Since the concept of bioelectrical potentials in the bone was developed, various electrical systems have been utilized to heal non-united fractures. The asymmetrical and time varied pulsed electromagnetic stimulator was designed and utilized to treat eight fractures of the lower extremity and one congenital pseudoarthrosis of the tibia. Nonunited fractures, neglected old fractures, and a case of congenital pseudoarthrosis responded favorably to our designed pulse waveform. On the other hand, fresh fractures responded equivocally. A new1y designed electromagnetic stimulator which can deliver vascular and calcification pulses, will be developed on an industrial basis to provide various clinical and experimental applications.
Electromagnetics/instrumentation ; Electromagnetics/therapeutic use* ; Equipment Design ; Fractures/therapy* ; Human ; Leg Injuries/therapy*

Adult ; Female ; Fibula ; injuries ; physiopathology ; Humans ; Joint Dislocations ; diagnosis ; therapy ; Leg ; Male ; Tendons ; Treatment Outcome

OBJECTIVE: To report and assess the usefulness of ultrasound (US) findings for occult fractures of growing bones. MATERIALS AND METHODS: For six years, US scans were performed in children younger than 15 years who were referred with trauma-related local pain and swelling of the extremities. As a routine US examination, the soft tissue, bones, and adjacent joints were examined in the area of discomfort, in addition to the asymptomatic contralateral extremity for comparison. Twenty-five occult fractures in 25 children (age range, five months-15 years; average age, 7.7 years) were confirmed by initial and follow-up radiograms, additional imaging studies, and clinical observation longer than three weeks. RESULTS: The most common site of occult fractures was the elbow (n = 9, 36%), followed by the knee (n = 7, 28%), ischium (n = 4, 16%), distal fibula (n = 3, 12%), proximal femur (n = 1, 4%), and humeral shaft (n = 1, 4%). On the retrograde review of the routine radiographs, 13 out of the 25 cases showed no bone abnormalities except for various soft tissue swelling. For the US findings, cortical discontinuity (direct sign of a fracture) was clearly visualized in 23 cases (92%) and was questionable in two (8%). As auxiliary US findings (indirect signs of a fracture), step-off deformities, tiny avulsed bone fragments, double-line appearance of cortical margins, and diffuse irregularity of the bone surfaces were identified. CONCLUSION: Performing US for soft tissue and bone surfaces with pain and swelling, with or without trauma history in the extremities, is important for diagnosing occult or missed fractures of immature bones in pediatric-aged children.
Adolescent ; Arm Bones/injuries/radiography/*ultrasonography ; Child ; Child, Preschool ; Female ; Fractures, Bone/radiography/therapy/*ultrasonography ; Humans ; Infant ; Leg Bones/injuries/radiography/*ultrasonography ; Male

OBJECTIVETo observe clinical efficacy in treating cutaneous deficiency of traumatic shank amputation stump with full-thickness skin graft combined with vacuum sealing drainage.

METHODSFrom September 2009 to December 2012, 15 patients with cutaneous deficiency of traumatic shank amputation stump were treated with full-thickness skin graft combined with vacuum sealing drainage. Among patients, there were 11 males and 4 females with an average age of 41.5 (ranged from 25 to 62) years old. Ten cases were caused by traffic accident and 5 cases were caused by heavy object, 9 cases on left and 6 cases on right. Six patients with smashed wound were treated with debridement and amputation, combined with vacuum aspiration in-emergency; 9 patients caused by infection and necrosis were treated with debridement and amputation, combined with vacuum aspiration, and full-thickness skin graft were performed at stage II. The skin defect area of residual limbs ranged from 40 cm x 20 cm to 25 cm x 15 cm.

RESULTSAll patients were followed up from 3 months to 1 year. Full-thickness skin graft of residual limbs were survived,and obtained satisfactory walking function with prosthetic. Residual skin increased thicken, wearproof without rupture and pain.

CONCLUSIONFull-thickness skin graft combined with vacuum sealing drainage in treating cutaneous deficiency of traumatic shank amputation stump could reserve the length of residual limbs, increase survival rate of skin graft with less scar of survival skin, get good wearability and it is conducive to prosthetic wear. It is a simple and easy treatment method.

