Objective To explore the incidence, etiological and protective factors, and preventive countermeasures of deep venous thrombosis (DVT) in patients undergoing hip surgery. Methods Four hundred and forty-one patients who had hip fracture surgery in our department from January, 2005 to May, 2010were analyzed retrospectively. They were 223 males and 218 females, aged 65.7 years. (range, 22 to 87). A binary logistic regression was performed, using gender, age, duration of surgery, surgery type, anesthesia type, blood transfusion, physical therapy, thrombo-prophylaxis and complication as covariates, taking DVT incidence as the dependant variable. Results The patients obtained a median follow-up of 17.2 months (range, 3 months to 4 years and 7 months). Sixty-nine patients developed DVT (incidence, 15.6%).Analysis of multiple variables showed that duration of surgery, anesthesia type, blood transfusion, hypertension and diabetes were risk factors to DVT. Physical therapy and thrombo-prophylaxis were protective factors.Age, gender and surgery type had no statistically significant influence on DVT (P ＞ 0.05). Conclusions The DVT incidence after hip fracture surgery is high. In order to decrease the DVT incidence, surgeons should try their best to estimate risk factors for every patient perioperatively, avoid general anesthesia or blood transfusion, shorten operating duration, effectively control complications, actively perform physical therapy or thrombo-prophylaxis, and prolong the anticoagulant therapy for patients with higher risk factors.

The international meeting of the 10th anniversary of the AADO, convoked from Oct.8 to Oct. 10 in 2002 in Shanghai, was sponsored by AADO and organized by the two orthopedics departments of Changhai Hospital and Ruijin Hospital, Shanghai. The supporters of this meeting were Stryker Pacific, Stryker Trauma and Stryker China. There were 180 conventioneers who came from all over the mainland China, America, Germany, India, Japan, Hong Kong and Taiwan. They were clinical specialists in traumatology, managers from traffic departments and experts in vehicle design. 17 theses were selected for the meeting. The theme of the meeting was musculoskeletal trauma in developing countries with focus on road traffic injuries &geriatric fall injuries. Many experts in orthopedic trauma were invited to give presentations at the meeting on the theme.

The instability of elbow is common among patients who suffered f ro m acute fracture or dislocation or from chronic strain. It is crucial to correct ly deal with the acute injury of the elbow, otherwise it would become chronic in stability of the elbow which is difficult to treat. This paper reviews the liter ature about the clinical representation, diagnosis and treatment of elbow instab ility. The surgical principle is to convert a complex fracture-dislocation patt ern into a simple dislocation pattern. Surgery should try to restore the anatomi c structure of the elbow, including articular surfaces and soft tissues. In inju ries to the ulnohumeral joint, reconstruction of the lateral tissues is the key to restoring joint stability. The premier treatment of recurrent instability of elbow is surgical treatment.

Objective:To analyze the clinical outcomes of the locking compression plate(LCP) fixation for the unstable sacral fracture.Methods: Nine patients with unstable sacral fracture were treated with locking compression plate fixation in our department,including 7 males and 2 females,with an average age of 34.8 years(ranged from 25 to 49 years).AO classification system found 1 B_(1),4 B_(2),2 B_(3) and 2 C_(1) type.Dennis classification found 6 Ⅰ section sacral fracture and 3 Ⅱ section sacral fracture.Incisions(6-8 cm) were made from each side of superior iliac spine to ipsilateral inferior iliac spine along iliac crest.After the fractures or dislocations were exposed and reduced,LCPs were chosen and remodeled.The iliosacral posterior ligaments were restored if injured.The LCP was pushed cutaneously to the other incision,placed on both dorsal ilia and fixed with locking screws.Each side of postal LCP was fixed with 3 locking screws for effective fixation.The reduction and fixation of fractures or dislocation were assured by radiostereoscopy.The operations lasted 45 min averagely(ranged from 30-80 minutes) and no patient needed blood transfusion.The average X-ray exposure period was 4 min(from 2-10 minutes).Results: All the patients were followed-up for a mean of 13.8 months,ranged from 6 months to 21 months.There was no iatrogenic nerve injury.The function and the feeling of sacroiliac joint and low extremities recovered to normality.According to the Majeed standards,the results were excellent in 4,good in 4,and fair in 1.Conclusion: The locking compression plate fixation is a simple and effective treatment for the unstable sacral fractures,with less trauma and complications.

