[Objective]To discuss the alterations of sesamoid position before and after opertation and its relation to the function of the metatarsophalangeal joints.[Methods]Eighty feet(39 hallux valgus feet,41 normal foot) were selected.The distance from sesamoids to the second metatarsal,the relative position of sesamoid bone to the first metatarsal bone,the function of the first metatarsophalangeal joints were determined and analyzed.[Results]The distance from sesamoid to the second metatarsal had no statistical significance in normal feet compared with the hallux valgus feet(P

[Objective]To analyze the reason for osteofascial compartment syndrome caused by tardive massive bleeding and to discuss the first-aid measure to treat continuing bleeding in operation.[Method]There were 5 cases in this study.Two osteofascial compartment syndrome with tardive haematoma were caused by secondary disturbances of blood coagulation.One iliopsoas muscle haematoma was caused by over-dose of warfarin(WARF).Vitamine K was applied to anti-warfarin and depressed haematoma by ultrasonic guiding puncturation aider a pause of warfarin.The other one suffered from continuing bleeding after a depression operation on right femoral bone haematoma.The bleeding could not be stopped until carbasus obturation and a supplementary of lood coagulation factor.The carbasus were taken out 36 hours later.Three traumatic pseudoaneurysm rupture happened to superior gluteal artec,arteriae tibialis posterior and deep femoral artery separately.The bleeding artery was ligated and removed the body of the blood tumor in these three cases.In addition,arterial embolism was applied in two of them before operation.[Result]No recurrence happened to the case with iliopsoas muscle haematoma after 16 weeks as a result of absorption and degeneration.As the patient with right femoral bone haematoma referred,the bleeding stopped after treated by carbasus obturation.The wound was closed 36 hours after the operation.A satisfactory sensory recovery,pulsation of dorsal pedal artery and arteria tibialis posterior were found.Rebleeding was found in 3 weeks after the wound closed.The pathobiology inspection of bone and muscle tissue around the fracture site showed osteoma sarcomatosum in right femoral bone.The author gave the patient to the operation of high amputation.No rebleeding,nervous symptoms caused by compression,limbs necrosis and ischemic contracture was found after 3 patients suffering from traumatic pseudoaneurysm rapture with followed-up from 8 month to 3 years.[Conclusion]Hemorrhea caused by secondary disturbances of blood coagulation or pseudoaneurysm can lead to osteofascial compartment syndrome.Embolism of the bleeding artery before removal of the aneurysm and haematoma can reduce bleeding in operation.It is the best choice for the doctor to stop operation immediately and stop bleeding by effective carbasus obturation.

[Objective]To assess the influence of three-dimensional computed tomography (3D CT) reconstruction on preoperative fracture classification of intraarticular fractures by comparing 3D CT and 2D CT in preoperative fracture classification of tibial plateau fractures and acetabular fractures.[Method]A retrospective study was performed to evaluate 28 tibial plateau fractures and 19 acetabular fractures.Four attending traumatic orthopaedic surgeons used 3D CT and 2D CT respectively to evaluate fractures and rendered fracture classification.Test of agreement was performed to evaluate interobserver and intraobserver agreement about fracture classification.[Result]With the use of 3D CT images,interobserver and intraobserver reliability for fracture classification increased to perfect agreement.[Conclusion]3D CT could improve the reliability of preoperative fracture classification for tibial plateau fractures and acetabular fractures.3D CT is helpful and worthwhile for preoperative evaluation for fracture classification of intraarticular fractures.

