Objective To evaluate the clinical effect of limited open reduction, poking reduction and QWIX cannulated screw internal fixation in treatment of posterior malleolar fracture. Methods A total of 14 patients with posterior malleolar fracture were treated by limited open reduction, poking reduction and QWIX cannulated screw internal fixation. Injury causes included traffic accidents in five patients, fall from height injury in four and inversion sprain in five. According to fracture type classification methods of Weber and Danis, there were two patients with type A3, seven with type B3 and five with type C3. Func-tional exercise was carried out based on postoperative exercise plan. Regular follow-up was performed to e-valuate the functional recovery of the ankle joint. Results All patients were followed up for 6-18 months (average 9.5 months). One patient with sural nerve injury returned to normal after six months. Twelve pa-tients showed excellent range of motion of the ankle joint and normal gait three months after operation. In 12 patients, dorsiflexion of the ankle joint was > 20° and plantar flexion > 40° six months after operation, which was approximately similar to contralateral normal ankle joint. The ankle joint function of all patients returned to normal six months after operation. According to Baird-Jackson ankle joint function evaluation, the result was excellent in 12 patients, good in one and fair in one, with excellence rate of 93%. Con-clusion The limited open reduction, poking reduction and internal fixation of QWIX caunulated screw are effective method for treatment of posterior malleolar fractures.

[Objective]To summarize the clinical characteristics and the treatment experience of the patients from Wenchuan earthquake area.[Method]Totally 129 patients injuried in the 5.12 Wenchuan earthquake from May 13 to June 10,2008 were admitted in this hospital.The recording content included chief complaints,diagnosis,damage locations and types,whether with infection or not,treatment,efficacy and so on.[Result]There were 95 fracture cases which included 35 open fracture with 51 fracture sites,60 closed fracture cases with 139 fracture sites;39 associated neural injuries in 26 patients(20.2%);54 cases of infection(31.8%);110 cases had operations.There was no death case,but one outside hospital amputation patient had multiple stump debridement and trimming due to severe infection.All open fracture cases were healing except 2 cases until now,no case with infection after operation.[Conclusion]The clinical characteristics of the patients being evacuated from Wenchuan earthquake are outstanding,it need individualized remedy according to the clinical characteristics and we should prevent and cure correlate complications positively in order to depress the fatality and disability rate.

[Objective]To investigate the in vitro antibacterial effect and biocompatibility of the bone filling materials of TiO_2-Ag-nHA/PA66.[Method]The inhibition ring test and plate-counting method were used to evaluate anti-bacterial performance against staphylococcus aureus ATCC25923 and escherichia coli ATCC25922.The effects of antiadhesion of staphylococcus aureus and escherichia coli were observed by scanning electron microscope(SEM).The cytotoxicity was detected via MTT and the biocompatibility of biofilm was evaluated by acute haemolysis test.[Result]The inhibition zone diameter of staphylococcus aureus and escherichia coli reaches the maximum at the first day[(23.6?1.14) mm and(18.8?0.84 mm)].The diameter of inhibition zone was lessening with the time going.It could effectively inhibite the survival and growth of staphylococcus aureus and escherichia coli within 33 and 24 days.The bacteria killing rate was 94.18% and 85.96%.Scanning electron microscope showed that the adhered bacteria in the experimental group were obviously fewer than in the control group.The MTT graded the cytotoxicity of the bone filling materials of TiO_2-Ag-nHA/PA66 as 1.The acute haemolysis assay showed that the hemolytic rate of bone filling materials of TiO_2-Ag-nHA/PA66 was 0.28%.[Conclusion]The bone filling materials of TiO_2-Ag-nHA/PA66 has good biocompatibility,significant antibacterial property against staphylococcus aureus and escherichia coli.No obvious cytotoxicity or erythrocyte destruction was found.