Objective To explore the significance of computed tomography in preoperative classification and surgical planning for Pilon fractures. Methods A retrospective analysis was done for 52 cases of Pilon fracture who had been admitted to our hospital from January 2000 to June 2005 and whose X-ray, Axial CT scan and follow-up data were complete. In the preoperative evaluation, the fractures were classified, the fracture angles measured and the anatomy of fragments analyzed on the basis of their plain radiographs and CT scans. The operative methods and approaches were based on the specific fracture types, fracture angles and courses of fracture line on the CT scans. Five patients received manipulative reduction and plaster splint, five closed reduction and internal fixation with lag screws coupled with plaster splint, 17 closed reduction and internal fixation with minimally invasive percutaneous plate osteosynthesis (MIPPO), 16 closed reduction and external fixation combined with limited internal fixation; and nine open reduction and internal fixation (ORIF). Results The average follow-up was 17.2 months.CT scan revealed an increased number of fragments in 21 patients. The fracture types were changed in nine patients according to new CT discoveries which revealed coronal main fracture lines in 61.5% of the cases and sagittal in 34.6% . The approaches and internal fixation positions varied according to the two different kinds of fracture. According to Mazur’ s criteria, the postoperative surgical results were evaluated as excellent in 30 cases, good in 13, fair in eight and poor in one. On average, the good to excellent rate was 82.7% for all the patients, 57.1% for patients with type Ⅲ fractures, but only 44.4% for patients with die-punch fragments in CT scan. Conclusions CT scan can increase accuracy in classification of Pilon fractures. Open reduction of articular surface is preferred for type Ⅲ fractures. Operative approaches and positions of the internal fixation should be based on the anatomy of main fracture lines and fragments. Die-punch fragments should be reduced under direct visualization and indicate unfavorable prognosis.

Objective To discuss the clinical effects of external fixator combined with limited internal fixation in treatment of serious comminuted distal radius fractures. Methods 35 patients with serious comminuted distal radius fractures were treated by external fixator combined with limited internal fixation from January 2001 to May 2004. There were 16 males and 9 females with an average age of 47.3 years. According to AO/ASIF classification, 9 fractures were A3 type, 9 C2, and 17 C3. Reduction was achieved and maintained in 27 cases by longitudinal traction and external fixation, 5 by external fixator with percutaneous K-wire, and 3 by external fixatator combined with ulnar limited internal fixation. Results All the patients were followed up from 5 months to 30 months (12 months on average). According to the anatomical alignment, 9 were excellent, 24 good, and 2 fair. It was necessary to restore the anatomy of distal radius both on sagittal and coronal planes in order to obtain good functions. Preoperatively, the radial inclination angle was -15? to 15?(10.5? on average), and the palmar tilt angle was -30? to 0?(-10? on average). After operation, the two angels were reduced to 20? to 35?(25? on average), and 0? to 20?(11.5? on average)respectively. The joint function was assessed by Dienst criteria, the results suggested that 12 were graded as excellent, 21 good, and 2 fair. No severe complications were found. Conclusion The treatment of serious comminuted distal radius fractures using external fixator combined with limited internal fixation is of easy performance, reliable fixation, satisfactory effect, and lower complications. It offers a new method which can obviously improve the union of the fractures and decrease the infection rate postoperatively for the treatment of the fractures of distal radius.

