The distal humeral fractures are difficult to treat because of the nature of the injury. Although numerous operative approaches have been describe d for them,satisfactory results are difficult to achieve because of the postoper ative complications.We have reviewed relative literature to discuss the incidenc e,cause,prophylaxis and treatment of different complications to deepen the knowl edge of distal humeral fractures.

The major surgical managements for tibial plateau fractures are anatomical reduction, firm fixation and bone grafting. There have appeared many new techniques in recent years, such as less invasive stability system (LISS) and arthroscopy assisted treatment. But such complications as loss of reduction, infection, soft tissue lesion around the knee, nonunion, posttraumatic arthritis, and knee stiffness seem to be inevitable. This article introduces the mechanism, treatment and prevention of the complications of the tibial plateau fracture.

Objective To study the clinical features,treatment methods and clinical outcomes of acute tibialis posterior tendon rupture.Methods Using [(posterior tibial tendon) OR (tibialis posterior tendon)] AND (rupture OR injury OR disruption OR trauma OR tear) as the search words,we searched the PubMed database to retrieve the 19 articles involving 24 cases of acute tibialis posterior tendon rupture.The injury mechanisms,X-ray manifestations,operational findings,treatment methods and clinical outcomes were analyzed.Results The mechanisms of the fracture-related tibialis posterior tendon rupture included motor accident (50.0％,12/24),falling from a height (41.7％,10/24) and sports injury (8.3％,12/24).The tendon rupture was mostly complicated with malleolar fracture (91.7％,22/24),especially the pronation type (70.8％,17/24).Direct suture of the tendon was adopted in 91.7％ of the cases (22/24).Favorable outcomes were achieved in 95.5％ of the cases (21/24).Conclusions Acute tibialis posterior tendon rupture is mostly seen in high-energy medial malleolus fracture.The mechanism of the rupture might be tendon distraction or bone flake incision.Early operation can lead to favorable outcomes.

BACKGROUND: Researches on the hand allograft have been transited from laboratory aspects to clinical application.OBJECTIVE: To evaluate the clinical significance of serial monitoring of co-stimulating signals in double hand transplantation.DESIGN: Case controlled observation.SETTING: Department of Traumatic Orthopaedics, Nanfang Hospital,Southern Medical University.PARTICIPANTS: From September 2001 to December 2001, a patient who was proposed to have double hand transplantation in the Department of Traumatic Orthopaedics, Nanfang Hospital Affiliated to Southern Medical University was taken as the subject of the experiment, meanwhile 15healthy adult man were enrolled as controls.METHODS: Before operation, blood sample was collected from the patient once before given immunodepressant and twice after given immunodepressant; blood sample was also collected before arteriovenous connection during operation, as well as once a day during the first week after operation, once every other day on the second week, twice a week on the third and fourth week, followed by once a week for total two month. The first week after operation was taken as inducing period with the remainder as maintaining period. 2 mL peripheral venous blood was collected from healthy adult and anti-coagulated by EDTA of mass scores of 20 g/L.Flowcytometry was used to carry out a serial monitoring of T cell surface co-stimulating moleculars (CD28, CD54, CD11a).MAIN OUTCOME MEASURES: The change of co-stimulatingmolecules on the surface of T lymphocyte before and after transplantation.RESULTS:The changes of the three co-stimulating molecules were consistent with each other after double hand transplantation (CD28,CD54,CD11a),displaying decrement during inducing period comparing to pre-operation [(9.84±5.28)%, (55.50±3.62)%; (71.03±5.33)%, (95.10±1.26)%;(9.40±9.17)%, (29.70±3.23)%] and keeping at lower level at maintaining period [ (22.54±6.56) %, (91.28±8.12 ) %, ( 11.22±4.08 ) %].CONCLUSION:The serial monitoring of the co-stimulating signals in the peripheral blood of patients with linb allograft is beneficial to the observation of the posopertaive immunologic reaction, providing important guidance for the application of immunosuppression medicine, as well as the prediction and diagnosis of postoperative immune rejection. Meanwhile, costimulating signal induced immunological tolerance is proved promising for the application of hand transplantation.

A preliminary exploration of the application and effects of digital orthopaedic technique combined with the clinical practice in our clinical teaching of orthopaedics and trauma for 8-year program medical students has been made. Construction of 3D-model of bone and joint with the digital reconstruction technology, combination of 3D-display with detailed clinical cases, individual studying of knowledge, and fracture models performed by three dimensional printing, all have enhanced the students' understanding of the basics knowledge of orthopaedic trauma and accelerated the process of its joining into clinical practice. Related software has been used to realize the virtual design of fracture reduction and fixation and based on it, students have been guided to personally involve in the development and realization of surgical simulation program on a personal computer, thus improving students' capabilities of analysis, diagnosis and treatment of illness. Besides, students have been actively guided to use digital technology to conduct the finite ele-ment analysis of posterior malleolar fractures and calcaneus fractures , and to produce APP software for mobile devices such as ankle fracture classification and function scoring , which has aroused students' in-terest of clinical research and innovation.

