The purpose of this study was to evaluate how soft tissue surgery for correcting equinus deformity affects the kinematic and kinetic parameters of the ankle and proximal joints. Sixteen children with spastic hemiplegic cerebral palsy and equinus deformities (age range 3-16 years) were included. Soft tissue surgeries were performed exclusively on the ankle joint area in all subjects. Using computerized gait analysis (Vicon 370 Motion Analysis System), the kinematic and kinetic parameters during barefoot ambulation were collected preoperatively and postoperatively. In all 16 children, the abnormally increased ankle plantar flexion and pelvis anterior tilting on the sagittal plane were significantly improved without a weakening of push-off (p < 0.05). In a group of 8 subjects with a recurvatum knee gait pattern before operation, the postoperative kinematic and kinetic parameters of the knee joint were significantly improved (p < 0.05). In a group of 8 subjects with ipsilateral pelvic external rotation before operation, the postoperative pelvic deviations on the transverse plane were significantly decreased (p < 0.05). These findings suggest that the soft tissue surgery for correcting equinus deformity improves not only the abnormal gait pattern of the ankle, but also that of the knee and pelvis.
Male ; Kinetics ; Joints/physiopathology/surgery ; Humans ; Hemiplegia/*surgery ; Gait/physiology ; Female ; Equinus Deformity/*surgery ; Child, Preschool ; Child ; Cerebral Palsy/*surgery ; Biomechanics ; Ankle Joint/physiopathology/surgery ; Adolescent

OBJECTIVETo analyze the fenestration operation for treatment of acetabular parastyle fracture combined with articular facet compression and collapse of acetabular top involving weight-bearing dome.

METHODSFrom July 2005 to February 2007, 52 cases of acetabular parastyle fracture combined with articular facet compression and collapse of acetabular top involving weight-bearing dome were treated by two methods. Among them, 24 cases were treated by fenestration operation for articular facet reduction, bone grafing, anatomical reconstruction of the acetabular parastyle with internal fixation, included 17 males and 7 females with an average age of (35.2 +/- 6.4) years old; the other 28 cases were treated only anatomical reconstruction of the acetabular parastyle with internal fixation, included 19 males and 9 females with an average age of (36.4 +/- 4.8) years old. All the patients were evaluated with modified d'Aubigne-Postel clinical evaluation standard.

RESULTSAll patients gained bone healing. There were only 1 patient occurenced femoral nerve injury and recovered 2 months later. There were no other complications. All patients were followed up from 12 to 51 months (averaged in 31.5 months). According to modified d'Aubigne-Postel clinical evaluation standard, there were statistic difference between the two groups of patients in pain, walking, range of motion and total score. In fenestration operation group, the results were excellent in 13 patients, good in 9, fair in 1, poor in 1; in parastyle reduction group,the results were excellent in 9 patients, good in 11, fair in 6, poor in 2 (u=0.613, P<0.05).

CONCLUSIONFenestration operation for treatment of acetabular parastyle fracture combined with articular facet compression and collapse of acetabular top involving weight-bearing dome is a feasible method for the recovery of hip joint function.

Acetabulum ; injuries ; physiopathology ; surgery ; Adult ; Aged ; Female ; Fractures, Compression ; physiopathology ; surgery ; Humans ; Joints ; injuries ; physiopathology ; surgery ; Male ; Middle Aged ; Treatment Outcome ; Weight-Bearing ; Young Adult

OBJECTIVETo evaluate the therapy and the key points of the tarsometatarsal joint injury combined with metatarsal fracture.

METHODSFrom Jan. 2006 to Jul. 2008,19 patients with tarsometatarsal joint injury combined with metatarsal fracture were treated with opened reduction and internal fixation of Kirschner wire or screws, included 13 males and 6 females with an average age of 38.1 years ranging from 21 to 56 years. The classification of tarsometatarsal joint injury showed that there were 2 cases of inner column injury, 5 cases of inner and medial column injury, 3 cases of lateral and medial column injury, 9 cases of tri-column injury. There were 8 cases of shaft fracture, 7 of neck fracture, 19 of foundation fracture.

