Recurrent anterior shoulder instability is a common problem we have to deal with in clinic. With the progress in shoulder and elbow surgery, there have appeared many new concepts about the etiology, diagnosis and treatment of this disease. About 2 decades ago, people realized the important role of glenohumeral ligaments. Now we believe that the stability of the glenohumeral joint relies heavily on the congruent articulating surfaces and surrounding soft tissues that act as static and dynamic stabilizers. Many new methods, such as MRI, physical examination under anesthesia and arthroscopy, can help us diagnose the disease accurately. Moreover, substantial progress has been made in the treatment of anterior shoulder instability. Open Bankart repair has become the golden standard for the treatment. With the advance of techniques, however, arthroscopic stabilization of anterior shoulder instability can now achieve good results comparable with those of open surgery.

Objective To observe the short-,mid-and long-term surgical complications of complex acetabular fractures treated by the Kocher-Langenbeck (K-L) approach combined with digastric trochanteric flip osteotomy (DTFO).Methods We reviewed the 40 cases of complex acetabular fracture that were treated at our department from December 2009 through December 2013.They were 34 men and 6 women,from 17 to 73 years of age (average,47.6 years).Of them,19 were treated by K-L approach combined with DTFO,including 17 males and 2 females,with a mean age of 44.7 ± 11.7 years.The other 21 controls were treated simply through the K-L approach,including 17 males and 4 females,with a mean age of 42.8 ± 14.4 years.The 2 groups were compared in terms of intraoperative results,postoperative outcomes and surgical complications like infection,sciatic nerve injury,heterotopic ossification,femoral avascular necrosis,and post-traumatic arthritis.Results The 40 cases were followed up for an average of 29.7 months (range,from 18 to 59 months).The operation time for the DTFO group (248.2 ± 123.2 min) was significantly shorter than that for the control group (276.1 ±50.6 min),the satisfactory reduction rate for the DTFO group (100.0％) was significantly higher than that for the control group (90.5％),the hip intorsion (19.7° ± 3.5°),hip extorsion (26.1° ±4.3°),and hip abduction (40.5° ±4.7°) at one year postoperation in the DTFO group were significantly superior to those in the control group (14.3°± 6.0°,21.0°± 7.2°,31.9°± 10.8°,respectively),and the hospital stay for the for the DTFO group (19.0 ±7.1 d) was significantly longer than that for the control group (13.6 ±4.9 d) (P ＜ 0.05).The intraoperative bleeding and transfusion for the DTFO group were insignificantly greater than those for the control group (P ＞ 0.05).Infection or iatrogenic sciatic nerve injury occurred in none of the patients.There were no significant differences between the 2 groups in terms of positive Trendelenburg test,hip function,heterotopic ossification,femoral avascular necrosis,or post-traumatic arthritis at the last follow-ups(P＞ 0.05).Conclusions In the surgical treatment of complex acetabular fractures,especially those involving the acetabular dome area and the femoral head,K-L approach combined with DTFO can obtain larger surgical exposure field,good fracture reduction and functional recovery,without obviously increasing surgical complications.This technique only slightly increases intraoperative bleeding and transfusion,and results in longer hospital stay.

The shoulder is a complex joint which consists of sternoclavicular joint, clavicle, acromioclavicular joint, scapula, glenohumeral joint,proximal humerus and scapulothoracic joint. It is important for us to have a good knowledge of the normal biomechanics of the shoulder when we treat shoulder problems. So this article intends to help its readers to get familiar with the characteristics of functional anatomy, biomechanics and motion of the shoulder under physiological condition.