For the current situation of the time background and the cultivation of innovation ability of undergraduates, the problems of fracture classification, function evaluation and postoperative rehabilitation were realized by a software research team which mainly consisted of medical undergrad-uates. We put the project into practice in forms of software production and software promotion trial separately in the field of teaching and clinical practice to encourage students to be involved in learn-ing in the process of software production of professional knowledge. The implementation of the project worked well, and developed the well-designed relevant mobile software which was convenient in clini-cal practice and acquired computer software copyright, indicating that it can effectively motivate the undergraduates' innovation interest and consciousness through participating in the various links and the software production process, and it can also contribute to the cultivation of the comprehensive practical and innovation ability of medical undergraduates.

Incidence of acute closed Achilles tendon rupture is high in clinic. Accurate diagnosis of this injury depends on a combination of physical signs and imaging examinations. Although conservative and surgical interventions are common for acute closed Achilles tendon rupture, its optimal treatment remains controversial. This literature review focuses on the research progress concerning this injury so as to analyze its risk factors, diagnostic methods, treatments, early functional rehabilitation, postoperative complications and prognosis evaluation.

With deepening understanding of surgical treatment of calcaneal fractures,clinical applications of external fixators have drawn more attention.At present,however,there has been no systematic review of such applications for intra-articular calcaneal fracture.This review collected all the recent reports available on such applications to analyze the use and clinical indications of different external fixators.Moreover,on the basis of our own clinical experience,we further proposed a novel treatment protocol for intraarticular calcaneal fractures which integrates internal and external fixation and minimally invasive techniques.

Malunion is a common complication following a calcaneal fracture which was not treated or treated inappropriately.It is a therapeutic target and a great challenge as well to relieve pain, correct deformity and restore the function of the affected foot in clinical treatment of calcaneal malunion. As a result of researches by scholars at home and abroad focusing on the biomechanical mechanisms underlying the symptoms caused by calcaneal malunion, a variety of corrective calcaneal osteotomy has been widely applied in clinical practice to specifically correct the calcaneal deformity and restore normal calcaneal morphology. This review expounds on the techniques, outcomes, indications and complications of corrective calcaneal osteotomies commonly used in clinic.

Objective To discuss the influence of Qihong Fang (Wolfberry and Hawthorn Decoction) on heart in aged rats with cold-congealing and blood-stasis pattern.Methods SD rats (n =48) were divided randomly into normal control group,model group,vitamin E group (13.5 mg/kg),low-dose Qihong Fang group (45 mg/kg),mid-dose Qihong Fang group (90 mg/kg) and high-dose Qihong Fang group (180 mg/kg).The aged rat model of cold-congealing and blood-stasis pattern was established through 28-d ozone leading to aging and 14-d ice water leading to cold-congealing and blood-stasis pattern in other 5 groups except of control group.On the 29th d,the blood samples were collected from abdominal aorta for isolating serum and plasma,and heart was separated too.The vitalities of serum total superoxide dismutase (T-SOD),Cu-Zn SOD,Mn-SOD,catalase (CAT),glutathione peroxidease (GSH-PX),content of malondialdehyde (MDA),and prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT) and fibrinogen (FIB) were detected.The morphologic changes of heart cells were observed after HE staining,fiber deposition quantity was observed after Masson staining,expression of transforming growth factor β1 (TGF-β1) was detected by using immunohistochemistry technique for reviewing aging model of cold-congealing and blood-stasis pattern,and protective effect of Qihong Fang on heart was observed in rats.Results Compared with normal control group,the vitalities of T-SOD,Cu-Zn-SOD,Mn-SOD,CAT and GSH-PX decreased significantly (P ＜ 0.05),MDA content increased significantly (P＜ 0.05,PT and APTT decreased significantly (P ＜ 0.05),and FIB content increased significantly (P ＜0.05) in model group.After Masson staining,morphometry observation by light microscope showed deposition of heart collagen fibers increased significantly (P ＜ 0.05),and expression of TGF-β1 increased significantly (P ＜ 0.05).Compared with control group,the vitalities of T-SOD,Cu-Zn-SOD,CAT and GSH-PX increased significantly (P ＜ 0.05),MDA content decreased significantly (P ＜ 0.05),PT and ATPP increased significantly (P ＜ 0.05),FIB content decreased significantly (P ＜ 0.05),deposition of heart collagen fibers decreased significantly (P ＜0.05),and expression of TGF-β1 decreased significantly (P ＜ 0.05) in mid-dose and high-dose Qihong Fang groups.Conclusion Qihong Fang has a protective effect on heart in aged rats with cold-congealing and blood-stasis pattern.