RESULTSAll the incisions were first stage healed without skin necrosis. The healing time of fracture was 11.2 weeks on average. All the patients were followed-up for 6 to 17 months with an average of 12.8 months. According to the standard of AOFAS, the average score was (84.500 +/- 8.553), the results were excellent in 4 cases, good in 9 cases, fair in 3, and poor in 3. The regular daily life was recovered after 6.4 months, 3 patients suffer from mild osteoarthritis.

CONCLUSIONNo matter which fixed mode was used, the anatomical reduction was the most important to rebuild arches of the foot and recover medial longitudinal and lateral arch. Rebuilding arches of the foot guaranteed the integrity of the stress point scaffold and avoided the pain and limp. The anatomical reduction of tarsometatarsal joint and metatarsal was also important to rebuild the function of foot.

Adult ; Female ; Foot Joints ; injuries ; physiopathology ; surgery ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; physiopathology ; surgery ; Humans ; Male ; Metatarsal Bones ; injuries ; physiopathology ; surgery ; Middle Aged ; Recovery of Function ; Young Adult

OBJECTIVETo explore the effects of posterior transarticular fixation with rod-screw in treating fracture and dislocation, spinal stenosis of lower cervical vertebrae.

METHODSFrom July 2005 to July 2009,11 patients with cervical fracture and dislocation and 9 with spinal stenosis of lower cervical vertebrae underwent operation with transarticular fixation with rod-screw (Vertex system). There were 16 cases male and 4 cases female, ranging in age from 29 to 76 years with an average of 51 years. All patients underwent decompression,internal fixation and fusion through posterior approach (combined with anterior approach in 3 cases). The method of insertion of screw: the starting point located in medial 1 mm of the midpoint of the lateral mass, angle in sagittal plane was 15 degrees-20 degrees of caudal clinism and in coronal plane was 35 degrees-40 degrees of external clinism. The position of screws, the cervical array, bone graft and fusion were observed by X-ray films.

RESULTSA total of 88 transarticular screws were successfully inserted, 10 screws located in C3,4, 20 in C4,5, 32 in C5,6, 26 in C6,7. There were no complications related to screw insertion, such as injury of the vertebral artery, nerve roots and the spine cord. All patients obtained bone fusion without internal fixation breaking. The improvement rate of JOA was 55.8% at the 1st week after operation, 5 cases got excellent results, 7 good, 7 fair, 1 poor; the improvement rate of JOA was 74.5%, at the 3rd month after operation, 6 cases got excellent results, 8 good, 6 fair. There was significant difference in the JOA between before operation and at the 3rd month after operation.

CONCLUSIONThe transarticular screw fixation with rod-screw in the lower cervical spine is an effective fixation, which has advantages of rigid stability, convenience to perform, and can reduce operative risk in initial application, but the long-term follow-up is very necessary.

Adult ; Aged ; Bone Screws ; Cervical Vertebrae ; injuries ; physiopathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Joints ; surgery ; Male ; Middle Aged ; Recovery of Function

OBJECTIVETo discuss the probable causes of the post-surgery complications with the intra-artcular fracture of calcaneus, the proper steps for prevention and solution.

METHODSSeventy-one patients (76 injured feet) included 49 males and 22 females aged from 19 to 56 years old (mean 35.6 years). According to Sanders' classification, 23 cases (24 injuried feet) belonged to type II, 36 (38 injured feet) were type III, the remain 12 (14 injured feet) met the criteria of type IV. All the patients received the operation of open reduction, autogenous bone grafting and internal fixation with stainless steel plates.

RESULTSThirteen injuried feet developed early complications. Two injuried feet got the superficial layer of the wound disrupted and infected, I had the deep layer of the wound disrupted and infected. Cutaneous necrosis at the pointed end of the wound occurred in 7 cases. Another 1 developed osteomyelitis. Two cases suffered from sural nerve damage. Two injuried feet developed late complications, both of them suffered from arthritis of talocalcaneal joint. All the patients were followed up at least 6 months (ranged from 6 to 42 months, mean 19 months). According to Kerr's post-surgery evaluation criteria, 34 injuried feet were excellent, 32 were fine, 9 were acceptable, only 1 was bad.

