About 20papers presented at the 2002Annual Meeting of Chinese Orthopaed ic Trauma As-sociation have been selected for thi s special issue.They demonstrate th e state of art of orthopaedic trauma i n China.The articles about managemen t of pelvic fractures discuss gross h emorrhage and lumbar sacral plexus i n-jury in pelvic fractures .To treat pelvic hemorrhage,general support co mbined with fixation of the fracture and homeostasis are the key.5of them dea l with the choice of implant for proximal femoral fractures.The DHS is more suitable for stable intertrochante ric fractures,while the intramedul lary fixation system is favored for u nstable in-tertrochanteric fractures.Many wa ys of fixation can be applied in the tr eatment of distal femoral fractures.Pre-operative planning and decent techniques should be emphasized.The diagnosis of calcaneal fractures should be based on the combination of X-ray and CT scan.The restoration of height,l ength,width and the congruency of th e articular surface of the calcaneus a re the goals of treatment.From now on,we should enhance the clinical rese arch on orthopaedic trauma and specify th e diagnosis criteria.[

Traction during reduction is essent ial for internal or external fixatio n of unstable distal radial fractures.Adequate and effective t raction is the key to the restoration of articular congruence,normal joint relation and the length of distal radius.The f orearm traction instrument develop ed by the authors is a simple,versatile and reliable device,from which stable,continuous and effective traction c an be expected during the surgery.The traction instrument is connected wi th the surgery-table before the operation.According to the needs of diff erent operations,many kinds of traction could be perfo rmed to support the operation.With t he help of the device,frac-ture reduction and fixation is signi ficantly improved during the surgery without excessively violent traction.The X-ray exposure and the operation hou rs can also be decreased as well.Over-traction or long-time violent traction could be avoided during the surgery.According to the author' s experience,the forearm traction i nstrument is an effective implemental device in the treatment of the unstable fractures of distal radius.[

Objective To summarize the outcome of volar approach for unstable distal radius fractures, as well as to explore and discuss the more prompt and efficient way with less complications. Methods Volar approach was used for unstable distal radius fractures in 129 cases (140 sides). This study involved 77 males and 52 females with an average age of 43.7 years (range, 15-76 years). According to the Coony universal classification, 36 sides were of type Ⅱ, 7 of type Ⅲ and 97 of type Ⅳ, which included 105 sides of fresh fracture and 35 old ones. Extra-articular reduction was performed under C-arm to restore the palm tilted angle and ulna deviated angle. For those with severe bone defect, artificial bone graft or auto-graft was applied. T-plates were fixed in 32 sides, T-plates with K-wires in 57, external fixators in 13, external fixators with K-wires in 38 respectively. Results The functional recovery was achieved at 3.8 months averagely after operation with a range of 2 to 6 months. The mean follow-up period was 23.6 months ( range, 12-40 months). 91 sides were rated as excellent, 38 as good, 10 fair and 1 poor. The long-term excellent-good rate was 92.1%. Conclusion The volar approach for unstable distal radius fractures has the following advantages: 1)less invasive without compromise to the bone and tendon sheath of distal radius; 2)The volar surface of radius is smooth , easier for plating; 3)no injury to the palmer ligaments and better for recovery; 4)better reduction; 5)avoidance of bone graft displacement; 6) shorten the operation time, less post-operative complication, earlier rehabilitation and faster functional recovery. The volar approach for unstable distal radius fractures is suitable either for internal or external fixation.

Objective To evaluate the treatment of unstable fractures of the distal end of the radius with external fixator.Methods 28 patients with unstable fractures of the distal end of the radius were treated with external fixators. 19 cases of them were fixed with K wires and bone graft was used in 4 patients with severe bone defect.Results The patients were followed up for an average period of 10.11 months. According to modified Mcbride grading, 25 patients showed excellent or good results with the excellent and good rate being 89.28% . Conclusion It is difficult to reduce unstable fracture of the distal end of the radius with close reduction. Redisplacement is frequent for plaster cast and is not reliable in maintaining reduction. These fractures should be treated with early open reduction. External fixation plus reasonable exercises taken after the operation is one of the good treatments and good results can be predicted. The most important factors affecting final outcome include radial shortening and reduction of articular surface.

