This issue of CJOT features geriatric fractures, involving surgical treatment of intertrochanteric femoral fracture, proximal humeral fracture, distal radial fracture, and fractures of distal femur, patella, tibial shaft, and ankle. Osteoporosis is not only a common high risk factor for fractures in the aged population but also a leading cause for most of the postoperative problems. Besides osteoporosis, the complications common to the aged people add to the difficulty of the treatment of the geriatric fractures. As a result, how to improve the clinical effects and prevent refractures for old patients has become the chief concern in the treatment of geriatric fractures.

Bone fracture is the most serious outcome of osteoporosis,the morbidity has been linked to age,gender and races.The characteristics of osteoporotic fracture include reduced bone quality,a delay in bone fracture union process,and a high incidence of re-fracture.The therapy of osteoporotic fracture includes surgical management and osteoporosis treatment.Osteoporosis treatment can improve bone quantity and bone quality,decrease the rate of fracture.The rule of surgical management is simpleness,safety,and efficacy.Because of poor bone quality,internal fixation and implant are easy lossened.Ideas for future research,such as development of a new implant with rigidity and elasticity like bone tissue,development of a new drug which can improve bone mass and quality quickly.Regardless of surgical management for osteoporotic fracture,pharmacological treatment of osteoporosis is also necessary.In order to get a good outcome of osteoporotic fracture treatment,both surgical management and osteoporosis treatment are important.

Objective To investigate the effects of absorbable gelatin sponge, chitosan and sodium hyaluronate(HA) on inhibition of postoperatively epidural scar formation in animal models with posterior discectomy and the concentrations of HA in the cerebral spinal fluid was also determined. Methods 96 Wistar rats older than 12 months were equally allocated into four groups. Each animal underwent a unilateral hemi-laminectomy and discectomy. Absorbable gelatin sponge, chitosan and HA were placed at the sites of surgery in three groups respectively. The fourth group undergone laminectomy and discectomy only, was served as control. At the time of 2,4, 8, 12 weeks postoperatively, 6 rats in each group were sacrificed for gross evaluation, histology and transmission electron microscope studies. The areas of epidural scar and spinal canal were measured by a computer image processor, and were compared statistically. The concentrations of HA in the cerebral spinal fluid in the HA groups and control groups were tested. Results The epidural scar areas in the chitosan and HA groups were significantly less than those in the control and absorbable gelatin sponge groups; no significant difference was found among the spinal canal areas of all the groups at different time phase; the compression and dislocation of the dura and spinal nerve roots and the discontinuity of the annulus fiber were observed in every group and time phase. The two cases with highest concentrations of HA were in the HA group at 2-week. Conclusion Chitosan and HA are able to inhibit the epidural scar formation after posterior discectomy. The healing of the annulus must be considered when evaluating the scar inhibition effects of materials. When the materials are placed in the epidural space, their effects on the central nervous system should be considered.

As the structure of shoulder joint is complex, proper method s should be adopted to treat the injured shoulder joint according to the type an d position of the trauma. Conservative treatment has been widely used to treat t he slightly displaced or stable fractures (including those of the proximal humer us, clavicle and shoulder blade), and most of the fresh dislocations of shoulder joint and acromioclavicular joint if the injuries are not serious. As for the o bvious unstable shoulder fractures, recurrent dislocation of shoulder joint, sev ere dislocation of acromioclavicular joint, dislocation of shoulder joint accomp anied with fracture, and rotator cuff tear, an operation should usually be the r ight choice. In either conservative or operative treatment, earlier systematic f unctional rehabilitation should be widely used in order to achieve satisfactory functional recovery of should joint.