CONCLUSIONIf proper measures are taken, the post-surgery complications of intra-articular fracture of calcaneus will be reduced. This requires us to be strict in selecting operation indication, to make a good plan and preparation, to select a right time for operation, to improve surgical skills and pay more attention to peri-surgery nursing. If complications happen, according measures should be taken in order to get a better outcome.

Adult ; Calcaneus ; injuries ; Female ; Follow-Up Studies ; Foot Joints ; injuries ; Fractures, Bone ; pathology ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; prevention & control ; Young Adult

PURPOSETo investigate efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury.

METHODSTen cases of Lisfranc injury treated by open reduction, miniplate and hollow screw in our hospital were retrospectively analyzed. There were 6 males and 4 females with age ranging from 25 to 45 years (mean 32 years). Among them, one case was classified as Type A, six Type B and three Type C. Injury mechanism included road traffic accidents (3 cases), fall from height (5 cases) and hit by heavy object (2 cases). All injuries were closed without cerebral trauma or other complicated injuries. The time interval between injury and operation was 6-10 days (average 6.6 days). Postoperatively, the foot function was assessed using Visual Analogue Scales (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) Scales. Healing time and complications were observed.

RESULTSAll patients were followed up for 18-24 months (average 20 months). Anatomic reduction was achieved in all patients on images. There was statistical significance between preoperative score (7.89 ± 0.34) and score at postoperative 8 weeks (0.67 ± 0.13). According to the AOFAS score, 5 cases were defined as excellent, 3 cases as good and 2 cases as fair. During follow-up, there was no wound infection or complications except for osteoarthritis in 2 cases. Healing time ranged from 3 to 6 months with an average of 3.6 months.

CONCLUSIONAnatomical reduction of Lisfranc injury can be achieved by open reduction and internal fixation with the miniplate and hollow screw. Normal structure of Lisfranc joint is regained to a great extent; injured ligaments were also repaired. Therefore, this method offers excellent curative effect and can avoid postoperative complications and improve the patients' quality of life.

Adult ; Bone Plates ; Bone Screws ; Female ; Foot Injuries ; physiopathology ; surgery ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Ligaments, Articular ; injuries ; Male ; Middle Aged ; Recovery of Function ; Retrospective Studies ; Tarsal Joints ; injuries

OBJECTIVETo study the feasibility of application of ilium inner table to repair the articular surface defects of tibial plateau complex fractures.

METHODSTwenty-three patients with tibial plateau complex fractures included 17 males and 6 females with an average age of 28.3 years old ranging from 18 to 51 years. The area of the articular surface defects ranged from 1 cmx2 cm to 3 cmx3 cm, averaged 6.7 cm2. Taking ilium inner table with periosteum after trimmed and implanting into the articular surface defect area with the concavity upward and drilled with diameter 1.5 mm Kirschner pin interval 3 to 4 mm. Bone grafting were placed under the ilium inner table and were fixed by T-shaped or L-shaped plate. The wounded limb were braked by plaster for 4 weeks after operation.

RESULTSTwenty-three patients were followed-up for 8 months to 3 years, averaged 13.6 months. X-ray film showed solid union and the smooth articular surface in all cases. According to the Rasmussen evaluation system, the results were excellent in 11 cases, good in 8 cases,fair in 3 cases, poor in 1 case.

CONCLUSIONTaking ilium inner table to repair the articular surface defects of tibial plateau complex fractures is a good resolving measures. It can repaire major area of articular surface defects, restore the smooth articular surface and acquire good function of knee joint with easy to operate, less complications at donor area.

Adolescent ; Adult ; Bone Transplantation ; methods ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Ilium ; anatomy & histology ; Joints ; injuries ; transplantation ; Male ; Middle Aged ; Tibial Fractures ; pathology ; physiopathology ; surgery ; therapy ; Treatment Outcome ; Young Adult