Adult ; Amputation Stumps ; surgery ; Female ; Humans ; Leg Injuries ; surgery ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; methods ; Skin ; injuries ; Skin Transplantation

OBJECTIVEAlthough long bone fracture in children is not life-threatening, it may cause major disability, loss of working days and severe psychological distress. We conducted this study to determine the pattern of extremity fracture due to trauma in children.

METHODSDuring one year in six general hospitals in Tehran, trauma patients who were hospitalized for more than 24 hours and sustained injuries within seven days before admission were included in the study. The records of children (< or = 16 years old) hospitalized in six general hospitals in Tehran due to trauma were reviewed prospectively.

RESULTSDuring the study period, 1 274 children had sustained extremity fractures. Male to female ratio was 3.6/1, with the mean age of (10.3+/-4.2) years. Falls and traffic crashes were the main causes of injuries, with the percentages of 57.3% and 37.1%, respectively. Simple fall (falling on the ground) consisted 60% of patients that sustained fall-related injuries. Pedestrians and bicycle riders comprised most of the cases that were injured due to traffic crashes. Of our cases, 56.8% sustained fractures in the upper extremities and 43.2% in the lower extremities. Forearm was the most common fracture site (34.1%). Comparing our results in preschool and school-age children, falls were the main cause of injuries in both groups, but fractures of lower extremities were significantly more common in preschool children.

CONCLUSIONSImprovement of physical condition of sidewalks and crossings in roads will be necessary for prevention of injuries. More attention to safety of home environment should be paid for control of preschools'injury at home. Education of children and adults is necessary to reduce injuries resulting from road traffic crashes.

Adolescent ; Arm Bones ; injuries ; Child ; Child, Preschool ; Female ; Fractures, Bone ; etiology ; therapy ; Humans ; Infant ; Leg Bones ; injuries ; Male ; Multiple Trauma ; complications

PURPOSE: The purpose of this study is to evaluate clinical outcomes and complications after fasciotomy in acute compartment syndrome. MATERIALS AND METHODS: Seventeen cases diagnosed as compartment syndrome and underwent fasciotomy from January 2011 to February 2015 were evaluated retrospectively. We investigated the causes and regions of acute compartment syndrome, the methods of wound management, the necessity of skin graft, and the complications including amputation and infection. RESULTS: According to the causes of acute compartment syndrome, there were 7 fractures, 1 traumatic hematoma, 6 reperfusion injury, and 3 rhabdomyolysis. The regions of acute compartment syndrome were 3 cases of thigh, 10 cases of leg, and 3 cases of foot. One case had acute compartment syndrome involving thigh, leg, and foot. Of 17 cases, 3 cases died due to reperfusion injury and one case with severe necrosis of soft tissues underwent amputation. Among the 13 cases excluding 4 cases with death or amputation, 3 cases underwent split thickness skin graft. Shoelace technique and/or vacuum-assisted closure (VAC) was used for 9 cases, and wound closure without skin graft was achieved in all except one case, while 2 cases required skin graft among 4 cases without shoelace technique or VAC. There were 2 cases of infection. CONCLUSION: Acute compartment syndrome caused by reperfusion injury had poor outcomes. Shoelace technique and/or VAC were useful for management of wound after fasciotomy.
Amputation ; Compartment Syndromes* ; Foot ; Hematoma ; Leg ; Necrosis ; Negative-Pressure Wound Therapy ; Reperfusion Injury ; Retrospective Studies ; Rhabdomyolysis ; Skin ; Thigh ; Transplants ; Wounds and Injuries

OBJECTIVETo investigate the effects of modified vacuum sealing drainage (VSD) technique in treating refractory sinus in the lower leg.

METHODSFrom January 2010 to December 2011, 11 patients with refractory sinus in the lower leg, including 7 males and 4 females, with an average age of 34.5 years (ranged,23 to 56). These patients were treated with modified VSD technique after thorough cleaning sinus and continuous washing. After 14 to 21 days of treatment, removed VSD and re-debrided the sinus and sutured wound.

RESULTSInfections got control after operation, sinus in the lower leg healed. All patients were followed up from 6 to 14 months with an average of 10 months, no recidivations were found.

CONCLUSIONModified VSD technique is an effective method in the treatment of stubborn sinus in the lower leg.