Objective To study the effects of glucosamine sulfate on nitric oxide(NO)production induced by interleukin(IL)-1β in human osteoarthritis chondrocytes(HOC),and explore the possible mechanism.Methods Chondrocytes were harvested from 10 osteoarthritis patients undergoing total knee replacement(TKR)operation.Human recombinant IL-1β(5 μg/L)and glucosamine sulfate GS in different concentrations(0.2 mmol/L,2.0 mmol/L,20.0 mmol/L)were administrated into cell culture medium for 24 h.The content of NO was detected by enzyme-linked immunosorbent assay(ELISA).The mRNA and protein expression of inductive nitric oxide synthetase(iNOS)were measured by RT-PCR and Western blot,respectively.Results Stimulation of HOC with IL-1β enhanced production of NO and expressions of iNOS mRNA and protein(t=-14.81,-45.38,all P＜0.01).Pretreatment with 2.0 and 20.0 mmol/L GS showed a dose-dependent inhibition of IL-1β induced NO production(F=12.43,P＜0.05)and the expression levels ofiNOSmRNA(F=142.28,P＜0.05)and protein(F=78.08,P＜0.01).20.0 mmol/L GS alone did not influence NO production(t =-0.17,P＞ 0.05).Conclusions GS may inhibit the synthesis of NO induced by IL-1β in HOC through down-regulate mRNA and protein expressions of iNOS.

Objective To evaluate alendronate with regards to its effect s on trabecular bone structural properties. Methods Alendronate was administered at a daily p.o. dose of 0.5 mg?kg－1?d－1 over a 12 weeks period in Hound do gs (n=8 ＋ 8 for control and treated group), the structural indices of the lumba r vertebral (L 1 and L 2) trabecular bone were assessed directly from 3 D image s. Results Treatment with alendronate increased bone volume fraction by 9.5％ a nd 7.7％ respectively, in the L 1 and L 2. Trabecular thickness significantly in creased after alendronate treatment, whereas trabecular separation remained cons tant. The degree of anisotropy for the alendronate treated group was decreased compared with that of the control group. Bone surface to volume ratio declined s ignificantly in the alendronate treated group, whereas alendronate induced a hi gher value of bone surface density. Conclusion Alendronate increased the struct ural properties of canine trabecular bone after short-term treatment at a dose of 0.5 mg?kg－1?d－1. Thus, alendronate could increase the structural properti es of healthy trabecular bone in a short-term period.

Objective To investigate the result of McBride operation for treatment of hallux valgus with more than 5 years follow-up. Methods There were totally fifity patients who underwent McBride operation in this study. The follow-up period varied from 5 years to 10 years and 2 months (average 7 years and 1 month). The symptoms and deformity before and after operation were compared statisticly. Results The angle between first phalanx and metatarsal is strongly correlated with the angle between first and second metatarsal.The coefficience of pre- and post-operation is 0.84 and 0.71 respectively.There were 64 feet whose symptoms were eliminated and the deformity were corrected basically. The effective rate was 71.1% according to the assessment criteria discribed by doctor ZHU Lihua. The common complications were pain residue, local numbness, hallux valgus recurrence, hallux varus and claw toes. The measurment showed the angle between first phalanx and metatarsal significantly decreased after operation and the angle between first and second metatarsal also decreased following the hallux valgus correction. Conclusion McBride operation is a good and reliable method to treat young patients with mild to moderate hallux valgus. Complications are related to congenital foot deformity, severe valgus deformity and normal structure injuries during the operation.

Objective To observe the reparative response and expression of basic fibroblast growth factor (bFGF) protein in the rotator cuff subjected to subacromial impingement. Methods Subacromial impingement of the infraspinatus tendon was experimentally created in 50 male SD rats by thickening the undersurface of the acromion with one platelike bony transplantation of the ipsilateral scapular spine. The contralateral shoulders that had undergone a sham operation were used as controls. The rats were sacrificed at 3, 7, 14, 28, and 56 th day, the whole shoulder joint was removed for detecting bFGF protein and the reparative response in the impinged infraspinatus tendon. Computer image analysis system were used to monitor the expression intensity and numbers of positive cells of bFGF protein. The OD scores and the size of area represent the expression intensity and numbers of positive cells respectively. Results All rats with experimental subacromial impingement showed an infraspinatus tear on the bursal side of the tendon. The shoulders in the control group were found intact without any alteration. There was proliferating cells in the fragmented tendons and vascularised connective tissue covering the area of ruptured area, whose source was the subacromial bursa. Few tenocytes and bursal cells expressed bFGF protein in unwounded tendons. In contrast, tendons subjected to impingement exhibited an increased signal for bFGF protein in both resident tenocytes concentrated along the epitenon and infiltrating fibroblasts and inflammatory cells from the subacromial bursa. Conclusion The bFGF protein is upregulated during tendon healing and the subacromial bursa is the main source of both bFGF secreting and rotator cuff repair; one should preserve as much as possible the subacromial bursa.