Thirty-six patients with acetabular fracture undergoing Kocher-Langenbeck approach surgery in Beijing Jishuitan Hospital between January 2001 and December 2005 were selected.All patients underwent tibial tubercle or femoral upper condyle traction before surgery.People with traumatic arthritis or other lower limb injury on postoperative X-ray were excluded.Using Biodex system to test the abduction and extension muscle at 60( ?)/s and 180( ?)/s.Peak torque,total work,and mean power were used for evaluation.The difference between bilateral limbs ≤ 10% was normal,≥ 20% was abnormal and 11%-19% was suspected.The muscle strength in fast test was more than the slow test(t=2.21,P

Objective To discuss complications in locking plate treating displaced proximal hu-meral fractures and explore preventive methods. Methods The study involved 92 patients who were treated with open reduction and internaI fixation with Locking plate from September 2004 to June 2007 and followed up for average 15.2 months(6-36 months).,There were 78 fresh fractures and 14 delayed ones.The average age of the patients was 47.7 years(17-83 years).American Shoulder and Elbow Surgeons Form(ASES)score,Constant-Murley score,University of California-Los Angels scoring system(UCLA) score and Simple Shoulder Test(SST)were used to evaluate the clinical results and observe range of mo-tion,recovery of pain and complications at the latest follow up.In the meantime.we observed the differ-ence of complications in different age,Sex,fracture side,operation time,injury causes,combined injury and fracture tvpe and compared the elinieal results between the patients with complications and those with-out. Results The average forward flexion wag(148.9 ±17.3)°(90°-170°).average external rota-tion up to(29.3 ±15.0)°(0°-70°)and average internal rotation reached T9(T4-L5).The mean VAS score was for(0.9 ±1.1)points(0-5 points).the mean ASES for(86.4 ±13.0)points(52-100points),the mean Constant score for(87.5±10.6)points(55-100 points),the mean UCLA for(30.2±4.0)points(18-35 points)and the mean positive answer of SST for 9.6(4-12).There were 17 pa-tients with complications.with incidence rate of 18.5%.As for incidence rate of complication.there was no statistical difierence upon different sex,time from injury to operation,injury side,combined injury,injury cause,fracture type or fixation type.However,there wag significant difierence in aspect of difierent ages.with incidence rate of complication for 25.5%in patients younger than 50 years old and 8.1% in those older than 50 years old(P＜0.05).Compared with non-complication group,complication group showed significant less extemal rotation and Constant-Murlev and UCLA functional score(P＜0.05).Conclusions Locking plate is a reliable method for displaced proximal humeral fractures.but there still with indication control and appropriate surgical technique,luring the whole procedure so as to reduce inci-dence rate of compl ication as possible.

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 evaluate the results of operative treatment of comp ou nd acetabular fractures through single ilioinguinal approach. Methods 46 cases o f compound acetabular fractures were treated through single ilioinguinal approac h from June 1994 to October 2003 in our department. Their functional recovery an d complications were followed up. Results On the average, 40 cases were followed up for 40.4 months. All the fractures healed and no infection was found. Clinic al results were excellent and good in 33 patients, and only one patient showed s light ectopic ossification after the operation. Conclusions Acetabular fractures associated with anterior and posterior hemi-transverse fractures, most both co lumn fractures and some T shape fractures can be treated through the single ilio inguinal approach which can result in good reduction, satisfactory functional re covery, less invasive incision, and low rate of postoperative complications.