Adult ; Drainage ; methods ; Female ; Fracture Fixation, Internal ; adverse effects ; Humans ; Leg Bones ; injuries ; surgery ; Male ; Middle Aged ; Postoperative Complications ; therapy ; Vacuum

OBJECTIVETo analyze the reasons on complications of treatment with elastic nail in children's long bone fracture.

METHODSSixty-six cases (75 parts of long bone fratures) were treated by elastic nail including 49 male and 17 female. The age ranged from 3 to 17 years, mean 7.8 years. There were 35 femur fractures (2 cases were hibateral), 20 tibia and fibula fractures (12 cases were tibia fractures), 8 radial fractures (1 case was ulna fracture) and 3 humerus fractures. The cases included 4 open fractures and 62 closed fractures. All cases were fresh fractures, no multi-segmental fractures. Three cases associated with brain and chest injuries. These cases were treated by open or closed reduction and internal fixaion with elastic nail. A cast or brace had been used after operation for a month. Following-up included the function of the joint,the bottom of the nail and the callus. Complications were timely recorded.

RESULTSAll the patients were followed-up for 12 to 29 months, averaged 17 months. The cases occurrenced compilications including 2 cases of nonunion, 2 of new fracture, 1 of displacment, 4 of joint dysfunction, 3 of irritation of the bottom of the nail and 1 malunion.

CONCLUSIONStrict indication, well design,canonical operation is a good way to avoid compliacations. At the same time,early treatment can reduce the sequela.

Adolescent ; Bone Nails ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Fractures, Bone ; complications ; surgery ; Fractures, Closed ; complications ; surgery ; Fractures, Open ; complications ; surgery ; Humans ; Leg Bones ; injuries ; surgery ; Male ; Postoperative Complications ; etiology ; prevention & control ; therapy

OBJECTIVETo evaluate the therapeutic effects of VSD combined with irrigation of oxygen loaded fluid on chronic wounds in diabetic patients.

METHODSTwenty-six diabetic patients hospitalized in Nanfang Hospital of Southern Medical University from September 2010 to June 2013, with chronic ulcers on lower extremities conforming to the inclusive criteria, were divided into group VSD (n = 8), VSD + irrigation control group (VSD + IC, n = 9), VSD + oxygen loaded fluid irrigation group (VSD OLI, n = 9) according to the random number table. After gross observation was conducted and wound secretion was sent for bacterial culturing right after admission, debridement was performed. During the debridement, granulation tissue of wound center was harvested for determination of the activity of lactate dehydrogenase (LDH) and succinate dehydrogenase (SDH) with ELISA. After debridement, the patients in group VSD were treated with VSD (negative pressure from -30 to -25 kPa, the same below); the patients in group VSD + IC were treated with VSD combining irrigation of normal saline; the patients in group VSD + OLI were treated with VSD combining normal saline loaded with oxygen (flow of 1 L/min ) irrigation. Drainage tube blockage was recorded and its incidence rate was recorded during the treatment. On post treatment day (PTD) 7, tissue exudates were collected and analyzed with blood gas analyzer for determining the partial pressure of oxygen of the exudate. After the VSD was terminated, bacterial culture was conducted as before, and the bacterial clearance rate was calculated. After the calculation of granulation tissue coverage rate, the granulation tissue in the center of the wound was harvested for histopathological observation with HE staining; morphological characteristics and density of mitochondria were observed with transmission electron microscopy; the activity of LDH and SDH was estimated as before; microvascular density (MVD) was counted after CD31 antibody immunohistochemical staining. Then the second stage operation was performed. The method of second stage operation was recorded and survival rate of grafted skin or flap was calculated. Data were processed with one-way analysis of variance, LSD- t test, rank sum test, or Fisher's exact test.