Objective To analyze clinical manifestation,diagnosis and treatment of 8 patients with gas gangrene in Wenchuan earthquake.Methods Eight patients with gas gangrene in Wenchuan earthquake were selected for analysis on their clinical manifestations.We finally diagnosed gas gangrene based on patients'clinical manifestation and the cultured ciostridium in the focus of infection.All the patients were treated with antibiotics,repeated surgical debridement,hyperbaric oxygen and nutritional support.Results Most patients had no erepitation of the extremities but found gas in interstice of tissues identified by X-ray,B-ultrasound and CT scanning.Film preparation of efflusion of all patients showed clostridium and bacterial culture manifested mainly perfringens.Most patients were demonstrated to be with polyinfection.In addition,all patients were characterized by pitchy necrotic tissues,effusion,systemic decrease of red blood cells,increase of white blood cells and platelet.No death or amputation occurred under active combined therapy.Conciusions Earthquake induces mainly open trauma often combined with mixed infection,when gas gangrene is one of main special infections.The predominant combined therapies include utility of antibiotics and thorough surgical debridement,while hyperbaric oxygen and nutritional support are important and effective adjunctive therapies.

Objective To evaluate the application and efficacy of direct anterior fixation of odontoid fractures with hollow screw.Methods From March 2001 to January 2006,13 patients with odontoid fractures were treated by direct anterior fixation with hollow screw.Results Of the 13 patients,except 2 patients with postoperative temporary dysphagia, 11 had excellent results.The follow-up was ranged from 9 to 18 months,with an average of 12.5 months.The odontoid fractures acquired fusion,and no unstability or pseudoarthritis was found. Conclusion The technique of direct anterior fixation with hollow screw is an efficacious means in the treatment of odontoid fractures.The meticulous surgical technique along with appropriate patients selection will be the key to successful surgery.

Objective To compare the effect of anterior and superior reconstruction plate internal fixation in treatment of middle clavicular fractures in the old patients.Methods Thirty-nine old patients with middle clavicular fractures received anterior and superior reconstruction plate internal fixation treatment,respectively.There were 19 males and 20 females at average age of 66.7 years.The operation time,intraoperative blood loss and healing time were observed and compared in two groups.According to the Constant scoring system,shoulder functional evaluation was made at half a year after operation and the latest follow-up.Results All the patients were followed up for 10-32 months (average 18.7 months).Of the two groups,there was no statistical significance in aspects of healing time and Constant score at half a year after operation and the latest follow-up ( P ＞0.05 ).The complication of superior reconstruction plate internal fixation group was significant higher than that of anterior reconstruction plate internal fixation group,while the anterior reconstruction plate internal fixation group had shorter operation time and less intraoperative blood loss in comparison with the superior reconstruction plate internal fixation group ( P ＜ 0.05).Conclusion As for the middle clavicular fractures in the old patients,both anterior and superior reconstruction plate internal fixation can obtain satisfactory curative effect.With shorter operation time,less intraoperative bleeding and less complications,anterior reconstruction plate internal fixation is a much reliable treatment for middle clavicle fractures in the old patients and deserves wider application.

Objective To analyze the clinical features of patients with open injuries combined with infections in Chinese Wenchuan earthquake and summarize the therapeutic experience. Methods An analysis was done on 54 patients with open injuries combined with infection transferred to our depart-ment from May 13, 2008 to June 10, 2008. Thorough debridement was performed based on general sup-porting management and anti-bacterial thempies done on the basis of results of bacteria culture and sus-ceptibility test. In the meantime, other managements including high-pressure oxygen therapy and external fixation were done for open fractures. Results Infection could be found in all open injuries, primarily combined infections with G+ coccus and G- bacillus or anaerobic. Moreover, most of the patients were infected by anaerobia. Of all, 1 patient with amputation received multiple debridement and repair because of severe infection of the amputation site and no death occurred. All patients recovered uneventfully, with sound wound healing, except for 2 patients. External fixation was stable and in good position. Conclu-sions The repeated and thorough debridement and the timely closure of wounds on the basis of energeti-cally anti-infection measures are key to diminishing the mortality rate and mutilation rate. Appropriate ad-junctive therapy can dramatically improve the curative effect.