Objective To discuss the clinical outcomes of trochanteric digastric osteotomy and surgical hip dislocation for treatment of Pipkin Ⅳ fractures. Methods We retrospectively reviewed the 12 patients with Pipkin Ⅳ fracture who had been treated by trochanteric digastric osteotomy and surgical hip dislocation from February 2012 to June 2016. They were 10 males and 2 females, with an average age of 44. 1 years ( from 24 to 63 years ) . According to the Pipkin classification for femoral head fractures, 9 fractures were type Ⅰand 3 type Ⅱ; according to Letournel-Judet classification for acetabular fractures, 10 were posterior wall fractures ( 9 belonging to the posterior superior subgroup ) and 2 transverse plus posterior wall fractures ( one involving the posterior wall belonging to the posterior superior subgroup ) . The operation time, blood loss, complications and functional results were recorded. Results The operation time averaged 165 min ( from 150 to 195 min ); the blood loss averaged 850 mL ( from 500 to 1, 200 mL ) . A spring plate was used additionally for posterior wall fracture in 7 cases. All the 12 cases obtained an average follow-up of 19 months ( from 6 to 52 months ) . Motion function was fully recovered from 6 weeks to 4 months after operation in 2 cases of preoperative incomplete sciatic nerve injury and in one case of iatrogenic incomplete sciatic nerve injury. Anatomical reduction was achieved in all femoral head fractures. According to the Matta criteria for acetabular fractures, anatomical reduction was achieved in 9 cases, good reduction in 2 and poor reduction in one. Heterotopic ossification occurred in 4 cases ( gradeⅠin one, gradeⅡin 2 and gradeⅢin one by the Brooker grading system ) . The trochanteric osteotomy was repeated in one case. No femoral head avascular necrosis was found. According to the modified Merle d'Aubigné and Postel scoring at the final follow-ups, the functional results of the affected hip were excellent in 4 cases, good in 7 and poor in one. Conclusion Trochanteric digastric osteotomy and surgical hip dislocation is a safe and effective treatment for Pipkin Ⅳ fractures.

Objective To evaluate white matter nerve fiber changes of children with binocular ametropic amblyopia by applying the technology of diffusion tensor imaging and the whole brain analysis method of deterministic tractography,and analyze its correlation with visual acuity.Methods Fourteen binocular ametropic amblyopia children was collected from the Second Xiangya Hospital of Central South University as study subject of experimental group,14 cases of normal sight children as the control group.All children were scanned by MRI system,conventional MRI examination,3DTlWI scan were made,then echo-planar sequence scanning was used to obtain diffusion tensor imaging.Quantitative analysis was made to all diffusion tensor imaging using deterministic tractography.Using the experimental group tracts with statistic changes of FA value,volume and tract count as the region of interest(ROI),the correlation analysis with vision for each ROI was performed.Results Isoametropic amblyopia children demonstrated low FA values in the right ventral and dorsal pathway,right optic radiation and corpus callosum compared to control group.There was low volume of fibers in the bilateral ventral and dorsal pathway,the left optic radiation and body of corpus callosum compared to control group.The tract count of right dorsal pathway had reduced compared to control group.Among FA value,tract count and volume,FA value had the maximum regression coefficient with visual acuity,the regression coefficient of tract count and volume was small.The relative correlation coefficient of FA value at right optic radiation,right ventral pathway and body of corpus callosum with vision acuity were 0.486,0.534 and 0.456,respectively,the right ventral pathway had the maximum correlation with visual acuity.Conclusion Isoametropic amblyopia patients shows abnormal structure on bilateral optic radiation,bilateral ventral and dorsal pathway and body of corpus cailosum,these may cause the capability loss of object recognition and spatial position recognition.The FA value of right ventral pathway has the maximum influence on visual acuity.

Objective To report our preliminary clinical experience of using the Stoppa approach in treatment of pelvic and acetabular fractures. Methods From March 2008 to November 2008, 10 cases of pelvic and acetabular fracture were treated through the Stoppa approach - low abdomen midline or suprapuhic transverse incision and infra-peetineal plating. Of them, 5 pelvic cases were all Tile type C. The Stoppa ap-proach was used to manage each fracture of peripheral pubic ramus. The other 5 cases of acetabular fracture included 2 transverse, 1 posterior column, 1 T type and 1 both column ones. The Stoppa approach was used exclusively in 2 cases, and together with Kocher-Langenbeck or ilioinguinal approach in the other 3 cases. Results The average incision length of the Stoppa approach was 10 cm, the mean operation time and blood loss were 1.5 hours and 560ml respectively. The reduction of the pelvic and acetabular fractures were all excellent. There were no operative complications. Of them, 7 cases were followed up for 4 to 8 months, showing satisfactory functional results. Conclusion The Stoppa approach can replace the ilioinguinal approach in management of fractures of peripheral pubic ramus, and can be used together with other ap-proaches for acetahular fractures, but it has advantages of simple dissection and a low complication rate.