Objective To summarize the methods of operative treatment for complex proximal humeral fractures and its clinical results. Methods 40 cases with complex proximal humeral fractures underwent operation from December 1999 to February 2002. Of 40 cases, 29 were followed up with a mean of 25 months (11 to 40 months). Using Neer system, Constant-Murley rating system and questionnaire were adopted to classify the fractures and evaluated postoperative functions of the daily life and work. A deltoid-pectoral approach was used in all patients. The surgical neck fractures were fixed with the terminal threaded pin or modified Ender's nail. The tubercle fragments were sutured with non-absorbable Ethibond No.5 or "8" figure tension band wire. Results The average absolute Constant-Murley score was 81.7(54 to 96), the excellent and good rate was 65%(19/29), fair 24%(7/29), and poor 11%(3/29). The average forward elevation was 142.5?(60? to 180?). The average pain VAH score was 12(9 to 15). The humeral head avascular necrosis, detected by the follow-up X-ray film, was diagnosed if the humeral head was completely or partially absorbed or reduced. In three-part fractures, 71% cases were excellent or good results, no poor result, and 17% had humeral head necrosis; in four-part fractures, 58% cases were excellent or good results, 25% poor, and 67% were found with humeral head necrosis. The extent of the humeral head necrosis was one of main causes to the poor function for complex proximal humeral fractures. All of the fractures healed at 6 to 8 weeks postoperatively without delayed union and nonunion. Conclusion For complex proximal humeral fractures, a good clinical result can be obtained on condition of the anatomical reduction of the tubercle fragments, as well as the stable fixation of the surgical neck fracture with appropriate suture materials and proper post-operative rehabilitation. Satisfactory result is possible even while the humeral head avascular necrosis happened.

Objective A retrospective study of GCTTS in the hand was undertaken to determine whether specific clinic or pathologic factors were associated with an increased risk of recurrence, and to investigate the relationship between the recurrence of GCTTS and its biological indices. Methods 83 patients with histologically proven GCTTS were treated and followed up. The clinical materials were reviewed. Comparison was made between certain factors to determine which were associated with increased recurrence rates. Results The patients were followed for an average of 55 months. 22 patients (26.5%) recurred. Age, gender, site, the origin of tumors, size, bone erosion or destruction, cellularity and the mitoses were not risk factors for recurrence. Tumors without capsule had higher recurrence rate than that with capsule, and the difference was highly significant. The local recurrence rate of Nm23 positive group was 28.3%, and Nm23 negative group was 19.2%, there was no remarkable difference between the groups. The PCNA-LI was 0.448?0.130 in recurrent group and 0.358?0.147 in nonrecurrent group, the difference was statistically significant. The aneuploidy DNA content was presented in 50% of the recurrent tumors, and in 23.2% of nonrecurrent ones. The SPF was 6.98?4.64 in recurrent group and 4.70?2.49 in nonrecurrent group. These values were also significantly different. PCNA-LI, the aneuploidy DNA content and SPF were significantly higher in group without capsule than those in group with capsule. These values were not different between tumors with and without bone destruction, large and small diameter, high and low cellular tumors, as well as high and low mitoses tumors. Conclusion The high proliferative indices of recurrent GCTTS may explain its aggressive biologic behavior. Tumors without capsule possess higher proliferative indices than the ones with capsule, and they have higher recurrent rate. The proliferative indices of the tumors with and without bone distruction are comparable, and the difference of the recurrence rate among groups is not significant.

