergic joint transplantation and tissue engineering development, bone-joint transplantation will have a wide prospect in treatment of finger joints damage.

BACKGROUND: Basic flbroblast growth factor (bFGF) can promote tendon proliferation, collagen secretion,and out-sheathed tendon healing; however, effects on in-sheathed tendon are still unknown.OBJECTIVE: To explore the effects of exogenous bFGF on in-sheathed tendon healing and adhesion formation. DESIGN,TIME AND SETTING: A randomized controlled animal study, which was carried out in Experimental Animal Center, Shanghai Sixth People's Hospital from May 2004 to February 2005.MATERIALS: Ninety Leghorn chickens were randomly divided into 3 groups with 30 animals for each, and the right third digitorum longns tendon of the chicken was transected. METHODS: In the control group, the tendon was sutured in situ after transection. In the fibrin group,the tendon was sutured after 0.6 μL fibrin sealant (FS) was applied at repair site. In the bFGF group,the tendon was sutured after 0.6 μL FS mixed with 500 ng bFGF was applied at repair site. MAIN OUTCOME MEASURES: At 1,2,4 and 8 weeks postoperatively, the tendons of 6 chickens in each group were harvested for morphological and histological evaluation.Another six specimens of each group was obtained for biomechanical test at 8 weeks.RESULTS: There were no significant differences between control group and fibrin group. In bFGF group compared with control and fibrin groups, appearance of the angiogenesis,fibroblast proliferation and collagen production in the sheath, epitenon and parenchyrna at repair site occurred earlier and were more in quantity,the gliding excursion of the tendon was shorter, and the work of flexion and the ultimate tensile strength of the tendon were greater. CONCLUSION: The exogenous bFGF at tendon repair site can facilitate in-sheathed tendon healing, but also increase the tendon adhesion.

BACKGROUND:Thrombogenesis is the most common cause of failure in the implantation of tissue engineered small-caliber vesselgrafts.And immobilizing heparin onto the surfaces of vascular scaffoidgrafts is often applied to improve their blood compatibility and patency.OBJECTIVES:To investigate the small intestinal submucosa(SIS)surface after heparinizadon with hypothermic plasma technique,to ireprove the blood compatibility of SIS and to explore the possibility for the construction of small-caliber vascular grafts with modified SIS seaffolds in vivo.DESIGN:Single exponent study.SETTING:Department of Orthopaedics,the Six People's Hospital Affiliated to Shanghai Jiao Tong University;ShanghaiInstitute for Microsurgery of Extremities.MATERIALS:This study was performed in the Shahghai Institute for Microsurgery of Extremities from January to October 2006.The jejuna were taken from farm pigs.METHODS:The SIS surface of pigswere processed by argon plasma(20mL/min)technique at different time periods(0,2,4,6,8,10,12,and 14 s),which were then immediately immerged in heparin sodium solution for 24 hours.Dogs were divided into two groups.The SIS films were sewn into a 3-mm diameter tube and implanted into the defect of a canine femoral by anastomosis as a vascular graft.The observation lasted for 6 weeks.MAIN OUTCOME MEASURES:The surface morphologies of SIS were observed under scanning electron microscope(SEM).The antithrombogenicity of SIS films was tested by water contact angle,blood coagulation time and platelet adherence observation by SEM.The efficiency of the SIS graft was evaluated by the patency in the circulation of blood with colour doppler detection and histology.RESULTS:Heparinized SIS showed great different surface morphology comparing with untreated SIS.Untreated SIS surface looked like wrinkled film,but on heparinized SIS surface spread with uniform micro-dots,which looked like a layer of heparin adhesion.Water contact angle decreased with the increase of plasma irradiation time.Prothrombin time (PT),partial thromboplastin time(APTT),and thrombin time(TT)of the SIS films modified with heparin were prolonged.Platelets adhered much more on untreated SIS film than on heparinized SIS film.Vascular graft from SIS embolized in the lumina completely at day 3 after anastomosis.Heparinized SIS graft kept patency for six weeks,and the inner surface of graft was covered with full endothelial cells.CONCLUSION:Hydrophilicity and antithrombogenicity of heparinized SIS are increased obviously after hypothermia plasma treatment.