Objective To determine the sensitivity and accuracy of CT do ub le-contrast arthrography (CTA) in detecting underlying soft-tissue and bony abno rmalities of recurrent anterior glenohumeral dislocations. Methods From March 19 90 to May 2003, 31 patients with the signs and symptoms of recurrent anterior in stability, which were 23 males and 8 females with an average age of 26.7 years ( ranging, 22 to 46 years), were recruited for the study. All patients suffered fr om more than three times of glenohumeral dislocations, underwent CT arthrography after intraarticular injection of air and radiographic contrast medium before o peration. The surgical procedures included open Bristow operation in 25, Bankart operation in 3, Putti-Platt operation in 2, and a combination of Bankart and ca psular tightness operation by arthroscopy in 1. Each patient also underwent arth roscopy or open surgery and the observations were compared with CTA. Results Les ions of labrum and capsulo-ligamentous complex were the two most common abnormal ities demonstrated by surgical findings, which were respectively found in 28 and 20 patients at surgery. Anterior glenoid labral abnormalities, including of tea r, detachment, degeneration, were detected on CTA in 26 of 28, 2 of glenoid labr al degeneration were undetected on CTA, and the accuracy rate diagnosis on CTA w as 93.5%, while the sensitivity of CTA was 92.8%. Capsular lesions, including of marked medial scapular insertion, glenoid marginal stripping, and loss of inter vening scapular marginal soft tissues, were detected on CTA in 19 of 20, 1 of ca psular glenoid marginal stripping was undetected on CTA, and the accuracy rate d iagnosis on CTA was 87.1%, while, the sensitivity of CTA was 95%. Subscapularis tendon abnormalities, including of tears and irregularities, were visualized in 7 cases on CTA, but only 4 of which were identified during surgery. Furthermore, all of 15 Hill-Sachs defects, 6 Bankart bony defects, and 1 rupture of supraspi natus tendon suggested by CTA, were identified during surgery. For 26 of the pat ients with above kinds of lesion resulting in recurrent anterior glenohumeral di slocation, the accuracy rate of diagnosis was 83.7%. Conclusion The utilization of CT double-contrast arthrography can improve the understanding of multiple les ions associated with recurrent shoulder dislocation, it is contributed to select proper operative procedure.

Objective To analyse the treatment results of proximal humerus fracture in over sixty-years-old patients. Methods From January 1999 to January 2003, 32 cases suffered from fractures of the proximal humerus were studied, which involved 13 males (mean age 73.2 years, range 60-88 years), and 19 females (mean age 75.5 years, range 60-94 years). There were 22 cases (65.7%) with two-part fractures, among them, 68.1% was surgical neck fracture. 3 cases with two-part and 1 with three-part fracture were treated conservatively because of either their poor health condition or their refusal to operation. The other 28 patients were operated. According to the Neer classification, through the statistic and analysis for the method and outcome, all the cases were evaluated in term of the American UCLA scale system. Results 25 of the 28 operated patients were available at the final follow-up, the mean period was 1.5 years with a range of 1 to 3 years. All the fractures had united. 5 patients with healing time more than 3 months were those fractures classified as three or four-part, which needed the tension-band fixation. All the patients complained with joint stiffness in different degree, 6 of the patients with three or four-part remained with sustaining shoulder contracture. According to the UCLA, the good-excellent rate was 81.2% in the two-part fractures, and only 33.3% in the three or four-part fractures. Conclusion The treatment methods of proximal humerus fracture in aged patients should be selected according to individual condition. The tension band fixation is a good choice for those who can't accept the joint replacement, though the outcome after the four-part fractures fixation is less satisfactory. Joint contracture and humeral head necrosis may be the common complications among the patients rated as three or four-part fractures. After operation, early and complete rehabilitation are closely related to the treatment results.