[Objective]To report the clinical results of free medical leg flap containing posterior tibial vessels (FMLFPTV) in repairing of serious limb trauma caused by high-energy in children and discuss the flap's unique superiorities.[Method]From Jan.1999 to Mar.2006,FMLFPTV were obtained under tourniquet and applied in ten children suffered from serious limb and extremity injuries complicated by soft tissue defects,meanwhile,vessels and nerves were repaired with the flaps' corresponding tissues,moreover,broken bones and tendons were reconstructed.[Result]Average blood loss was 183ml and mean operative time was 208 min.All flaps were transplanted successfully with excellent results including satisfactory limb appearance.Follow-up ranged 14 to 67 months (averaged 35 months).Sensation has recovered to more than S3 in all cases.In those who were treated with this innervated flap to repair defects of weight-bearing area of sole,no sore or ulcer occurred and normal gait recovered.Bone union took 4～9 months(averaged 6.7 months).Through investigation forms filled by parents and clinical examination,no blood supply problem or morbidity was discovered in donor limbs.[Conclusion]FMLFPTV is easy to dissect under tourniquets with relative short operative time and less blood lost which especially benefits children.The flap is thin and has almost necessary related tissues for all reconstructive needs,for example,to bridge vessel and nerve defects,and offer excellent results.It is an easy and reliable method.

[Objective]To discuss the clinical results and treatments of the Monteggia's fracture in children.[Method]Total of 66 patients including 61 fresh and 5 old fractures were reviewed.There were 47 males and 19 females.According to the Bado classification system: 46 of type Ⅰ,4 of type Ⅱ,15 of type Ⅲ,1 of type Ⅳ,all patients received conservative or operatire treatment.The conservatively treated patients received manipulation and plaster immobilization.In the operative group,the patients were fixed with single or/and double Kirschner's wires after reduction of the radiohumeral joints or/and fractured ulna.Neither reparation nor reconstruction was needed.[Result]All patients were available at the final follow up with 0.5～5 years.According to the Li Hanmin's scoring system for the motion function in children: excellent and good rate was 95.7% in conservative group and 84.2% in operative group.There was no complication such as myositis ossificans,synostosis of radius and ulna,ulna nonunion,radial head dislocation and profundus radial nerve injury.The cases of nerve injury were complete recovered after operation two or four months later.[Conclusion]The clinical results of the Monteggia's fracture in children was very good with immediate reduction and internal fixation in proper cases,a good overall therapeutic outcome can be expected in children with Monteggia's fracture.It is very important to prevent missed diagnosis.

[Objective]To simulate the biomechanics mechanism and environment of humeral fracture caused by indirect impact force for the purpose of biomechanics understanding and treatment of such fracture.[Method]Based on the data source, which was high-resolution anatomic slice images from approximal clavicle to distal humerus, 1 mm thickness and totally 380 layers, the geometric model of total shoulder joint was established according to the order:point, line,area, and further meshed to set up the three dimension finite element model of shoulder, fracture sites and instantaneous stress and strain of humerus were simulated and analyzed under the condition which longitudinal impact force was loaded on the humerus based on the 12 functional positions of shoulder(abduction 30?、 45?、 60?、 90?, and simultaneous neutrality, internal rotation 45?,external rotation 45?).[Result]According to the humeral shaft load-strain curve in different functional positions of shoulder, linear relation was found when load changed from 0 N to 250 N, after which non-linear come out, and even load was removed , bone was deformed eternally. With the rise in load amount, the increase in stress was detected. When abduction degree changed from 90? to 30?, the strain of humerus, both the lateral and the medial increased gradually,and increase in internal rotation 45?and external rotation 45? was more significant than that in neutrality. Meanwhile, stress difference could be seen between the lateral and the medial , and medial was larger than the lateral. Increase in stress in rotation positions was quicker and more than that in other functional positions.[Conclusion]Based on 4 abduction degrees (30?, 45?, 60?, 90?) and 3 rotation degrees(neutrality, internal rotation 45?,external rotation 45?) ,the three dimensional finite element shoulder could simulate precisely stress, strain, general trend of fracture line, three dimension images of bone failure. Three dimension finite element simulation and analysis of shoulder is a valuable mechanical method for research on biomechanics theory related to humerus fracture.