RESULTS(1) The gross observation showed that before debridement there was only necrotic tissue without granulation tissue in the wounds of patients in all the 3 groups. On PTD 7, granulation tissue was found in the wounds of patients in all the 3 groups. HE staining showed that there were more abundant newborn microvessels and regularly arranged fibroblasts in the wounds of group VSD + OLI; less newborn microvessels and relatively sparsely fibroblasts were observed in the wounds of group VSD + IC. There were only sparse newborn microvessels and fibroblasts in the wounds of group VSD. (2) Rates of drainage tube blockage, granulation tissue coverage, and bacterial clearance showed significant differences among the 3 groups (with F values from 10.98 to 770.24, P values below 0.01). The drainage tube blockage rate was significantly lower in groups VSD + IC and VSD + OLI [(2.0 ± 0.4)% and (1.9 ± 0.6)%] than in group VSD [(16.0 ± 1.3)%, with t values respectively 28.77 and 29.20, P values below 0.01]. (3) On PTD 7, the partial pressure values of oxygen of the exudate in groups VSD + IC, VSD + OLI, and VSD were respectively (111 ± 4), (43 ± 4), and (40 ± 4) mmHg (1 mmHg = 0.133 kPa, F = 882.76, P < 0.01). (4) The density of mitochondria in group VSD + OLI was obviously higher than that of the other 2 groups, full in shape, with complete outer membrane and no vacuolization. (5) During debridement, the activity of LDH and SDH in 3 groups showed no significant differences (with F values respectively 0.08 and 1.03, P values above 0.05). On PTD 7, the activity of LDH was lower in group VSD + OLI [(103 ± 15) U/L] than in group VSD + IC [(136 ± 16) U/L, t = 4.49, P < 0.01], while it was higher in group VSD [(155 ± 16) U/L] than in group VSD + IC (t = 2.47, P < 0.05). The activity of SDH was higher in group VSD + OLI [(2.93 ± 0.27) U/L] than that in group VSD + IC [(1.77 ± 0.22) U/L] or group VSD [(1.61 ± 0.19) U/L, with t values respectively 10.21 and 11.65, P values below 0.01]. (6) On PTD 7, there was more positive expression of CD31 in group VSD + OLI than in the other 2 groups. The MVD of groups VSD, VSD + IC, and VSD + OLI were respectively (109 ± 5), (124 ± 5), (141 ± 6) per 400 times visual field (F = 68.78, P < 0.01). (7) The patients in 3 groups mainly received skin or flap grafting as the second stage operation. The survival rates of skin and flap in group VSD + OLI were higher than those of groups VSD + IC and VSD (with t values from 3.32 to 8.26, P < 0.05 or P < 0.01), and the rates were higher in group VSD + IC than in group VSD (with t values respectively 2.67 and 3.18, P values below 0.05).

CONCLUSIONSVSD + OLI is effective in reducing drainage tube blockage, removing necrotic tissue and bacteria, ameliorating ischemia and hypoxia of wound tissue, providing fresh wound bed for wound healing, and improving skin or flap graft survival rates.

Debridement ; Diabetes Complications ; Diabetes Mellitus ; Drainage ; Granulation Tissue ; Humans ; Leg Ulcer ; etiology ; surgery ; Male ; Negative-Pressure Wound Therapy ; methods ; Oxygen ; Skin ; injuries ; Skin Transplantation ; Surgical Flaps ; Treatment Outcome ; Vacuum ; Wound Healing

OBJECTIVETo explore a treatment approach for severely injured lower extremities.

METHODSThe data of 42 patients with severely traumatic lower extremities from 1989 to 1999 were retrospectively reviewed. According to MESS (mangled extremity severity score) the mean score of all the limbs was 6.24+/-1.45, 34 cases had MESS score < 7 and 8 cases had MESS score > or = 7. Treatment approaches included microvascular anastomosis technique, compound tissue flap transplantation technique and compound bone tissue flap transplantation.

RESULTSTwo patients died after operation and one patient had delayed amputation of a lower limb. The rest 39 patients were followed up for 4-13 years. All the lower extremities of the 39 patients survived and had equal length. The 39 cases were evaluated by Chen's criterion, showing that 37 had good result (29, Chen I and 8, Chen II), 1 sufficient (Chen III) and 1 poor (Chen IV).

CONCLUSIONSSuccessful emergency treatment of severely injured lower extremities could be achieved by using microsurgery techniques and strict controlling of lower extremity salvagel indications.

Adolescent ; Adult ; Child ; Emergency Medicine ; methods ; Female ; Follow-Up Studies ; Fractures, Bone ; physiopathology ; therapy ; Humans ; Leg Injuries ; physiopathology ; therapy ; Male ; Middle Aged ; Multiple Trauma ; physiopathology ; therapy ; Muscle, Skeletal ; physiopathology ; Orthopedic Procedures ; methods ; Range of Motion, Articular ; Recovery of Function ; Retrospective Studies ; Survival Analysis ; Tissue Transplantation ; methods ; Treatment Outcome