Objective To evaluate the efficiency of free myocutaneous flap transfer for the treatment of refractory post-traumatic osteomyelitis of the lower leg and foot. Methods Eleven patients with refractory post-traumatic osteomyelitis of the lower legs and feet were treated between February 2004 and December 2007. There were 9 males and 2 females. The average age was 3.5 years. All patients had at least four to five unsuccessful surgical procedures and prolonged antibiotic treatment prior to presentation. The mean duration of osteomyelitis was 26 months (12-47 months). According to the Ciemy-Mader classification, there were 3 cases for ⅢA, 2 for ⅢBL, 4 for ⅥA and 2 for ⅥBL. After radical debridement, free myocutaneous flaps were immediately performed. Nine latissimus dorsi and 2 rectus abdominis myocutaneous flaps were used.External fixation was applied in 6 patients with skeletal instability due to tibial defects. Results An average follow-up was 3.5 years. Two cases suffered partial necrosis and were managed successfully with split-thickness skin grafts later. In 4 patients of presenting segmental bone defect, autogenous bone grafting was applied in one patient and achieved consolidation after 5 months; bone transplantation in 2 patients and achieved consolidation after 8 and 10 months; and vascularized fibula graft in one patient in whom the gap of the tibia was about 10 cm and achieved consolidation after 4 months. The other 7 patients of this group achieved bone consolidation without bone graft. Conclusion The cornerstone of the treatment of chronic osteomyelitis was to be the radical debridement of all involved necrotic and infected soft tissue and bone.The free myocutaneous flaps transfer which has the advantage of obliteration of dead space and stable coverage of the defect was a safe and viable treatment option in chronic osteomyelitis of the lower leg and foot.

Objective To observe the effects of decimeter wave irradiation on the rehabilitation of the acute peripheral nerve injury of rats. Methods Eighty Sprague-Dawley rats(200～250 g)were randomly divided into 2 groups:group A,the decimeter wave irradiation group and group B,the blank control group.The right sciatic nerves of all the rats were crushed with forceps to establish the experimental animal model of acute peripheral nerve injury.Then the rats of group A were exposed to decimeter wave irradiation for 10 minutes every day for 8 weeks.The rats of group B were also fixed on a table as those in group A but receive no decimeter irradiation.At different time points observation with light and electron microscopy,immunochemical staining,axon morphometric analysis,electrophysiological examination were carried out.Results Morphometric analysis showed that at different time points after operation the recovery of nerves in group A was better than that in group B.Axon morphometric analysis showed that the number,the diameter and the thickness of sheath of myelinated nerve fibers in group A were greater than those in group B. Electrophysiological assessment showed that the latency was shorter,the amplitude was higher,and the nerve conduction velocity was faster in group A than those in group B at the end of 8 weeks of decimeter wave treatment after operation.Conclusion Decimeter wave had significant effects on the rehabilitation of the acutely injured peripheral nerves.

BACKGROUND: Tendon injury is a common injury in the department of hand surgery. The postoperative recovery of hand function is always affected by tendon adhesion after tendon repair. To prevent tendon adhesion, especially the adhesion after flexor tendon repair is always the key in the rehabilitation of hand surgery.OBJECTIVE: To investigate the impact of decimeter wave therapy on tendon adhesion and healing after flexor tendon repair.DESIGN: Randomized controlled study based on experimental animal SETTING: Provincial Institute of Orthopaedics.MATERIALS: The study was conducted in Hebei Provincial Institute of Orthopaedics from January 2001 to June 2003. Totally 28 Leghorn chickens were randomly divided into decimeter wave therapy group and operation control group.METHODS: The flexor digitorum profundus tendons of Leghorn chickens were transected and repaired. Decimeter wave therapy was applied to the toes on chickens of decimeter wave therapy group. Animals were executed at week 3 or 6 after operation for macroscopical observation and histological observation under optical and electron microscopes, and biomechanical analysis.MAIN OUTCOME MEASURES: Principle index: results of macroscopical observation and the observatory results under optical and electron microscope, and the results of biomechanics. Secondary index: results of the classification of tendon adhesion and healing.RESULTS: It could be seen under macroscopical and histological observation that the adhesion significantly reduced in decimeter wave therapy group. The protein synthesis of fibroblast was significantly more than that of the control group under electron microscope. As indicated by biomechanical analysis, the tendon gliding distance[ (5.37 ± 1.06) mm at week 3, (6.76 ± 1.52) mm at week 6]and the rehabilitative compliance( 1. 04 ± 0.65 at week 3)of decimeter wave therapy group were bigger than those of the control group respectively [ (4.43 ±1.03) mm, (5.33±1.27)mmand0.63±0.31](P ＜0.05), and the anti-tension strength of decimeter wave in therapy group (N, 26. 93 ± 4. 80,47. 12 ± 7.76) was significantly bigger than that of the control group respectively(21.29 ±4. 88 and 38.96 ±7.52) (P ＜0. 01).CONCLUSION: Decimeter wave therapy can effectively promote tendon healing and reduce tendon adhesions and provide prerequisites for early rehabilitative training after flexor tendon repair. Hence, it is an ideal assistance in the prevention of tendon adhesion.

Objective: To evaluate a self-designed external fixation restorer used for femoral shaft fractures in children. Methods: From September 2016 to October 2017, 19 children were treated at Department of Pediatric Orthopaedics, The Third Hospital of Hebei Medical University for irreducible femoral shaft fractures using our self-designed external fixation restorer. They were 15 males and 4 females, aged from 4 years and 2 months to 8 years (average, 6.3 years). There were 7 transverse fractures, 11 short oblique fractures and one oblique fracture. The restorer was applied directly to the femur for traction and temporary external fixation. The femoral shaft fractures were reduced closely before internal fixation with elastic stable intramedullary nails. The Flynn criteria for lower limb fracture were used to evaluate the curative effects postoperatively. Results: The operative time ranged from 32 to 45 minutes (37 minutes on average). All the fractures obtained closed reduction. No such intraoperative complications occurred as traction and compression injury to soft tissues like muscle, nerve and blood vessel. Follow-ups ranged from 8 to 20 months (average, 13 months). All the fractures got united after 7 to 15 weeks (average, 10.1 weeks). No implant failure or breakage occurred. The implants were removed 6 to 8 months after operation when the fractures got united. According to the Flynn evaluation criteria at the last follow-up, 18 cases were excellent and one was good. Conclusions Due to its advantages of simplicity, easy manipulation and direct action on the femur for traction, our self-designed external fixation restorer can improve the closed reduction for femoral shaft fractures in children so that its sustained and effective traction force and high quality of fracture closure avoid surgical opening. The temporarily fixation it provides after fracture reduction can facilitate intraoperative fluoroscopy of the femur.