[Objective]To evaluate the efficacy of nerve transfer for reconstructing the sensory function of the sole.[Method](1)Select saphenous nerve as donor nerve for the patients with the sensory loss beneath ankle level:dissect and cut off the saphenous nerve at the medialposterior aspect at upper-middle 1/3 of the leg and divide the gastrocnemius to expose the tibial nerve at the medialposterior aspect of the tibia, cut off partly nerve fibre of the tibial nerve and then end-to-end anastomose to the proximal end of the saphenous nerve. (2) Select sural nerve as donor nerve for the patients with sensory loss of sole only:dissect and cut off the sural nerve at the posterior aspect of the lateral malleolus, expose the tibial nerve at the posterior aspect of the medial malleolus and then cut off partly nerve fibre of the tibial nerve. The sural nerve was comdicted from the subcutaneous tunel at the anterior aspect of the Achilles's tendon to the posterior aspect of the medial malleolus and end-to-end anastomose to the partial nerve fibre of the tibial nerve. [Result]All the 9 cases were followed up from 1.5 to 2 years(mean 2 l months). The SCV(sensory conduction velocity) of the tibial nerve was ranged from 36.1 to 41.2 m/s, mean 38.3 m/s and the amplitude of wave (peak-to-peak amplitude) was a range from 7 to 15.3?V, mean 11.2 ?V by orthodromic electrophysiologic techniques. All 9 cases regained the sense of pain and touch of the sole.Three cases restored their sense of two point discrimination. All the patients expressed their satisfaction with their ability of walk and no muscles atrophy of the foot. The sensory loss in donor region was oberserved only lateral part of the foot beneath the lateral malleolus (sural nerve as donor nerve) and a small part of the anterior aspect of the ankle(saphenous nerve as donor nerve).[Conclusion]Nerve transfer can reconstruct the sensory function of the sole effectively.

[Objective]To study the clinical results of treatment of local osteochondral fracture lesions on the talus dome associated with ankle fracture using autologous osteochondral transplantation.[Method]There were 18 patients with osteochondral fracture defects of the talus dome associated with ankle fracture, male 10, female 8, with the average age 33.5 years (18~49 years). Transplantation procedure was osteochondral cylinders from non-weight bearing surface of the ipsilateral knee and implant the donor graft into the recipient holes of talus cartilaginous defects with press-fit technique. The outcomes were assessed on the basis of ankle functional rating score, radiographic findings and MRI findings.[Result]The patients were followed up for 17 to 40 months (mean, 28 months). The ankle functional rating score was measured by the Baird and Jackson functional rating score system. The averaged scores was 96.3?3.5,excellent in 14 cases, good in 3 cases and fair in 1 case. The rate of being excellent and good was 94.4%.The rate of posttraumatic arthritis was 5.6% (1/18) and osteochondritis dissecans was 5.6% (1/18).[Conclusion]Autogenous osteochondral transplantation using ipsilateral knee osteochondral grafts is an effective surgical procedure on treating acute local osteochondral fracture lesions of the talus associated with ankle fracture.

0.05).No sign of aseptic loosening or change in implant position was noted.[Conclusion]This short-term study showed that bipolar femoral head arthroplasty seems to be a suitable alternative for primary treatment of displaced femoral neck fractures in patients over 80 years.More attention should be paid to coexisting medical illness(e.g.diabetes mellitus,hypertension,and ischaemic heart disease)and prevention of complications.

[Objective]To study various surgical approaches to the treatment of scapular neck and body fratures,and evaluate the clinical results.[Method]From January 1996 to December 2006,thirty-two cases with scapular neck and body fratures including 21 males and 11 females with age range from 18-56 years (mean 29 years) that had been admitted to the author's hospital were retrospectively analyzed.On the basis of the fracture patterns,straight incision along lateral border of the scapula,posterior approach,Judet approach were performed with plates or lag screws for open reduction and internal fixation.[Result]All cases were followed up for a period of 8-22 months.The mean time of bone union was 6-8 weeks.According to Hardegger's evaluation,22 cases showed excellent results,7 good,2 fair,1 poor.[Conclusion]Open reduction and internal fixation are emphasized to the severe separated scapular neck and body fractures.Straight incision along lateral border of the scapula,posterior approach or Judet approach can be chosen on the basis of the fracture patterns.Most scapular neck and body fractures can be treated by straight incision approach along lateral border of the scapula.This surgical approach can provide exposure of the fratures directly with saved surgical time and attain perfect reduction and fixtion with less trauma.