Objective To introduce a procedure, proximally based conjoined t en don transfer, which is to be used for coracoclavicular ligment reconstruction in the treatment of acromioclavicular separation. Methods From 2001 to 2003, 26 pa tients with acromioclavicular dislocation of Rockwood Grades Ⅲ-Ⅴwere treated with transfer of the lateral half of the conjoined tendon to the distal clavicle in a proximally based fashion with additional coracoclavicular fixation. Radiol ogy was used to evaluate the acromioclavicular correspondence. ASES (American Sh oulder &Elbow Surgeon) score, SST (Simple Shoulder Test) form and Constant-Mur ley score were adopted to evaluate the shoulder functions. Results Follow-ups o f 22.6 months on average revealed that the height of distal clavicle reached ana tomic reduction in all the cases during operation. At the latest follow-up, the mean ASES score was 94.2, the mean VAS(Visual Analog Scale) score for pain was 1.2,the mean forward flexion was 150?,and the mean external rotation was 35? . The mean Constant-Murley score was 92.8. The number of positive answers to th e SST was 11. The overall satisfaction rate was 88.5%(23/26) and all patients r eplied with “Yes”when questioned with “Do you want to accept the same operati on if the same condition happens to your contralateral shoulder?”Conclusions Th is surgical procedure proves reliable without sacrificing the coracoacromial lig ament during coracoclavicular reconstruction. When the patients are complicated with fresh or old rotator cuff injury, or the coracoclavicular ligament is thin, or long ligament is needed in the reconstruction, the proximally based conjoine d tendon can be served as a good source of autograft ligament.

Objective To explore a better treatment of fresh Monteggia fracture and factors which lead to unsatisfactory results. Methods A retrospective study was done on 60 of the 114 patients with Monteggia fractures who had been treated from 1994 to 2004 in our hospital. According to Bado classification, 26 patients were type Ⅰ, 14 type Ⅱ, 19 type Ⅲ, and 1 type Ⅳ. All the cases received operation. Fixation included plates and screws, plates with tension band, with or without plaster to immobilize the limb after operation. For the fracture of the radial head, the radial head was totally or partially removed and fixated with screw or k-wire. Results 60 patients were followed up for an average of 2 years(1 to 6 years). The average score according to the system of Broberg and Morrey was 95 points (53 to 100 points). The result was excellent for 48 patients, good for 6, fair for 4 and poor for 2. Complications included heterotopic ossification, ulnohumeral osteoarthrosis, cross-union, nonunion, radial nerve injury and dysfunction of elbow joint and forearm. Conclusions Yong adults, especial males, tend to suffer this kind of low-energy injury. Anatomic reduction and rigid fixation is the key to satisfactory results. Heterotopic ossification, ulnohumeral osteoarthrosis are the major factors leading to unsatisfactory results.

Objective To report a group of uncommon cases, and discuss t he impact of distal tibiofibular synostosis on the patients and its clinical sig nificance. Methods At a mean follow-up of 22.8 months(11 to 54 months), 14 pati ents with distal tibiofibular synostosis after ankle fracture were evaluated wit h Philips and Schwartz clinical scoring system of ankle. Results 3 patients comp lained of transient pain after strenuous activities. The others complained of no discomfort. All of them had no trouble in normal working and daily activities. The mean degree of plantar flexion was 47.9?, with 3.5?(0 to 10?)less than the normal side. The mean degree of dorsiflexion was 20?, with 8.6?(0 to 20? )less than the normal side. There were no degenerative changes in all ankles. T he mean Philips and Schwartz score was 90.8(82 to 98). The excellent rate was 71 .4%, and the excellent and good rates were 100%. Conclusion Distal tibiofibul ar synostosis after an ankle fracture usually gives rise to few symptoms and nee ds no specific treatment.

Monteggia fracture dislocation refers to the fracture of the ulna with associated dislocation of the radial head. This rare injury only accounts for less than 5%of all the forearm fractures. By literature review of the history of Monteggia fracture dislocation, the authors further clarify the definition, classification, injury mechanism and treatment protocol of this special type of fracture. The key to a good result of the treatment for a Monteggia fracture dislocation is timely diagnosis and management so that anatomic reduction and stable fixation of the ulna can be achieved. In addition, enough attention must be paid to the associated injuries at the level of the elbow, including fractures of the coronoid process and the radial head as well as posterolateral rotatory instability of the ulnohumeral articulation. The factors strongly affecting prognosis include comminuted fractures of the ulna combined with fractures of the radial head and coronoid process.