BACKGROUND:Plate fixation or intramedulary fixation for clavicle fractures has remained a matter of debate. At present, there is a need for a higher level of evidence to evaluate the advantages and disadvantages of two different surgical methods.
OBJECTIVE:To assess the clinical efficacy of intramedulary fixationversusplate fixation in the treatment of clavicle fractures.
METHODS:We conducted a computerized search of the electronic databases like Cochrane Library, PubMed, Embase, OVID, CBM, CNKI, Wanfang and VIP for relevant randomized controled trials on plate fixation or intramedulary fixation for clavicle fractures. The quality of the included studies was independently assessed with RevMan 5.3 software. The meta-analysis was performed in Stata 13.0.
RESULTS AND CONCLUSION:Eight randomized controlled trials with 527 patients were included in this meta-analysis. The meta-analysis results showed union time, surgery time, incision length, hospital stay and infection rate were less in the intramedullary fixation group than in the plate fixation group (P< 0.05). No significant difference in shoulder function score, upper limb function score, fracture nonunion and refracture was determined between the two groups (P< 0.05). The current evidences suggested that intramedullary fixation is the optimum choice in the treatment of clavicle fractures.

Objective To investigate the in vitro cytocompatibility of three-dimensional porous scaffolds of poly-D,L-lactic acid (PDLLA) and discuss the feasibility of PDLLA as a scaffold for bone tissue engineering.Methods BMSCs of the third passage were seeded on osteogenetic differentiation medium or culture medium containing 20％ volume fraction degraded liquid (PDLLA degradation liquid of 0,3,6,9,and 12 weeks) according to the random number table.Osteogenetic differentiation medium or culture medium without PDLLA was used as controls.Cell viability,cytotoxicity,and osteogenic differentiation were detected for study on cytocompatibility of PDLLA.Scanning electron microscopy was used to observe the growth of BMSCs on the surface of PDLLA scaffolds.Results PDLLA scaffolds presented no significant cytotoxic on the growth of BMSCs.PDLLA scaffolds had no negative effect on cell viability compared with the controls (t3 =-0.441,P =0.671; t6 =1.596,P =0.154; t9 =-0.492,P =0.636; t12 =-1.135,P=0.283).ALP staining and calcium nodule staining were positive and there were no significant differences in ALP and collagen Ⅰ protein quantitative detection compared with the controls.BMSCs grew well on the inner surface of the PDLLA three-dimensional porous scaffolds.Conclusion Three-dimensional porous scaffolds of PDLLA present good cytocompatibility in vitro and can be used as bone tissue engineering scaffolds for subsequent in vivo research.

Objective To investigate the therapeutic effects of nano-hydroxyapatite/polyamide 66/platelet-rich plasma com-pound(n-HA/PA66/PRP)on the recovery of rabbit femur bone defect.Methods 40 New Zealand rabbits were artificially made to be bone defect by resecting the 1 cm substantia ossea with periosteum of femur,and were divided into two groups averagely depen-ding on implanted materials:experimental group(n-HA/PA66/PRP),control group (n-HA/PA66).Every five rabbits were sacri-ficed on week 2,4,8,12,and the femur healing status was observed by X ray,histology,and immunohistochemistry.Results No rabbit was infected or died,no implantation objects dropped.Gross observation,X-ray result and histology results demonstrated that the experimental group began to have a new bone tissue at 2 weeks after the operation,with the extension of time,the experimental group new bone growth speed and the quantity was better than the control group.The Lane-Sandhu method X-ray score showed that the experimental group (6.80±2.05)points and the control group(4.20±1.30)points at 12 weeks after the operation,and there were significant differences between two groups(P <0.05).Immunohistochemistry indicated that expression intensity of Vas-cular endothelial growth factor at 2 weeks and 4 weeks were significant differences between two groups(P <0.05),but there was no significant difference at 8 weeks and 12 weeks (P >0.05).Conclusion PRP combined with n-HA/PA66 artificial bone could accel-erate the healing of bone defect,and the effect of repair of bone defect is better than that of n-HA/PA66 artificial bone in the early.