Locking compression plate(LCP)functions as an internal fixator in orthopedic surgery.It is a new screw-plate system developed by combining the traditional plating techniques with the principles of AO internal fixator.Compared with them,LCP omits pre-bending,avoids large-area exposure of fracture site,minimizes the damage to soft tissue,significantly reduces implant failure and decreases the incidence of infection and bone non-union.In addition,LCP can function as internal fixator with multiple anchor points to improve stability.All these properties of LCP accord with BO internal fixation principles and expand the application in the treatment of complex fracture.However,it is still not uncertain about the appropriate application of LCP including plate length,appearance,and type,and principles of screw application such as the number,type,sequence and position of screws.

Objective To explore the clinic results of the locking compression plate fixation for injuries at the posterior ring of pelvis. Methods 5 patients with injuries at the posterior ring of pelvis were treated with locking compression plate fixation. 2 of them resulted from crashing, 2 from crushing and 1 from falling. They included 4 males and 1 female and their average age was 35.6 years. According to AO classification system, there were 1 type B1, 2 type B2, 1 type B3 and 1 type C1; according to Dennis classification system, there were 4 section I fractures and 1 section II fracture. Results All the patients were available at follow-up, with a mean period of 5.8 months (ranging from 3 to 12 months). The average intraoperative time was 50 minutes (ranging from 30 to 80 minutes), and no patient underwent blood transfusion because the intraoperative blood loss was only 100 to 400 mL. There was no iatrogenic nerve injury and all the incisions healed during the primary procedure. The function and sense of sacroiliac joint and low extremities recovered to normal. Conclusion The locking compression plate fixation is one of the effective methods for treatment of injuries at the posterior ring of pelvis, for it is simple and minimally traumatic, and has a low rate of complications.

[Objective]Pilon fractures are often high-energy injuries.One third to half of these fractures are companied by other fractures or organs injuries.10%~30% Pilon injuries are open fractures.This study was aimed to evaluate the significance of external fixator in the multi-staged management of Pilon fractures.[Method]Ten patients(M=8,F=2) with high-energy Pilon fractures were managed from February 2004 to March 2007.Their average age was 56.2 yrs(range 22 to 72 yrs).All patients underwent external fixation of single-arm external fixator(Orthofix)or Hoffmann external fixator-II(Stryker) in the very early stage.Then it was replaced by strong internal fixation through open reduction or close reduction with the technique of minimally invasive percutaneous plate oesteosynthesis(MIPPO) when general conditions were controlled,the wound surface healed and the soft tissues improved.[Result]The mean duration of external fixation was 13.2 days(range 7-49 days).All the external fixations were changed to internal fixations.All the traumatic and operative wounds healed.All bone fractures united.No compartment syndrome or osteomyelitis occurred in this study.One case of open Pilon fracture was found infection after external fixation.It was changed to internal plate fixation after 7 weeks of anti-infection treatment.The infection was controlled and the bone reunited.[Conclusion]For high-energy Pilon fractures,multi-staged management,including correct evaluation of local soft tissue injuries and general conditions,proper damage control via external fixator,and right timing to change to internal fixator,is safe and effective.

[Objective]To analyze the causes for aseptic shaft nonunion of the lower extremities after intramedullary nailing and to observe the therapeutic effects on bone nonunion by the combined technique of internal bone grafting with blocking screws.[Method]In 12 patients suffering from shaft aseptic nonunion of the low extremities(femur:5 cases;tibia:7 cases;hypertrophic nonunion: 8 cases;atrophic nonunion:4 cases),the therapeutic effects of the method of stabilizing the bone segments(exchanging larger nailing plus blocking screws technique),correcting bone deformity(blocking screws technique plus reduction finger) and reinforcing the bone healing capacity(internal bone grafting technique) were observed respectively.[Result]All patients were followed up for 1-2 years(mean 1.5 years) and all nonunions healed.The union rate was 100% and the period required to achieve union was 4.7-13.5 months(mean 7.8 months).All patients felt no pain at last and no complication occured.[Conclusion]Internal bone grafting combined with blocking screws is an effective treatment for aseptic nonunion of the lower extremities after intramedullary nailing.